IMG - sacrifices

[heykki]

For an IMG, will there need to be some sacrifices done in order to get a residency at all? For me the situation is so that the peticular residencies, or specialties if I should say, I'm interested in, are the most competitive. These include ENT, ortho surgery and derm (derm mostly for good hours&money tho ). Is there any way match for example in ENT? Sure I could get my PhD done first and then come to the US but is that good at all? Or should I match for ENT over here and get two years training to have better chances of matching?

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[GeneGoddess]

I'd highly recommend finishing your PhD if you are in the middle of it. And doing VERY well on the boards. Otherwise, I can't say.

 

[heykki]

Not quite in the middle of it, but having to decide whether to go with the combined PhD-MD program. This would of course add a year or two to already long med school.

 

[rhinosp_33]

For an IMG, will there need to be some sacrifices done in order to get a residency at all? For me the situation is so that the peticular residencies, or specialties if I should say, I'm interested in, are the most competitive. These include ENT, ortho surgery and derm (derm mostly for good hours&money tho ). Is there any way match for example in ENT? Sure I could get my PhD done first and then come to the US but is that good at all? Or should I match for ENT over here and get two years training to have better chances of matching?

i've always wondered, if i was IMG, i would consider the option to apply into a US med school and just get a MD from a US school if you really want to get into a very competitive residency. even if you get round 225 in step 1 from a US school, u would have a shot at one of the competitive fields. whereas, getting a 250 step 1 would still be difficult to land, say ortho, as a IMG. don't even know if thats a possibly for you, but I would look into it if you serious about "sacrifices".

 

[heykki]

i've always wondered, if i was IMG, i would consider the option to apply into a US med school and just get a MD from a US school if you really want to get into a very competitive residency. even if you get round 225 in step 1 from a US school, u would have a shot at one of the competitive fields. whereas, getting a 250 step 1 would still be difficult to land, say ortho, as a IMG. don't even know if thats a possibly for you, but I would look into it if you serious about "sacrifices".

250? Holy s***.. That'd be tought but definately possible though. Better give it a shot than regret for the rest of my life

 

[BellKicker]

i've always wondered, if i was IMG, i would consider the option to apply into a US med school and just get a MD from a US school

I don't think it's possible to go through medical school twice. There was a thread about that in the international forum where someone wanted to do what you suggest and lots of poeple cited evidence that it couldn't be done.

A better option would be to transfer (although very difficult) or simply go the US route from day one (less difficult but very expensive for a foreigner).

Maybe a third option would be to do a less competitive residency in the US, or even a TY or pre-lim year to get your feet wet and then apply for the "tough" residency.

The people I hear matching into very competitive specialties seem to have a combination of PhDs, publications, high scores and previous experience in the field.

 

[scrub monkey]

an img can get a phd outside of the us for only 1-2 years extra?

that's crazy. it takes anwhere from 4-6 extra years in the us.

i'd say go get that phd if it only takes a few extra years. you will greatly improve your chances of getting a residency spot.

still, if a phd only takes 1-2 years, how many years is college out there? and how many years is med school? to get a md/phd in the us is close to 12-13 years (adding college, med school, and grad school). it seems pretty unfair that img's can get those degrees in half that time (consider most fmg's go to med school straight out of high school).

 

[Miklos]

an img can get a phd outside of the us for only 1-2 years extra?

that's crazy. it takes anwhere from 4-6 extra years in the us.

i'd say go get that phd if it only takes a few extra years. you will greatly improve your chances of getting a residency spot.

still, if a phd only takes 1-2 years, how many years is college out there? and how many years is med school? to get a md/phd in the us is close to 12-13 years (adding college, med school, and grad school). it seems pretty unfair that img's can get those degrees in half that time (consider most fmg's go to med school straight out of high school).

A couple of notes.

North American High School diplomas (generally speaking, there are very few exceptions) are not considered equivalent to most continental European leaving certificates (e.g. German Abitur). The educational system is structured very differently. Unlike the U.S., the educational requirement for minors usually ends around age 16. (Many students never get a leaving certificate and end up in either technical colleges or vocational/guild training programs.)

Those European students who wish to enter medical school in their home countries, essentially take the U.S. equivalent of college courses in the sciences for several years prior to entering medical school.

In essence, they specialize much earlier than U.S. students. This has advantages (no courses in advanced basketweaving) and disadvantages (a much narrower scope of study).

In addition, continental medical education is six years in length for a medical diploma.

Consider also that combined MD/PhD programs in the US also add two years or three (sometimes more) to the course of study.

Miklos

 

[heykki]

an img can get a phd outside of the us for only 1-2 years extra?

that's crazy. it takes anwhere from 4-6 extra years in the us.

i'd say go get that phd if it only takes a few extra years. you will greatly improve your chances of getting a residency spot.

still, if a phd only takes 1-2 years, how many years is college out there? and how many years is med school? to get a md/phd in the us is close to 12-13 years (adding college, med school, and grad school). it seems pretty unfair that img's can get those degrees in half that time (consider most fmg's go to med school straight out of high school).

It's a combined program and the 1-2 years is minimum which will be added to it. Also, our high school really is more advanced and basically takes until 19 years of age. Separate PhD is then 3, 4 or even 6 years in some cases, depending on you and your research.
Medical school itself is 6 years, normally two times the length of barchelor of science.

 

[PathOne]

A Ph.D. is nice, but not really valuable, if it's a Finnish Ph.D. and you want to come to the US. If that's your plan, it's FAR better to get your current M.D. and then take the Ph.D. in the US -- which will take AT LEAST 3 yrs.

Thing is, that you'd have a hard time matching in ANY residency, with the poss. exception of IM and FP, without US clinical and/or research exposure. And I doubt your non-US Ph.D. will be very helpful. It'll look nice on a cv, but once the PD sees that it's a non-US degree it WILL be fully or at least partially discounted.

Taking derm as an example you'd need to look at:
1. Will you with reasonable confidence be able to get a residency in Derm at a top program in your home country? If not, it's highly unlikely that you'll succeed getting one, at any program, in the US, because of the vast applicant pool.
2. Since grades and the structure of your MD program will be meaningless to the PD, you will need to AT LEAST match, and more likely exceed, in the directly comparable stats with other applicants, i.e. USMLE, publications and the like.
3. You will inherently be a lesser known entity than an AMG, which will be a real problem if the applicant pool consists of supremely competitive AMG's. Only way around that is to work in the US - probably in research or clinical research - so you can get great Letters of Recommendation from well-respected leaders in the field, or possibly work with someone who knows derm PD's.
4. You will be locked out of some programs, because they will not sponsor a visa for you. If you do get a visa, it's most likely a J-1, which will take you back to your home country for a minimum of two years after completing your residency. So working hours and salaries as a newly minted board certified US physician wouldn't be really meaningful to you. To add insult to injury, you can in no way be certain that your US training will be accepted in Europe. I personally know people who trained at top institutions in the US, only to do the whole thing over again when they went back to Europe.

The above would obviously also apply for the other fields you mentioned.

I don't want to rain on your parade, but matching into a competitive field as a FMG is exceedingly difficult, and would require a vast amount of hard work and luck... And a Ph.D. wouldn't give much of a boost, except if it's a US Ph.D. The one other thing which can set you apart, is if you do all or most of the training in your preferred specialty in Europe. You'd probably still have to redo the whole thing in the US, but it can set you apart from other applicants.

Don't get me wrong. It is of course possible. But last stats I saw (a couple of years ago) I think it was 3 FMG's among 226 derm residents. Stats a bit better in othopods and ENT, but not much.

BTW: Getting an MD in the US isn't a option for most Europeans, since you'd need a US undergrad degree, or at least US premed courses, to even apply. I have firsthand knowledge of a person from Singapore who applied for a Ivy League MSTP program with a PERFECT MCAT score of 45 and tons of research, who was rejected by the MD adcom because they didn't think he had enough EC's, US shadowing etc.

 

[Slowmo214]

Minne kaupunkiin ajattelit hakea opiskelemaan vai opiskeletko jo jossain? USA:aan on kyllä todella vaikea päästä erikoistumaan, niinkuin varmaan olet huomannut jos olet lukenut tätä foorumia. Itse olen jo lääkiksessä ja erikoistuminen ulkomailla kiinnostaisi. Iso-Britannia tuntuu kuitenkin realistisemmalta vaihtoehdolta, vaikkei sinnekään vain noin vain mennä.

Had to write in Finnish when I noticed he was from Finland as well...

 

[BellKicker]

Thing is, that you'd have a hard time matching in ANY residency, with the poss. exception of IM and FP, without US clinical and/or research exposure.

This is very pessimistic. Most fields are wide open for IMGs with strong applications. I will agree that a few specialties would be veyr hard to get into - but that's true even with years of USCE. I personally feel that clinical exposure in the US is sometimes given too much weight in these forums.

 

[scrub monkey]

i agree that a phd at a foreign school wouldn't be too much help. but i think a us phd would definitely help for competitive academic fields, such as derm, ent, and ortho. that would take likely 4-5 years, and would require a sacrifice. you also should be very productive during that phd, getting as many pubs and presentations as you can get. still, fields like derm, ortho, and ent and very tough, even for top-notch us grads.

i didn't know that european high school takes longer than high school in the us. i had a friend in high school who was not a very good student, but instead of going to junior college in the us, he went directly to med school in india following high school. he was an md before most of us were finishing college.

 

[heykki]

Minne kaupunkiin ajattelit hakea opiskelemaan vai opiskeletko jo jossain? USA:aan on kyllä todella vaikea päästä erikoistumaan, niinkuin varmaan olet huomannut jos olet lukenut tätä foorumia. Itse olen jo lääkiksessä ja erikoistuminen ulkomailla kiinnostaisi. Iso-Britannia tuntuu kuitenkin realistisemmalta vaihtoehdolta, vaikkei sinnekään vain noin vain mennä.

Had to write in Finnish when I noticed he was from Finland as well...

Todennäköisesti Turkuun taikka Helsinkiin. Ensi vuonna olisi vasta tarkoitus hakea.

Back to the topic,

I don't understand why there is no other way for an IMG for not doing the whole residency again once completed outside US already.. Sounds insane but on the other hand, it certainly prevents too many IMGs coming to the US

I'm starting to consider other options, if it really is that hard to get in Definately not the Brits, though, like you Slowmo (hate their accent ) but maybe Australia
Oh well, let's see how the USMLE goes

Cheers

 

[windycitygirl]

This is very pessimistic. Most fields are wide open for IMGs with strong applications. I will agree that a few specialties would be veyr hard to get into - but that's true even with years of USCE. I personally feel that clinical exposure in the US is sometimes given too much weight in these forums.

My impression from talking to PD's and other medical school administrators--as well as several FMGs--is that clinical exposure in the US is very, very important...the applicant is applying to train and practice in the US, so they take it quite seriously.

I have never seen anything clinically outside the US, though, so I couldn't speak to whether the experiences were similar or very different. One friend of mine who graduated from India told me that the basic science here was better, while the clinical exposure there was MUCH better. I would believe that, as the "art of the physical exam" (as crochety old attendings like to refer to it) has been lost from US med schools with the increasing reliance on scans and studies and tests....and overseas (esp in India, where you can't order a CT for every appendix that crosses your path) you better have fantastic clinical skills. So it's a toss-up....but to any FMG applying, I would just say--make sure to get good clinical exposure if you can. If you've got the skills, flaunt them!!! No harm, no foul. My experience has been--the better known your attendings are and the more they like you and the more phone calls they can make on your behalf, the easier it is to get a spot.

 

[PathOne]

Todennäköisesti Turkuun taikka Helsinkiin. Ensi vuonna olisi vasta tarkoitus hakea.

Back to the topic,

I don't understand why there is no other way for an IMG for not doing the whole residency again once completed outside US already.. Sounds insane but on the other hand, it certainly prevents too many IMGs coming to the US

I'm starting to consider other options, if it really is that hard to get in Definately not the Brits, though, like you Slowmo (hate their accent ) but maybe Australia
Oh well, let's see how the USMLE goes

Cheers

Yes, but remember that it's a two-way street: US training isn't automatically accepted anywhere in Europe either!

Since you seem to care about mutual acceptance of medical & training qualifications, I find it somewhat odd that you're looking at the US and Australia. Europe has an exellent system, where ALL medical degrees AND board certifications from one EU country (such as Finland) are accepted in ALL other EU-states+Norway/Switzerland/Iceland. I should think that would give quite a number of opportunities for anyone who wants a change of scenery.

Your problem going to Australia would essentially be the same as going to the US: You can run into quite a lot of red tape getting licensed and a residency, and you can't be certain that your training will be accepted if you decide to go back to Europe someday. Personally, I think that's a fairly high price to pay for going to a country where one "likes the accent better".

Also, regarding the question of US clinical exposure. I've tried working in both Europe and the US. And I can attest to the fact that there's VAST differences in working in the two systems. Your workload is significantly higher in the US, which probably also explains why a lot of US residencies are shorter than comparable residencies in Europe. Thus, I would personally be very careful about studying for USMLE etc. without ever having seen the inside of a US hospital. You'll essentially have no idea if the environment suits you, and you suit the environment.