IMG and cardiology

[canal]

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I was wondering if its going to be impossible for me to pursue a residency in general noninvasive cardiolgy if I am an IMG with a 220 on my step 1...no score for step 2 or cs yet. thanks

 

[dragonfly99]

Are you still a student? I'm assuming so if you didn't take Step 2.

Nobody can answer this for you if you are still a student. The 220 Step 1 isn't going to help, but some cardiology fellowships don't even ask for step scores, so it's not that big of a deal. Try to do better on Step 2 and 3...like 230's or 240's if you can.

Only about 40% or so I think of IMGs who try to get cardiology actually get in. But you have to realize that is for trying once...what if a person tried once, didn't get in, and then tried again. Even assuming the chance is going to be less the 2nd year, it still might be >50% overall for a person who tried a couple of years in a row.

I think if someone wants to come to the US only if he/she will be able to definitely do cardiology later, then it's a bad plan to do so. But if you want cardiology but could (if you had to) accept a different career like general medical doctor, endocrinologist, or renal specialist, then coming could be a good plan. This is just my opinion - I am not an IMG.

 

[Phospholipid]

I'm currently a 1st year at SGU, a caribbean medical school, although Iam a US citizen. After looking at the past thread, it has been very discouraging for me in terms of looking at IMG interview rates at cardiology. Would your advice differ slightly for me? Is it common for people to work a yr or 2 as an internist while reapplying? This is what i'm scared of, not being able to get it and working and having to reapply. Do most go directly without losing time? Also, is doing research mandatory in terms of increasing your chances? Research is not something I really look forward to.
I'm having a difficult choice in choosing Neurology or Internal Medicine/Cardiology, which is not really a guarantee. Neurology seems to be the easier path, but I don't really think my heart's into Neurology though. Thanks in advance

 

[dragonfly99]

phospho,
yes my advice would be different.
I honestly think that a good chunk of the problems that FMG's have with getting cards fellowships can be attributed to visa issues. The fellowships just don't want to deal with the visas because it's a pain for them - they have numerous qualified applicants who do NOT need visas because they are US citizens, so the programs probably are thinking why even deal with the visa issues at all. If you go to SGU and are a US citizen, I'd think your chances would be better than your average FMG, assuming comparable performances in residency.

Usually folks who apply for cards have some research on their resume, just because it's such a competitive specialty to get. You have to do SOMETHING to set yourself apart from the crowd of people applying, and to show your interest. Even if you don't like bench research, try to do an elective(s) in residency where you can try to help out with some clinical research or something. You could even try to set up some cardiology elective time during your 4th year of med school, and/or a 4th year 2 or 3 month research block, if your school allows that.

Phospho, if you like cards > neuro, I think you should chance it and go for IM. To do neuro you'd need to do an IM prelim year anyway. I think if worse comes to worse, you could likely do a 2nd residency in neuro, and would then have wasted only 2 years. However, for anyone applying into IM, unless you are the top of your class (in US) and already have publications, I'd say cardiology is far from guaranteed...it's just more of a gamble for you.

Phospho, if you can get yourself into a university internal medicine program, or at least a hospital affiliated to a university IM program, I think your chances at any competitive fellowship would be >> than if you end up at some unknown community program. You need to try hard to ace the Step 1 and as many 3rd year clerkships as possible...I'd think that would give you a shot.

 

[Miradautas Vras]

Dragonfly as usual delivers some wise advise. I am a FMG and waiting for IM match this year with cards in mind. As he states, majority of trouble getting into a competitive fellowship comes from visa issues [ people trying to get into cards/GI while on H1, which is too difficult.] and the fact that most of them do their residency from small community IM programs. I looked at the fellowship match list of a certain Uni program [ middle tier, for those in love with tiers] I interviewed at and was astonished to see foreign grads matching into all sort of specialties. Same is the experience of lots of my pals who were lucky/good enough to get a couple of Uni ivs. Getting into a uni program exposes one to lots of research and contacts. Like it or not, everybody wants to hear about it when you try to do anything competitive in medical field. I have a masters in epidemiology from a top place in US and have seen many residents from the attached uni program doing research just for the CV stamp. They wanted to get into competitive fellowships and it was a must. Getting into a good community/uni program with in-built fellowships is the best shot a foreign grad has for fields like cards/GI IMHO.

For me, I just want to do cards, at any place but many [ esp american grads, IMGs don't have such luxuries in general!] want to have specific/super-academic fellowship preferences which might add to their struggle. A uni prog + some research/contacts +willingness to go anywhere regardless of visa/greencard quagmire is the key to success.

 

[Phospholipid]

phospho,
yes my advice would be different.
I honestly think that a good chunk of the problems that FMG's have with getting cards fellowships can be attributed to visa issues. The fellowships just don't want to deal with the visas because it's a pain for them - they have numerous qualified applicants who do NOT need visas because they are US citizens, so the programs probably are thinking why even deal with the visa issues at all. If you go to SGU and are a US citizen, I'd think your chances would be better than your average FMG, assuming comparable performances in residency.

Usually folks who apply for cards have some research on their resume, just because it's such a competitive specialty to get. You have to do SOMETHING to set yourself apart from the crowd of people applying, and to show your interest. Even if you don't like bench research, try to do an elective(s) in residency where you can try to help out with some clinical research or something. You could even try to set up some cardiology elective time during your 4th year of med school, and/or a 4th year 2 or 3 month research block, if your school allows that.

Phospho, if you like cards > neuro, I think you should chance it and go for IM. To do neuro you'd need to do an IM prelim year anyway. I think if worse comes to worse, you could likely do a 2nd residency in neuro, and would then have wasted only 2 years. However, for anyone applying into IM, unless you are the top of your class (in US) and already have publications, I'd say cardiology is far from guaranteed...it's just more of a gamble for you.

Phospho, if you can get yourself into a university internal medicine program, or at least a hospital affiliated to a university IM program, I think your chances at any competitive fellowship would be >> than if you end up at some unknown community program. You need to try hard to ace the Step 1 and as many 3rd year clerkships as possible...I'd think that would give you a shot.

Dragonfly
That was a very thought out response and has helped me a lot to reaffirm what I want to do. Thank you for taking the time to reply.

 

[astropilot]

Last year (I think this is correct)

~ 80% of all AMG matched

~ 20% of all FMG matched

I think there was a larger proportion of FMGs that applied for cardiology as compared to AMG, thus driving down that match percentage.

 

[Phospholipid]

Last year (I think this is correct)

~ 80% of all AMG matched

~ 20% of all FMG matched

I think there was a larger proportion of FMGs that applied for cardiology as compared to AMG, thus driving down that match percentage.

When you quoted those rough stats, do you mean that 20% of all FMG who applied matched? or that 20% of all cardiology people who matched are FMG. If it is the former, do you know what this correlates to in terms of percentage of all cardiologist who matched in 2008? I think i read somewhere its around 35% of people who matched in cardiology are FMG. Does that sound about right?
Also, is there any way to find out how many of the 20% who matched, how many have visa issues? compared to US FMGs? thanks

 

[dragonfly99]

When you quoted those rough stats, do you mean that 20% of all FMG who applied matched? or that 20% of all cardiology people who matched are FMG. If it is the former, do you know what this correlates to in terms of percentage of all cardiologist who matched in 2008? I think i read somewhere its around 35% of people who matched in cardiology are FMG. Does that sound about right?
Also, is there any way to find out how many of the 20% who matched, how many have visa issues? compared to US FMGs? thanks

phospho
I believe you are right...about 35-36% I think is about right most years.
I am pretty sure astropilot is wrong.
If you look on nrmp.org there are various reports of the Match results (PDF files) from last year. There is one for residency and one for the fellowship match, I believe. The document shows I think about 64% of allopathic cards fellowships were filled by US allopathic grads. The other 30-something percent were filled by a combination of FMG/IMG/DO's. Unfortunately it's hard (or impossible) for me to calculate the match rate for US IMG's in particular from what's in that document...they do list the absolute numbers of US allo grads, DO's, FMG's and US IMGs who participated in the cards fellowship match, though. There aren't a lot of DO's...lots of FMG's and some IMGs. I know that some cards fellowships simply won't sponsor visas, so that by itself would give you an advantage vs. FMG's...

 

[astropilot]

Yep, I was wrong...by 16% or 108 people.

Of all the AMGs that applied last year (550), 79.6% matched (438).

Of all the FMGs that applied last year (714), 35.7% matched (255).

My point was that if you are an AMG you have a much better chance of matching than a FMG.

Phospholipid, you were right that 36.8% of the cards spots were filled by FMGs. Of course that means that 63.2% of the spots were filled by AMGs.

Dragonfly99, the NRMP document does not list the absolute numbers of US allo grads, DO's, FMG's and US IMGs who participated in the cards fellowship, but the number of US allo grads, DO's, FMG's and US IMGs who matched (Table 2) - i.e. toal match 693 = 438 + 25 + 2 + 46 + 182. But, again, I might have missed something.

 

[dragonfly99]

Of all the AMGs that applied last year (550), 79.6% matched (438).

Of all the FMGs that applied last year (714), 35.7% matched (255).

Yes, I agree, definitely it is harder to match as an FMG...glad I've never been an FMG!

There were 550 US allopathic grads who applied to cardiology last year...there were 1264 total applicants. 1264-550 = 714. That's not all FMG's, though...that includes DO's and IMG and foreign born/non US FMG people. I think I was unclear in my post above...my point was you can't really calculate the match rate for an FMG, IMG or DO based on their data...at least not the data I can find. This is because they lump those 3 groups together in their document. I mean, is the match rate better for US IMG's vs. FMG (foreign docs)? I would think it would be better/higher, given similar stats (like pretty good USMLE's, good LOR's some research etc.). That's because with a US IMG they won't have to deal with visa issues. However, I guess the FMG match rate could be higher than US IMG match rate...I mean in order to even get a medicine residency spot, foreign docs usually have to have high board scores, etc. so they may tend to be stronger applicants in general than the average DO or US IMG.

I think there are a lot of variables in play here....the OP would have his work cut out for him but not fruitless to try if he/she isn't very risk averse. Also, suppose that a person was willing to try 2x .... 35% + 35% is 70% chance of matching within 2 years. That is probably not really correct b/c might be a worse chance the 2nd year for some...I mean, there may be a reason they didn't get the spot the 1st year so they are likely the less competitive applicants.

 

[cardsfellow2007]

Yes, I agree, definitely it is harder to match as an FMG...glad I've never been an FMG!

There were 550 US allopathic grads who applied to cardiology last year...there were 1264 total applicants. 1264-550 = 714. That's not all FMG's, though...that includes DO's and IMG and foreign born/non US FMG people. I think I was unclear in my post above...my point was you can't really calculate the match rate for an FMG, IMG or DO based on their data...at least not the data I can find. This is because they lump those 3 groups together in their document. I mean, is the match rate better for US IMG's vs. FMG (foreign docs)? I would think it would be better/higher, given similar stats (like pretty good USMLE's, good LOR's some research etc.). That's because with a US IMG they won't have to deal with visa issues. However, I guess the FMG match rate could be higher than US IMG match rate...I mean in order to even get a medicine residency spot, foreign docs usually have to have high board scores, etc. so they may tend to be stronger applicants in general than the average DO or US IMG.

I think there are a lot of variables in play here....the OP would have his work cut out for him but not fruitless to try if he/she isn't very risk averse. Also, suppose that a person was willing to try 2x .... 35% + 35% is 70% chance of matching within 2 years. That is probably not really correct b/c might be a worse chance the 2nd year for some...I mean, there may be a reason they didn't get the spot the 1st year so they are likely the less competitive applicants.

By those statistics you will have a 105% chance of matching in 3 years.

 

[dragonfly99]

No, because like I said, the 35% rate probably would go down a bit each year one tries to get in. Programs like applicants who are still in residency > those who are already out. They think they will be more teachable and also that there must be something wrong with folks who didn't match on the first go-round, to some extent. Most people get fewer interviews the 2nd year they try to get in vs. the first year, and sometimes at less competitive schools. It's really worthwhile to try at least 2x if you want to get in, though. What you have to realize is there are eager young PGY2's trying each year, and for the people who don't get in twice, it usually means they just weren't quite competitive enough or they tried programs where they weren't competitive enough. If someone is an FMG with average or lower USMLE's, did residency at a community program, and doesn't have some stellar publications (I don't mean poster and abstracts, I mean 1st or 2nd author papers in major journals) and needs a visa it's going to be an uphill battle because there are just so many qualified applicants.

 

[Miradautas Vras]

I don't know why scores should matter even in the fellowships. I had a server disaster back in India during step 1 that strangled my score at 88/212. I corrected it during the step 2 while doing my MPH. I have had enough trouble due to that step1 in the match itself [ >120 apps, 4 ivs, three of them being Unis the only fortunate thing abt. it; has any of you AMGs even heard of that!] , the thought that it'll keep on haunting me throughout the fellowship match is exasperating.

 

[dragonfly99]

It's just that the process is so competitive that everything ends up mattering, at least at some places.

However, like I said up above, there were a bunch of places I applied for fellowship that didn't even require one to turn in/submit USMLE scores, so if that's the only thing you are worried about, you can just apply to a bunch of places like that. Different programs value different things - I don't think it's any more discriminatory to use USMLE scores than it is to use grades or clinical rotation evaluations, since some medical schools and residencies are harder than others and those have a tougher evaluation process.

 

[Tigerz_Fan]

bump