IMG - what do in gap year before residency?

[Axonic]

Dear all,

I'm a medical student in my penultimate year in Europe and I'm planning to apply for the match once I graduate.

As an IMG, I cannot apply on the same year I graduate (because I need to have graduated in order to apply for the match). My question is - what do you think I should do in this year to improve my chances at being matched? The options are:
1. Do nothing! rest a bit, take more time to study and take step 2 etc.

2. Apply for another degree. The options are: master in public health or master in health administration (programs are usually 2 years long - which means another year before I can apply to the match) or go for a research Ph.D (I'm really interested in that, but that means 3-4 years before I start residency - which means 2-3 years beyond this gap year).

3. Start residency in my country. This would mean I'll gain some clinical experience (and also have some income). The thing is - I'll have to quit after one year (assuming I'll be admiited to a residency program in the states).

I'm not 100% sure about what residency I'm going to pursue, but my idea right now is either IM or IM/Peds.

Please let me know what you think. I would also like to hear from IMGs who also had to take this gap year before they apply.. What did you do? .. and how did it affect your chances at matching? Did interviewers ask about what you did during this year? etc.

I thank you all for your time!

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[Raryn]

Dear all,

I'm a medical student in my penultimate year in Europe and I'm planning to apply for the match once I graduate.

As an IMG, I cannot apply on the same year I graduate (because I need to have graduated in order to apply for the match). My question is - what do you think I should do in this year to improve my chances at being matched? The options are:
1. Do nothing! rest a bit, take more time to study and take step 2 etc.

2. Apply for another degree. The options are: master in public health or master in health administration (programs are usually 2 years long - which means another year before I can apply to the match) or go for a research Ph.D (I'm really interested in that, but that means 3-4 years before I start residency - which means 2-3 years beyond this gap year).

3. Start residency in my country. This would mean I'll gain some clinical experience (and also have some income). The thing is - I'll have to quit after one year (assuming I'll be admiited to a residency program in the states).

I'm not 100% sure about what residency I'm going to pursue, but my idea right now is either IM or IM/Peds.

Please let me know what you think. I would also like to hear from IMGs who also had to take this gap year before they apply.. What did you do? .. and how did it affect your chances at matching? Did interviewers ask about what you did during this year? etc.

I thank you all for your time!

You do not need to be graduated to apply for the match. You just need to be able to have someone at your school sign a piece of paper stating that you are on track to graduate prior to July 1 of the year of the match. IMGs from all over the world apply to the US match while they're in their last year of study. You do not need ECFMG certification (which requires a diploma) to match, just to start residency.

On the other hand, you do need to have Step 1, Step 2 CK, AND Step 2 CS passed to apply for the match. Very few programs will even consider you without you having done this prior to applying, and if you delay those too long you will be removed from the match.

 

[Axonic]

Thank you Raryn for the quick response.

I was sure I read this somewhere - that IMGs cannot apply without having their diploma, but maybe I got confused with the ECFMG certification. I guess I should try to be done with CK and CS ASAP then. I was sure I'll have a year off because I thought I won't be eligible to apply on the same year I graduate.

Another quick question - how crucial is it to have clinical experience in the states? Would a good step 1 mark, 2-3 publications and good transcript somehow compensate for me not having clinical experience in the states? I'm looking to aply for IM or IM/Peds - so not ultra-competitive residencies.

I'm on a tight budget - and clinical experience in the states would mean at least $3K - 4K (tuition, flight, accomodation living costs etc.).

How crucial is it?

 

[ThoracicGuy]

Thank you Raryn for the quick response.

I was sure I read this somewhere - that IMGs cannot apply without having their diploma, but maybe I got confused with the ECFMG certification. I guess I should try to be done with CK and CS ASAP then. I was sure I'll have a year off because I thought I won't be eligible to apply on the same year I graduate.

Another quick question - how crucial is it to have clinical experience in the states? Would a good step 1 mark, 2-3 publications and good transcript somehow compensate for me not having clinical experience in the states? I'm looking to aply for IM or IM/Peds - so not ultra-competitive residencies.

I'm on a tight budget - and clinical experience in the states would mean at least $3K - 4K (tuition, flight, accomodation living costs etc.).

How crucial is it?

Very. US residencies trust US rotations and US doctors. Your rotations in Europe may be great, but US programs just don't know them and don't have time to research all of these. You want to have a letter from at least one and preferably more US doctors for your application as well as the experience in these hospitals. Multiple rotations are preferable.

 

[gutonc]

Thank you Raryn for the quick response.

I was sure I read this somewhere - that IMGs cannot apply without having their diploma, but maybe I got confused with the ECFMG certification. I guess I should try to be done with CK and CS ASAP then. I was sure I'll have a year off because I thought I won't be eligible to apply on the same year I graduate.

Another quick question - how crucial is it to have clinical experience in the states? Would a good step 1 mark, 2-3 publications and good transcript somehow compensate for me not having clinical experience in the states? I'm looking to aply for IM or IM/Peds - so not ultra-competitive residencies.

I'm on a tight budget - and clinical experience in the states would mean at least $3K - 4K (tuition, flight, accomodation living costs etc.).

How crucial is it?

Crucial to match at all? Not very, assuming you come from a well known program in Western Europe.

Crucial to matching well? As TGuy points out, very.

 

[Axonic]

Okay. Thank you guys! You all have been very helpful.

 

[Axonic]

You do not need to be graduated to apply for the match. You just need to be able to have someone at your school sign a piece of paper stating that you are on track to graduate prior to July 1 of the year of the match. IMGs from all over the world apply to the US match while they're in their last year of study. You do not need ECFMG certification (which requires a diploma) to match, just to start residency.

On the other hand, you do need to have Step 1, Step 2 CK, AND Step 2 CS passed to apply for the match. Very few programs will even consider you without you having done this prior to applying, and if you delay those too long you will be removed from the match.

I was trying to remember where I read this - and I found this:
http://en.wikipedia.org/wiki/National_Resident_Matching_Program#International_medical_graduates

To participate in the NRMP, an international medical graduate is required to have an ECFMG certification (not required of M.D. graduates of Canadian medical schools, who are not considered IMGs in the U.S.)[41] by the "rank order list certification deadline" time (usually in February of the year of the match).[42]
To acquire an ECFMG certification, the main requirements are:[43]
Completion of USMLE Step 1, USMLE Step 2 Clinical Knowledge and USMLE Step 2 Clinical Skills
A medical diploma of medical education taken at an institution registered in the International Medical Education Directory (IMED)
In comparison, regular graduates from medical schools in the United States or Canada need to complete USMLE Steps 1 and 2 as well, but can participate in the NRMP while still doing their final year of medical school before acquiring their medical diplomas.[44] In effect, taking regular administrative delays into account, and with residency programs starting around July, there is a gap of at least half a year for IMGs between graduation from medical school and beginning of a residency program, in contrast to US graduates who may start residency directly after completing medical school.

Yet, on the NRMP website FAQs I found this:
"If I have not received my ECFMG certification when ranking opens, can I still enter my rank order list?
Yes, you can enter a rank order list. If the NRMP receives notification from ECFMG® that you have passed the required examinations (USMLE® Step 1 and Step 2 CK and CS), you will be included in the Main Residency Match. If the NRMP does not receive ECFMG confirmation of passed examinations, you will be withdrawn from the Main Residency Match shortly after the Rank Order List Deadline and your rank order list will NOT be used when the matching algorithm is processed. If the NRMP receives ECFMG confirmation of passed examinations prior to Match Week, you will be eligible to participate in the Match Week Supplemental Offer and Acceptance Program® (SOAP®)."

I know Wiki is not always a reliable source of information .. so it seems Raryn is right - but are we 100% sure this applies to all applicants (including IMGs)? Is there any IMG that entered right after med-school around this forum?

 

[gutonc]

I know Wiki is not always almost never a reliable source of information .. so it seems Raryn is right - but are we 100% sure this applies to all applicants (including IMGs)? Is there any IMG that entered right after med-school around this forum?

Fixed that for you.

And I would venture to guess that the vast majority of IMGs in residency in the US entered right after med school. Raryn is right, Wikipedia is (and I'm shocked, just shocked to discover this) wrong. You'll need the following to apply straight out of school:
Steps 1, 2CK and 2CS...done and crushed (first-time pass on all of them, 240+ on 1 and 2CK)
Verification from your school that you'll graduate before 7/1

That's it. USCE is a huge benefit but not an absolute requirement.

Also, you state that the $3-4K required to do a month or two in the US is a stretch for you, which I completely understand. But how are you going to swing the 2-3 months of travel and time in the US (in multiple locations) required for the interview season? I mean, I lived in NYC and interviewed at 16 places, about half within driving distance and half requiring a flight and a night or two in a hotel and I spent well over $5K. if I added 3 months rent in the US and RT ticket to some random place in Western Europe, that number is $10K easily, maybe closer to $15K if you live somewhere like NYC or Chicago where the rent is high but the travel options will be easier.

 

[Axonic]

Fixed that for you.

And I would venture to guess that the vast majority of IMGs in residency in the US entered right after med school. Raryn is right, Wikipedia is (and I'm shocked, just shocked to discover this) wrong. You'll need the following to apply straight out of school:
Steps 1, 2CK and 2CS...done and crushed (first-time pass on all of them, 240+ on 1 and 2CK)
Verification from your school that you'll graduate before 7/1

That's it. USCE is a huge benefit but not an absolute requirement.

Also, you state that the $3-4K required to do a month or two in the US is a stretch for you, which I completely understand. But how are you going to swing the 2-3 months of travel and time in the US (in multiple locations) required for the interview season? I mean, I lived in NYC and interviewed at 16 places, about half within driving distance and half requiring a flight and a night or two in a hotel and I spent well over $5K. if I added 3 months rent in the US and RT ticket to some random place in Western Europe, that number is $10K easily, maybe closer to $15K if you live somewhere like NYC or Chicago where the rent is high but the travel options will be easier.

Thank you for that.

I checked with my school, and apparently graduation is normally between 15th-30th of July. I guess this means I won’t be eligible to apply [?]. What if I apply for residency places that allow me to start later on (say August or October)?

Is there any other option for me not to wait till the match of the following year?

 

[Raryn]

Thank you for that.

I checked with my school, and apparently graduation is normally between 15th-30th of July. I guess this means I won’t be eligible to apply [?]. What if I apply for residency places that allow me to start later on (say August or October)?

Is there any other option for me not to wait till the match of the following year?

There are no exemptions. If you are not graduated before July 1 the year you start, you cannot apply to the match. Even if you attempted to, the ECFMG will contact your school to verify your graduation rate, and you will be removed from the match once it is verified to be after July 1.

Even if you could graduate in mid-June, it would be pushing it. July 1 is an absolute requirement, but the relative requirement is that you should have your diploma in hand early enough to actually start your program on time. It takes a few weeks each to process your ECFMG certificate and your visa (if you need one), and orientation at most programs is the last 1-3 weeks in June, so a "soft" requirement would be that you should be graduated by mid-May.

Given all that, you actually do have a gap year. I don't have all too much advice for it.

 

[Axonic]

There are no exemptions. If you are not graduated before July 1 the year you start, you cannot apply to the match. Even if you attempted to, the ECFMG will contact your school to verify your graduation rate, and you will be removed from the match once it is verified to be after July 1.

Even if you could graduate in mid-June, it would be pushing it. July 1 is an absolute requirement, but the relative requirement is that you should have your diploma in hand early enough to actually start your program on time. It takes a few weeks each to process your ECFMG certificate and your visa (if you need one), and orientation at most programs is the last 1-3 weeks in June, so a "soft" requirement would be that you should be graduated by mid-May.

Given all that, you actually do have a gap year. I don't have all too much advice for it.

Thanks again for your time and help.

I'm going to try and talk to people from my school dean's office next week - but I cannot really see them changing the graduation date just for one or two students. Still, I'll give it a try anyway.

Back to the original question then - what to do in this year? I already know I'm going to try and gain some USCE for a month or two (although I'm not sure this would be possible after I graduate because technically I will not be a "student" anymore - and cannot apply for "electives").

Still - I have to think what to do in the rest of my time. The options I can see at the moment are -

1. Do nothing! rest a bit, take more time to study and take step 2 CK & CS (and hopefully rock them) etc.

2. Apply for another degree. The options are: master in public health or master in health administration (programs are usually 2 years long - which means another year before I can apply to the match) or go for a research Ph.D (I'm really interested in that, but that means 3-4 years before I start residency - which means 2-3 years beyond this gap year).

3. Start residency in my country. This would mean I'll gain some clinical experience (and also have some income - which I guess will be needed for the month or two I'll be spending in the states for interviews). The thing is - I'll have to quit after one year (assuming I'll be admitted to a residency program in the states) and I'm not sure how this will be seen. It feels "wrong" - especially because I'm not going to be sincere about my intentions to leave. On the other hand, no one will accept me to residency here if I explicitly say I'm planning to leave after one year.

4. Another option I'm considering: do some medical volunteer work with one of the international organizations working in underprivileged countries. It doesn't have to be an entire year, I can do it for half a year and use the remaining time to prepare for the interviews etc.

Any other suggestions? .. any input is welcome!

 

[DrBacchi]

I have the same problem in a couple of years, I'm planning to work as a general practitioner (locums) and saving up money to travel around for interviews. I could probably apply without a gap year, but it would be tough to make it to interviews when we still have classes. I dont know if I'll start a residency here, but probably yes, since the US residency could be counted as credit for specialization in my country also. Also I'd like to pay off my loans (about 15k) before moving to the US.

 

[Axonic]

Thank you Bacchi.

Any other input - SDNers? Which of the options I mentioned would look better - from the viewpoint of a program director?

 

[DrBacchi]

Do you get a unrestricted medical license at graduation? There are only 4-6 months between your graduation and interviews, I dont think starting a whole new degree to fill that gap would help you much in the interviews. I would work (if you have a license), do specialty specific research or something else that you can tall about in interviews. You could also finish USMLE Step 3 during that time (to increase your odds and make you qualify for a H1b visa, if you need one).