IMG seeking advice

[khl31]

I am an IMG seeking advice regarding getting into a plastics programme in the US. Before you start lobbing the rotten vegetables my way, please hear me out...


I'm currently coming to the end of my 1st out of 3 years at the University of Cambridge Clinical School (finished my undergrad BA in Pathology last year here). And I actually enjoy research, having spent many happy hours during my final undergrad year locked away in the Medical Research Council's Laboratory of Molecular Biology (MRC-LMB), [home of people like Watson+Crick, Fred Sanger, Max Perutz, Cesar Milstein, etc etc] doing research. At the current moment, I have no projects on hand, but a MBPhD friend has been trying to recruit me to some clinical trial in cardiology he's doing (which I'll probably agree to, since I enjoy such things). I also have another idea for a clinical trial which I'm trying to interest senior people in so that I can run...

But anyway, why do I want to come to America? Firstly, as an international student here in the UK, I have recently been made to feel extremely unwelcome by the new immigration laws that essentially ban me from any specialist training. And even if I manage to miraculously get onto a programme, I'll never be allowed to apply for consultant (=attending) jobs as a non-EU citizen. (I have been told by senior people willing to help that there are ways around that, but I'm not keen to stay and take what I feel is unnecessary abuse from the system.) Secondly, with the new adherence to the EU working time directive, the NHS has been forced to cut back doctors' working hours to something along the lines of 45 hours per week. Some might like this, but I actually enjoy being in hospital/working, and I know that being forcibly kicked out halfway through the day will not agree with me. Lastly, it's not as if the training I receive in the US, should I manage to get onto a programme, will be any worse than anywhere else in the world...

Okay, after that lengthy introduction, here's what I would like to ask of people on this board:

1. Is there *any* hope at all for an IMG looking for a career in plastics in the US? The NRMP website shows a few international acceptances into plastics programmes, but I'm just curious as to how (over)qualified these applicants were...

2. How can I make myself more attractive to various plastics programmes?

3. Any recommendations for electives?

4. Anyone know of any good British plastic surgeons, particularly in East Anglia/Cambridge, that I could attach myself to in order to see what plastics is like?

5. Any hope of fitting in a PhD sometime in a programme? I want to do research, but didn't apply to the Cambridge MBPhD programme because I wanted to do research relevant to my chosen specialty, rather than in molecular immunology or molecular cell biology, which was what has been offered to me by a number of labs in the MRC-LMB.

(I could go into *why* plastics, and it ain't the money/lifestyle, but I don't think people would be interested...)

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[Winged Scapula]

1. Is there *any* hope at all for an IMG looking for a career in plastics in the US? The NRMP website shows a few international acceptances into plastics programmes, but I'm just curious as to how (over)qualified these applicants were...

Obviously its very difficult, for anyone, to match into PRS. The situation is even more dire for those trained outside of the US because of the number of applicants. PRS is widely considered THE most competitive residency - whether straight out of medical school or after surgery training (general, ortho or ENT).

Since we don't have details on the internationals who got into PRS spots, its difficult to say specificallty how qualified or overqualified they were, save to say that they must have been at least as qualified as US grads.

2. How can I make myself more attractive to various plastics programmes?

PRS is a small field and knowing people and working well with them counts for a lot. The internationals that I've known who've gotten PRS positions have not only come to the US for clinical electives but a few have stayed on in research positions for a year or two before getting in. They made themselves known, worked hard, impressed people and didn't give up. A known entity who you like and know will fit in well with your program is much easier to bank on than someone who just looks good on paper. That said, its a big gamble to take - working in a lab (assuming you don't match) hoping you get a chance to get into a training program. But that commitment is what you need to do.

Research in the field is also impressive to the programs, but bear in mind that most US candidates will have that as well. Again, those that I know that have matched from international training have either been well published or well known to the programs.

3. Any recommendations for electives?

Saleh Shenaq, when he was at Baylor in Houston, was well known for taking internationals for electives and even on occasion, as a resident. He now has his own private Brachial Plexus Clinic in Houston. **

Again, in a small field, sometimes its who you know. Big name programs (which don't necessarily give you better training but at least might put you in touch with big names who can help) are: UTSW in Dallas (Rohrich), Pittsburgh, Wash U (MacKinnon), Brigham (Pribnaz), Kleinert and Kutz in Louisville for Hand (1/2 of their hand fellows each year are internationals), etc.

I recommend checking out other resources such as Rob Oliver's blog (a plastic surgeon trained in Louisville, Ky), now in practice in Alabama: http://plasticsurgery101.blogspot.com/

and the common site for those applying to PRS programs in the US: http://www.sfmatch.org

4. Anyone know of any good British plastic surgeons, particularly in East Anglia/Cambridge, that I could attach myself to in order to see what plastics is like?

Sorry, I don't.

[/quote]5. Any hope of fitting in a PhD sometime in a programme? I want to do research, but didn't apply to the Cambridge MBPhD programme because I wanted to do research relevant to my chosen specialty, rather than in molecular immunology or molecular cell biology, which was what has been offered to me by a number of labs in the MRC-LMB.[/quote]

Depends on the program. Most plastic residencies are completed following basic surgical training (which must be completed in the US if you are to be Board Certified) and aren't set up for offering a PhD concurrently. It is possible to get one during surgical training, but again it depends on the program, the facilities and funding. Expect to be asked if you interview as to what your aspirations are for the field of PRS; getting a PhD implies you are more interested in research than clinical work and you should thusly seek a program which has the facilities to train you as so.

I know you haven't gotten any replies besides mine thus far and it is likely due to the fact that the road for internationals to PRS is not well-paved and many of the users here do not know much about it. What you're proposing to do is difficult, especially adding the PhD on top of it.

Although I know a fair bit about international education, I must admit to some confusion about where you are in training...

I understand you have your BA. But the Clinical School at Cambridge does not sound like "medical school". To get into PRS training in the US, you must either:

complete medical school here in the US (for integrated programs)

complete medical school somewhere else, get your ECFMG certificate and apply for surgical residency in the US (either general surgery, Ortho or ENT)

complete your surgical training in the US and then apply for PRS Independent training programs

It has become much more difficult to train outside of the US and get into advanced training in PRS; the board is unlikely to approve any non-US training required for BC. Without BC you will find it difficult to get any insurance plan or Medicare to pay for your services. If you are contemplating an aesthetics (cash only) practice or pure research then that won't be a problem. Obviously if you aren't planning on stay in the US to practice, board certification here isn't an issue. But programs may be loathe to train someone without basic US training...although its worth a look at their websites for further information and to at least make an attempt at your dream.

Anyway, I hope this has helped somewhat.

 

[khl31]

THANK YOU very much for the reply, it has been most helpful!


I am fully prepared to spend a year or two doing lab work if it'll get me where I want to go. As for clinical electives, well, I have about 10 weeks coming up in summer '08, which is probably sufficient for 2 different electives. At the moment I have been tentatively snooping around the various places, and have a few other questions to ask about them - would it be better to go for broke and go after the big names, hoping for letters of recommendation, or would it be advisable to go "audition" at places I think I might have a "realistic" chance of getting into?

Again, those that I know that have matched from international training have either been well published or well known to the programs.

By well published, what exactly do you mean? This is probably going to sound a bit snooty, but "well published" to the scientific community over here implies fairly regular publications in Nature, Science, Cell, etc. etc. And as an undergraduate here, students would have to be VERY lucky (and hardworking, of course, though that's no guarantee), to make authorship on one of those! (silly thing is, the stuff I did for my undergrad BA project - my supervisor reckons with enough work, as in a year or two, it'll be exciting/sexy enough for a BIG paper. but at the moment it's sitting at -20 deg C in a freezer - lack of manpower)

Depends on the program. Most plastic residencies are completed following basic surgical training (which must be completed in the US if you are to be Board Certified) and aren't set up for offering a PhD concurrently. It is possible to get one during surgical training, but again it depends on the program, the facilities and funding. Expect to be asked if you interview as to what your aspirations are for the field of PRS; getting a PhD implies you are more interested in research than clinical work and you should thusly seek a program which has the facilities to train you as so.

I enjoy research, but I'm not particularly fussed about getting the PhD, to be honest. I have received more than adequate lab exposure and training in my one year to understand how "science", and a lab, works. Enough so, that I'm happy to conduct research without the technical/intellectual grounding of the PhD. I believe the PhD is more about learning how to think, and of course acquiring specialist technical skills, than about those letters after the name. Learning to think, I have learnt from amongst the best England has had to offer, as well as the numerous guest lecturers invited from all over the world to give talks and presentations pretty much every day of the week! Specialist skills, in my particular case, I hope to acquire during residency.

I know you haven't gotten any replies besides mine thus far and it is likely due to the fact that the road for internationals to PRS is not well-paved and many of the users here do not know much about it. What you're proposing to do is difficult, especially adding the PhD on top of it.

I appreciate that, and thank you, once again, for making the effort. (and as earlier implied, the PhD can be dropped like a hot potato if it'll get me into a residency!)

Although I know a fair bit about international education, I must admit to some confusion about where you are in training...

I understand you have your BA. But the Clinical School at Cambridge does not sound like "medical school". To get into PRS training in the US, you must either:

complete medical school here in the US (for integrated programs)

complete medical school somewhere else, get your ECFMG certificate and apply for surgical residency in the US (either general surgery, Ortho or ENT)

complete your surgical training in the US and then apply for PRS Independent training programs
Anyway, I hope this has helped somewhat.

British undergrad education for medics goes as such. Coming out of the A levels (high school/SAT equivalent), students apply directly to a medical degree programme, which generally lasts 5-6 years. Upon acceptance and entry, they spend the first 2 years studying preclinical sciences (=MSI+II).

Depending on the university/programme, some allow/demand an "intercalated degree", whereby the student spends the 3rd year studying a related, but not directly medical, field. (Pathology in my case). End of such years, we graduate with an undergraduate bachelor's degree in science (BA Hons (Cantab.) in my case)

After that, we proceed to the Clinical years/Clinical School (=MSIII+IV). Anyone accepted into an undergraduate medical degree is guaranteed a spot in a clinical course somewhere in the UK, though not necessarily at the place you did the undergrad/"premedical" degree in. As far as I know, all clinical courses in the UK are 3 years in duration, as compared to 2 in the US. And aside from the elective period (ranges from ~6-~10 weeks, depending on school), everything is prescheduled for us (i.e. no choice).

In summary, British medical education, coming out of "high school" (locally known as upper-sixth form), = 2+1(?)+3. This is in comparison the American medical education, which is, as far as I understand it, 4(3?)+2+2. (I split the preclinical and clinical years)

At the moment, I'm coming to the end of my 1st clinical year (4th out of 6), and am probably the equivalent of MSIII.5, ish. Hence the starting to consider my options/laying of groundwork.

Anyway, one final question. Integrated/Combined Plastics vs GS+PRS Fellowship. As a fresh IMG, am I eligible (ignoring "chances of getting in") to apply for integrated programmes? I know there are some fairly decent/famous GS programmes that have, and therefore presumably will, accept IMGs. I've only found *one* programme with an IMG integrated plastics resident. And IM programmes, at least the better ones that I checked out, wanted IMGs to have a year of experience in the US before being considered for residency, but this is nowhere in evidence with regards to GS programmes... any thoughts?

Once again, thank you for taking the time to reply!

 

[Winged Scapula]

At the moment I have been tentatively snooping around the various places, and have a few other questions to ask about them - would it be better to go for broke and go after the big names, hoping for letters of recommendation, or would it be advisable to go "audition" at places I think I might have a "realistic" chance of getting into?

I think it best to rotate at places that have a history of taking foreign grades; these may be big names or not. Really what is more important will the amount of contact you have with big names in the field and the contacts they have.

BTW, Shenaq no longer appears on the Baylor faculty list, and neither do Kleinert/Kutz on the Louisville list. Are they still there?

Shenaq has opened up his own Brachial Plexus center in Houston and is Chief of Plastics at St. Luke's. He's still a big name whether or not he's at Baylor, but not sure about whether he can take people for clinical electives. Here's his contact info...http://www.internationalbpi.com/en/cms/?55**

Kleinert is IN Louisville, they are not affiliated directly with the University, although the PRS residents from Louisville do rotate there. Here is their link: http://www.kleinertkutz.com/

By well published, what exactly do you mean? This is probably going to sound a bit snooty, but "well published" to the scientific community over here implies fairly regular publications in Nature, Science, Cell, etc. etc. And as an undergraduate here, students would have to be VERY lucky (and hardworking, of course, though that's no guarantee), to make authorship on one of those! (silly thing is, the stuff I did for my undergrad BA project - my supervisor reckons with enough work, as in a year or two, it'll be exciting/sexy enough for a BIG paper. but at the moment it's sitting at -20 deg C in a freezer - lack of manpower)

I agree, publishing in Nature, Cell or other big name scientific journal is a rarity, for anyone. However, it is not necessary to publish in these journals, there are many others less well known, but still respected, in which students get published. Published may not mean first author (which is particularly impressive), but somewhere in the list of authors. In addition, most have clinical work published because it can take less time than bench work. Most of the internationals that I know of who were successful did not come straight out of medical school into training here in the US; hence they had many more years of doing work in the UK and time to publish.

I appreciate that, and thank you, once again, for making the effort. (and as earlier implied, the PhD can be dropped like a hot potato if it'll get me into a residency!)

I was not meaning to discourage you from obtaining a PhD, either before coming to the US or trying to do so here or during a residency training program here. It *may* make you a more attractive candidate if your PhD was in a sufficiently relevant field in which you could get funding for a PRS research lab. At any rate, I was meaning to suggest that it is not clear what your motives were for pursuing a PhD. In the US you can do high level research without it and I wasn't clear if you wanted to pursue clinical surgery or a research practice.

In summary, British medical education, coming out of "high school" (locally known as upper-sixth form), = 2+1(?)+3. This is in comparison the American medical education, which is, as far as I understand it, 4(3?)+2+2. (I split the preclinical and clinical years)

Thank you for the clarification, although as one trained abroad, I'm pretty familiar with the schema. It was the fact that you could be awarded your BA without completing the entire 6 year program that was unknown to me. Not so in the US, although some exceptions may be made, generally they want you to finish the entire training program or transfer out.

BTW, American medical education does not require a full 4 year degree, just 90 units, but the vast majority of students have completed at least 4 years at undergrad uni here before starting medical school. One, because it takes a long time to get the prereqs and your major studies completed - most US degrees are more than 120 units. It would be unusual to finish in 3 years. Secondly, having the degree maximizes job opps if you don't get into medical school.

Anyway, one final question. Integrated/Combined Plastics vs GS+PRS Fellowship. As a fresh IMG, am I eligible (ignoring "chances of getting in") to apply for integrated programmes?

yes, you are eligible.

I know there are some fairly decent/famous GS programmes that have, and therefore presumably will, accept IMGs. I've only found *one* programme with an IMG integrated plastics resident. And IM programmes, at least the better ones that I checked out, wanted IMGs to have a year of experience in the US before being considered for residency, but this is nowhere in evidence with regards to GS programmes... any thoughts?

Once again, thank you for taking the time to reply![/QUOTE]

The US experience is highly valued, but more so for people that come from Third World countries. If a program does specify 1 year of training in US hospitals, that is their own requirement, not a requirement of the match system or the American Board of PRS.

Best of luck...

 

[khl31]

Hmm... after going away and doing some thinking + research, I have come back with some other questions.

Firstly, to begin, I have been given new hope! The list of new plastics residents from plasticseducation.com shows a Singaporean (guess where I'm originally from ) getting a residency spot in Case Western! Unfortunately, a quick google shows that he is MRCS already. bugger. The *earliest* one can take the final MRCS examination to get the MRCS qualification is immediately after PGY-3 i.e. start of PGY-4!!!

Anyway, I shall not give up hope!

Okay, on to the questions...

Say I try a different approach, a road much more well-trodden and explored, relatively speaking How about a GS residency into a plastics fellowship? I know that this year, from the GS forum, about 15-20% of GS spots went to IMGs, so it is definitely do-able. And with a GS residency under the belt, I'm sure my IMG status will fade into the background, and it will be up to my performance during the residency.

Question is, do I continue pursuing research in plastics (have a publication+presentation lined up for September, another one in the pipeline, timeline uncertain, and a few more lurking on the horizon) or should I start diversifying to boost a GS application?

I'm sure I can get vascular, CT, uro, ortho, colorectal and GI or possibly even paeds surg papers if I approach the local consultants, since around here everyone is doing research as a hobby but needs someone to do the manual labour involved in getting data collated, analysed and a paper written up. And I probably would enjoy it, since by nature I like research work. But should I streamline my application towards GS -> plastics, or just go for a straight GS, shotgun-done-everything-under-the-sun-in-surgery kind of publication record?

 

[Seona]

Sadly, Dr. Shenaq passed away earlier this month: http://www.chron.com/disp/story.mpl/deaths/4644756.html

 

[mofonyx]

Hello,

This was a very helpful thread. Thanks for your posts!

I have a Step 1 score and would like to do an elective in Plastics, pretty much in the same shoes at khl31 three years ago. With the new change of regulations in the UK, I'm quite confident he has more options to exercise today. You recommended some popular places for visiting medical electives.

I spoke to a surgeon the other day. He trained in Harvard and expressed that throughout his training he saw elective students just queueing outside the theater. There were at least 20 of them by his count. I wouldn't want to travel half way around the world to be part of a queue. He wisely advised me to avoid popular places such as Harvard/Yale. Taking heed, I'd prefer a smaller place, albeit less popular, with a good 'teaching' plastics department - if there is such a thing. He recommended Hersey's Kentucky, but they do not take international students.

Are there any places that come to mind? Any help would be much appreciated. Thanks.

 

[maxheadroom]

Not sure what you mean by Hersey's Kentucky.

Hershey Medical Center is in Hershey, Pennsylvania and is affiliated with Penn State. I have no knowledge of that institution beyond the fact that they do have a Plastics program.

There are two programs in Kentucky -- an integrated program at the University of Kentucky in Lexington and an independent program at the University of Louisville in (surprise) Louisville.

I know that there have been issues for foreign medical students in the past at the institutions where I've worked. Most of these have been a lack of malpractice coverage. When a student rotates at another institution, s/he is typically covered by the institutional policy where they are actually a student. I know in one case this was an issue for a foreign medical student as he did not have coverage in the U.S. from his school, making him able to only observe.

 

[mofonyx]

How embarrasing, I have the two mentioned to me as separate entities and have them mixed up together as one. I meant to say Hersey Medical Center. They don't take international students. Also, as far as I know, the universities in Kentucky do not offer programs to international students.

I will be sure to have malpractice coverage. Any suggestions as to where I should apply?

 

[MNIkid87]

Potentially stupid question: what does the whole IMG situation look like for Canadians / people with medical degrees from the cold North? I am asking because I remember hearing that at least in several other specialties medical experience in Canada was equivalent to medical experience in the States (regarding the whole US clinical experience thing for IMGs). That's why I am wondering whether we people from across the border are treated more like FMGs/IMGs or US med school graduates.

 

[turundu]

How embarrasing, I have the two mentioned to me as separate entities and have them mixed up together as one. I meant to say Hersey Medical Center. They don't take international students. Also, as far as I know, the universities in Kentucky do not offer programs to international students.

I will be sure to have malpractice coverage. Any suggestions as to where I should apply?

If you are a MS you can apply to a clerkship/Sub-I mostly anywhere. Google "international visiting medical students rotations". I recall Baylor, mount Sinai, Hopkins, Harvard among others had it. They charge you a fee that includes the malpractice insurance, it varies depending on the institution (up to $2,500 per month).


If you are an IMG (already have your medical diploma), it's basically not possible due to Hospital liability issues and medical licensing. However, University of Washington (Seattle) offers a 2-month Sub-I in GS that I recently completed and I think is phenomenal.

 

[maxheadroom]

Potentially stupid question: what does the whole IMG situation look like for Canadians / people with medical degrees from the cold North? I am asking because I remember hearing that at least in several other specialties medical experience in Canada was equivalent to medical experience in the States (regarding the whole US clinical experience thing for IMGs). That's why I am wondering whether we people from across the border are treated more like FMGs/IMGs or US med school graduates.

Canadian schools are LCME accreditted, which means that they are essentially US schools. I know several Canadians who have trained in the US. The only issue that they face is that when they come on a J1 visa, they have to go home for 2 years before they're eligible for a greencard as an attending. There used to be some loopholes, but I've been told (by Canadian friends) that those are closing.

Plastic surgeons who train in the Canadian system are eligible to sit for the ABPS exam -- I've trained with several faculty who did their training in Toronto.

 

[mofonyx]

If you are a MS you can apply to a clerkship/Sub-I mostly anywhere. Google "international visiting medical students rotations". I recall Baylor, mount Sinai, Hopkins, Harvard among others had it. They charge you a fee that includes the malpractice insurance, it varies depending on the institution (up to $2,500 per month).


If you are an IMG (already have your medical diploma), it's basically not possible due to Hospital liability issues and medical licensing. However, University of Washington (Seattle) offers a 2-month Sub-I in GS that I recently completed and I think is phenomenal.

Thanks for your reply. Application is not a huge issue and I've found many places to apply to. I'm just not sure WHERE I should apply to. My chances are as good as winning a lottery when it comes to trying to get a residency program in America in the future. I was hoping to use this 'visiting medical elective' opportunity to give me a boost by establishing a good working relationship with people on the program (attendings). Slim chance, but I'll take what I can get at the moment.

I am weary of applying to places like Mt Sinai or Harvard because I get the impression that they are oversubscribed. It would be important that I can exercise this opportunity to secure a good letter of recommendation I can use in the future.

Perhaps I'm asking for too much?

 

[turundu]

Thanks for your reply. Application is not a huge issue and I've found many places to apply to. I'm just not sure WHERE I should apply to. My chances are as good as winning a lottery when it comes to trying to get a residency program in America in the future. I was hoping to use this 'visiting medical elective' opportunity to give me a boost by establishing a good working relationship with people on the program (attendings). Slim chance, but I'll take what I can get at the moment.

I am weary of applying to places like Mt Sinai or Harvard because I get the impression that they are oversubscribed. It would be important that I can exercise this opportunity to secure a good letter of recommendation I can use in the future.

Perhaps I'm asking for too much?

Look for places that are actively involved in research, you will need to spend a couple of years in the lab strengthing your CV (pubs, awards, grants). Undoubtedly, research has become the usual route for IMGs to get matched in PRS.

Places that have research labs and have taken IMGs in the past:
-Harvard
-Pitt
-Yale
-Stanford
-U. Mass
-UTSW
-Penn State (Hershey) -- requires green card/US citizenship

U. Chicago, Mount Sinai and Ohio are "IMG friendly", but I don't know much about their current research projects or if they take foreign postdocs. I should underscore that NYU has great PRS research labs/mentors and they publish/present like crazy; they have placed former postdocs at very competitive places.

 

[mofonyx]

Thank you. It would be unlikely for me to leave the country I am studying at (UK) for a research program, so I will not be keen on that. If it means compromising my chances working in America, I'd rather spend those years researching as a trainee in UK.

I understand it's a long shot, and I appreciate your suggestion. I'm looking for a place that can offer up a good visiting medical elective, but it doesn't seem like anyone has an answer for me. I guess there's really no telling how good a place would be unless you've been there yourself. So like everything else in life, luck of the draw really.