IMG Couple match, Visa and LORS

[FranticFrancis]

I know, yet another post inquiring about matching chances. It must be boring, but bear with me a bit: I have some unanswered questions.

I am a Brazilian medical student starting my 6th and final year of graduation in December along with my girlfriend. Our step 1 scores are, respectively, 259 and 247 and we are both going to have clerkships in the US in February and March.
If our LORs were at least average, what would be our chances of matching in the same program? And how about scoring an H1B visa?

Also, our clerkships will be in 2017 but we will probably apply for the match only in 2018 or 2019 (as a male medical student, I am obligated to serve in the military as field physician for 1 year). How should I proceed with the LORS? I ask the attending or PD to write a preview-LOR and ask him or her again 2 years later to upload the letter, or can I sign in on ERAS, ask for him or her to upload the letter right after the clerkship only to apply for the match 2 years or so later?

I hope this won't be much of a nuisance,
Thanks in advance for the answers.

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[Animalcules]

It's hard for IMGs to match in the first place, as a couple you may set yourselves up for disappointment. I would suggest for her to match as soon as possible, and then use your connections to maximize your chances of matching in the same program or city. Of course, cities with many residency programs would be preferred.


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[droption]

Hi Frantic,

IMG here.
- LOR - You have several options.
1 - Ask the LOR writer to write you a letter in paper so you can keep it and upload it later
2- You can tell them that you will apply in a couple of years and you will need a lor.
I did the 2th. If you have a great relation with the LOR writer he will do it for you. But if you don't, do the first option(better have an american letter than none). Also if you do the number 1 your letter will not be waived and most pd will not like that. Don't bother asking anyone from Brazil to write you a letter, as nobody in US will care.

- H1B Visa - It's possible, I know several residents on h1b. But be advised that the h1b visa process takes longer and is worse than j1 for fellowships. If you are planning to apply to a competitive fellowship it will be against you.

 

[FranticFrancis]

Thank you for the replies droption and Animalcules.
About fellowship, our plan is, indeed, to work as hospitalists straight out of residency, so we can apply for a GC. Later we would try to match for a fellowship. Even though there would be a time gap that could reduce our chances of matching for a fellowship, having a GC, I believe, would counterweight in our favor. What do you think?

 

[droption]

Are you applying for which speciality?

 

[Chalo1986]

I should add that with the new administration's policy in regards to foreign workers it may become increasingly more difficult to obtain a J1 visa, let alone an H1b visa. Your best bet as was said previously is for one of you to match first as soon as possible and establish connections. Be advised though its unlikely that hospitals will offer H1b visas anymore, they where already becoming scarce in the last few years, it's anyone's guess what will happen in the coming months. Don't be disheartened you have solid scores, but one of you should get their foot on the door ASAP.

 

[FranticFrancis]

Are you applying for which speciality?

That`s the thing: I am not even sure what specialty I would apply for. Maybe nephro or CCM. Or maybe I just won't do a fellow.

I should add that with the new administration's policy in regards to foreign workers it may become increasingly more difficult to obtain a J1 visa, let alone an H1b visa. Your best bet as was said previously is for one of you to match first as soon as possible and establish connections. Be advised though its unlikely that hospitals will offer H1b visas anymore, they where already becoming scarce in the last few years, it's anyone's guess what will happen in the coming months. Don't be disheartened you have solid scores, but one of you should get their foot on the door ASAP.

I find it hard to be true, Chalo. There are over 25thousand residency spots a year and only 17 thousand AMGs a year. J1s are a must for residency programs. H1Bs, I would argue, are a plus, but also necessary. I would be very interested in any links you could provide to back your post, more specifically the new administration`s policy regarding those said visas. If you are referring to Trump`s administration, be advised: congress would never allow the visa policy to be altered so abruptly. But I am surely very interested in what you have to provide as evidence to back up your statements.

Thank you all for the responses so far!
Please, don't let this post grow cold, I feel that we are having a meaningful discussion that may help fellow IMGs.

 

[Chalo1986]

I 100% agree with your reasoning, however you presume the upcoming administration will be filled with reasonable people. I don't want to incite panic but the elected president has already said he will stand by his promises on immigration reform during his first 100 days in office. Here's what he's said on record in terms of what his immigration policy will be:

https://assets.donaldjtrump.com/Immigration-Reform-Trump.pdf

He explicitly says he'll make it extremely hard for companies to sponsor H1b visas, and completely get rid of the J1 visa program, likely replacing it with something "great and huge". The people he's choosing to fill his cabinet only points towards him fulfilling this plan; with republican control over congress and the house of representatives, it's anyone's guess just how much he'll be able to accomplish, and how fast.

That`s the thing: I am not even sure what specialty I would apply for. Maybe nephro or CCM. Or maybe I just won't do a fellow.




I find it hard to be true, Chalo. There are over 25thousand residency spots a year and only 17 thousand AMGs a year. J1s are a must for residency programs. H1Bs, I would argue, are a plus, but also necessary. I would be very interested in any links you could provide to back your post, more specifically the new administration`s policy regarding those said visas. If you are referring to Trump`s administration, be advised: congress would never allow the visa policy to be altered so abruptly. But I am surely very interested in what you have to provide as evidence to back up your statements.

Thank you all for the responses so far!
Please, don't let this post grow cold, I feel that we are having a meaningful discussion that may help fellow IMGs.

 

[FranticFrancis]

https://assets.donaldjtrump.com/Immigration-Reform-Trump.pdf

Thank you for that Chalo! But I still feel that even if Trump`s administration could completely change the immigration process and the visas as he intends to, It would probably be different for medicine. I must repeat: over 8,000 residency spots won't have AMGs to fill them. It all seems like overt populism to me.
Also, republican control over congress and the house of representatives does not mean that Trump's ideas are passing through. One could argue that inside the GOP there are several different parties, and most of them do not agree with Trump.

Or maybe I am just in denial. Nonetheless, I shall keep up with this quest.

 

[droption]

Nephrology is not competitive and CCM is ok. You don't need to worry and should apply for a H1. Again, I know several people with similar profiles in very good places with a H1 visa. You are an excellent candidate. Young graduate, with USCE and high scores. Try to publish something too and collect the prize!

Best

 

[the argus]

Thank you for that Chalo! But I still feel that even if Trump`s administration could completely change the immigration process and the visas as he intends to, It would probably be different for medicine. I must repeat: over 8,000 residency spots won't have AMGs to fill them. It all seems like overt populism to me.
Also, republican control over congress and the house of representatives does not mean that Trump's ideas are passing through. One could argue that inside the GOP there are several different parties, and most of them do not agree with Trump.

Or maybe I am just in denial. Nonetheless, I shall keep up with this quest.

This number is a little inflated. Currently the number of IMGs entering ACGME residencies yearly is 6500-7000. This includes both US-IMGs (mostly Caribbean grads) and foreign-IMGs. Best estimates put that number at ~4500 by the year 2024, a decrease of ~2000 over the next ~8 years. So while there still will be thousands of spots for qualified IMGs over the coming years, it will likely be foreign-IMGs that feel the squeeze first.
http://www.acgme.org/About-Us/Publi...Graduate-Medical-Education-Data-Resource-Book
http://www.nejm.org/doi/full/10.1056/NEJMp1511707#t=article

I agree with those above that your girlfriend should apply as soon as possible, and then try and pave the way for you in the coming years. I know my program has had multiple examples over the past few years of partners/spouses matching a year later after the first person was a good intern. Couples matching is great, but doesn't guarantee that you would end up in the same program/city (unless you only rank combinations that ensure this).

You guys should sit down and really think about what priorities are most important for you. Would you be willing to live apart for 3 years while you do residencies in different cities? If the answer is no, then you should re-evaluate your plan to come to the US. You guys very well may end up in the same program/city, but that is by no means a guarantee. If the answer is yes, then there is no reason for your girlfriend to delay applying so that you can couples match a year later.

Best of luck!

 

[CCM-MD]

Nephrology is not competitive and CCM is ok. You don't need to worry and should apply for a H1. Again, I know several people with similar profiles in very good places with a H1 visa. You are an excellent candidate. Young graduate, with USCE and high scores. Try to publish something too and collect the prize!

Best

Due to the unfortunate state of nephrology, even well known institutions have empty positions. Having gone through the match this year, CCM is competitive. There's only around 25 programs in the country and interest is increasing as residents are becoming more aware of the shift work model that is similar to hospitalists for a significantly higher compensation. I encountered EM residents, fellows from pulm only programs, and ID/nephrology fellows from well regarded programs.

To OP: I would try to apply and match into the best IM program you can get into, as soon as possible. Things are only going to become more challenging as time passes.