IMG and MD/PhD

[Jorje286]

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Hi everyone,

Basically the short story is that I'm currently studying medicine in a non-LCME school, and I'll be finishing my second year at the end of the year (it's the same American system), and I'll be taking my Step 1 at the end of the year. I've always been interested in being a physician-scientist particularly in neurology/computational neuroscience and there's a very good likelihood that I'll be accepted into an excellent computational biology PhD program in the US (I already have a few interviews). My goal is to finish my first two years of medical school, complete the PhD in the US, and then finish my last two years of medical school. Only a couple of questions:

1) Would it be advisable to take step 1 now or later? I prefer to take it now and get done with it, and I know US MD/PhDs have no problems if their Step 1 scores are off by several years from the time they apply to residency. I am not sure if it's the same case with IMGs. I will still do Step 2 in all its components right before I apply to residency.

2) Is there any chance I can transfer my last two years of medical school into a US medical school, or if I'm really lucky, transfer into an MD/PhD program? I will have the chance to build connections in my PhD years, and my Step 1 score (assuming it's good) could help me, or maybe I'm just engaging in wishful thinking?

Thanks in advance.

 

[SBR249]

You should check whether your medical school and graduation year is in the International Medical Education Directory (IMED) which is a requirement to be a licensed IMG in the US.

Then you'll need to check with the Educational Commission for Foreign Medical Graduates for requirements for certification by ECFMG which is required in order to apply for residency in the NRMP (residency match). I believe that you must complete Step 1, Step 2 CS and CK all within a 7 year period. In addition, I believe that you must have already graduated from medical school before you can apply for ECFMG certification and subsequently residency match.

 

[tigol31]

I am not sure about transferring for medical years 3 and 4, but most of the MD/PhD programs that I have looked into do not take transfer students. Throw in the fact that you are an international student, and the odds of you transferring into one is slim to none. Again, these are only the programs that I have looked into.

 

[K31]

I am aware of MD/PhD students transferring between programs,but I would be extremely surprised if any would take a med student who completed the first two years at a foreign school. Your best bet would probably be take Step 1, do the PhD in the US, then return to your home country to complete medical school before applying for residency in the US if you want to practice here.

 

[SBR249]

There's also the whole very few MSTPs take international applicants to begin with never mind transfer international students thing.

 

[Neuronix]

there's a very good likelihood that I'll be accepted into an excellent computational biology PhD program in the US (I already have a few interviews). My goal is to finish my first two years of medical school, complete the PhD in the US, and then finish my last two years of medical school. Only a couple of questions:

I think this is a bad idea. I've never been a fan of doing an MD/PhD program outside of an integrated program (except for maybe GPP), and this is no exception. You will be looking at a 5 year PhD MINIMUM, and likely even more. This will make you a 9+ year MD/PhD student off the bat. Plus your med school loans (if any) will be accruing. Obviously the PhD programs are happy to have you, because you are a good cheap indentured servant for them, but I'm worried this is truly not in your best interests. Have you considered a year off or master's program instead? I would recommend you focus on getting residency first, which is your first bottleneck as a non-AMG, then worry about getting more research experience later in fellowship/post-doc. This might be difficult for you if you are not a US citizen or permanent resident, so more info is needed about that to properly advise you.

1) Would it be advisable to take step 1 now or later? I prefer to take it now and get done with it, and I know US MD/PhDs have no problems if their Step 1 scores are off by several years from the time they apply to residency. I am not sure if it's the same case with IMGs. I will still do Step 2 in all its components right before I apply to residency.

Frankly, I'm afraid program directors are not going to know what to do with you. The big name academic programs where you will hope to match will likely not take FMGs. Meanwhile, the community programs that are open to FMGs don't have research, and won't provide you with PhD-level research opportunities, and thus won't seriously consider you as a candidate. Now, you say "non-LCME". Are you talking about Canada, Europe, Caribbean, or another area? The advising here is different for those possibilities.

To directly answer your question, if you take step 1 after your first two years of medical school you almost certainly will need to retake step 1 later to not run afoul of the 7 year from step 1 to step 3 completion. This is state dependent for licensing as seen here: http://www.fsmb.org/usmle_requirementschart.html

This does not apply for MD/PhD students who complete in 8 years or less. But I think this is a very low probability for you. Further, many states do provide exceptions for MD/PhD students, but I cannot say whether you will get such an exception in your circumstances. I do not generally know anything about advising foreign students, but based on limited reading, it also seems that the ECFMG has the same seven year limit. I do not know if they would provide you an exception. It seems unlikely based on the limited information that I'm reading.

Thus you're in a catch 22 on this question. You will either have to postpone step 1 until after or late in the PhD OR take step 1 after second year and plan on taking it a second time in fourth year or internship. I'd recommend the latter, but it's a very tricky situation. You will need very high scores, which is why I recommend not delaying. If you retake it, as long as you have a residency position, the score won't matter as long as you pass.

Is there any chance I can transfer my last two years of medical school into a US medical school, or if I'm really lucky, transfer into an MD/PhD program?

Very unlikely, but it again depends on the specifics of your situation.

 

[Jorje286]

Thanks a lot everyone for the responses. I checked the ECFMG conditions, and all components of the Steps need to be taken in 7 years, which means I must finish my Ph.D in 6 years. I'm not sure this is a bad thing, cause that's another incentive to work harder and get it done as good/quick as I can.

I would recommend you focus on getting residency first, which is your first bottleneck as a non-AMG, then worry about getting more research experience later in fellowship/post-doc. This might be difficult for you if you are not a US citizen or permanent resident, so more info is needed about that to properly advise you.

I am neither, which makes things very complicated. I fear that without a PhD I will have very little chance to develop as a basic scientist. I will most likely match on a J1 visa, and there's this 2 year rule thing - very few advisors will be willing to support me with a fellow salary starting up from nowhere. Also, the type of research I'm interested in needs a lot of skill development - it's not like running a gel, it's heavily mathematical and a structured program in computational biology will be my best bet to develop those skills.

The big name academic programs where you will hope to match will likely not take FMGs

Why do you say so though? Several research-oriented academic programs (top echelon and a little less - Partners, Yale, Columbia, Chicago, Penn, Vanderbilt..etc) seem to have quite a few FMGs, at least going by their neurology websites.

Are you talking about Canada, Europe, Caribbean, or another area? The advising here is different for those possibilities.

Other, but it's a reputable medical school and was for most of its history LCME before the geographical criterion was added in the 80s I think.

 

[gbwillner]

Why do you say so though? Several research-oriented academic programs (top echelon and a little less - Partners, Yale, Columbia, Chicago, Penn, Vanderbilt..etc) seem to have quite a few FMGs, at least going by their neurology websites.

Neuronix is right, conditionally. In some specialties, like Rad Onc and rads and some surgical subspecialties, this is absolutely correct. In other specialties, like medicine and pathology, there are lots of FMGs, even in the best programs.

 

[Neuronix]

I checked the ECFMG conditions, and all components of the Steps need to be taken in 7 years, which means I must finish my Ph.D in 6 years.

Step 3 must be taken after graduation from medical school unless different rules apply for FMGs. If you assume two years of medical school after PhD, then the PhD can only last up to 5 years. This also assumes you could squeeze in Step 3 just after graduation and assuming you took step 1 in the summer.

i.e. if you take Step 1 July 2012
PhD 5 years (through 2017)
MD 2 years (through 2019)
You could then conceivably take the Step 3 just before the deadline in July 2019. This is again kind of iffy that you could squeeze the step 3 in like this, because you have to apply for it after you graduate, get paperwork signed and mailed in, schedule a date to take, etc... This is why I said 4 years for PhD earlier. Now you could retake step 1, and some US MD/PhD students who take 9+ years for their combined programs end up doing this.

I am neither, which makes things very complicated. I fear that without a PhD I will have very little chance to develop as a basic scientist. I will most likely match on a J1 visa, and there's this 2 year rule thing - very few advisors will be willing to support me with a fellow salary starting up from nowhere. Also, the type of research I'm interested in needs a lot of skill development - it's not like running a gel, it's heavily mathematical and a structured program in computational biology will be my best bet to develop those skills.

The other issue is that as an FMG you don't qualify for training grants only available for US citizens/permanent residents. This is not insurmountable, but does create another hurdle because programs will want you to obtain funding that you are not eligible for. That said, I don't necessarily believe that a PhD will help you obtain the positions you want later versus obtaining a master's degree.

Why do you say so though? Several research-oriented academic programs (top echelon and a little less - Partners, Yale, Columbia, Chicago, Penn, Vanderbilt..etc) seem to have quite a few FMGs, at least going by their neurology websites.

The overall match rate for independent match applicants (such as FMGs) has dropped to 44.2% in 2011 (see charting outcomes). This is forecast to drop further as US medical schools continue to open and expand and funding for residency positions stays relatively flat. As it is, my experience with FMGs who are able to match to top programs is that they were attendings in their home countries, that they went to big name medical schools in other first world countries, and/or they worked for several years in the local department and established connections.

In any case, I'm not saying it's impossible to succeed in your plan. I just think it's foolish to spend a minimum of 9 years in a non-integrated MD/PhD program which creates many hassles for you to even become medically licensed when you may not even be able to get a residency. I think you should focus on the short-term, which is acquiring a residency in the USA, becoming board eligible, and then worry about a long-term research career. At the very least, if you want to get research experience up front, you should invest your time in short research programs (such as a master's) that will not provide ECFMG certification hassles. I don't believe a PhD will provide you any greater ability to research your long-term goals provided you obtain a research-oriented fellowship out of residency, which remains not terribly difficult to procure.

As always, this is just my advice.

 

[SBR249]

I don't think ECFMG certification requires step 3 of the USMLE only Steps 1, 2CK, and 2CS which must all be completed in 7 years. Plus, I think only in a minority of states in the US can IMGs even take Step 3 before residency.

 

[Jorje286]

Thanks a lot Neuronix. I greatly appreciate your advice. For the 7 years thingy, I forgot to mention that it doesn't include Step 3. It's basically the steps required for ECFMG certification, and they are Step 1 and both components of Step 2.

I do have an option of doing a masters, but I'm thinking getting around 3 good publications will be a big plus for my research resume. I would greatly appreciate it if you can expand a little on opportunities for research fellowships for IMGs. I think I will have to apply for a grant and get my own funding.

Yes, I don't disagree that there's a "foolish" element in there. But I also think that sort of goes with any commitment to an academic career. To be more exact, if my research interests were purely in molecular biology like most MD's, I wouldn't think at all about the PhD. I already have good research experience (one publication), and picking the skills needed in that field isn't a big deal (the MD classes cover the scientific knowledge needed anyway), but it's a different thing with computational work.

 

[Neuronix]

I would greatly appreciate it if you can expand a little on opportunities for research fellowships for IMGs.

I don't know enough about the topic to speak in detail about this.

To be more exact, if my research interests were purely in molecular biology like most MD's, I wouldn't think at all about the PhD. I already have good research experience (one publication), and picking the skills needed in that field isn't a big deal (the MD classes cover the scientific knowledge needed anyway), but it's a different thing with computational work.

I strongly disagree with this sentiment. Molecular biology researchers need extensive training as well. You seem to have your mind made up already, so good luck to you.