Is EM still a possibilty for non-US IMGs?

[DocRPP]

Hello,

I am a non-US IMG in my final year, going to graduate this summer. I am pursuing USMLE to get into EM. EM is an emerging thing where I come from, and its hard to come across good PG training programs in EM back home.

I know that EM is extremely competitive in US. In 2017 only 20 IMGs matched into EM and I heard that 2018 is even grim. However, I know this for a fact that EM is what I want to go into and I want to give this my best try. I did my EM home rotations and I completed two EM away rotations in the US, one academic program and one non academic program. I think I did well in these rotations. It was a great learning experience working in a US ED and it is an experience I will cherish even if I don't get to do EM in the US. It transformed me as a physician and as a human being and molded my thought process in a very different path.

I will have three eSLOEs from these rotations and one EM LOR from a well reputed university. I will also have some EM research experience. My USMLE Step 1 score is very average(I know I messed this up). I am confident about getting a good Step 2 CK and Step 3 score before I apply.

What do you suggest that I should do in addition to what I am already doing to make me a better candidate and increase my chances? Is EM in US still a possibility? I want to be realistic about my chances, hence I decided to ask here. Any help you can provide to me in this regard will be greatly appreciated.

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[gro2001]

Hello,

I am a non-US IMG in my final year, going to graduate this summer. I am pursuing USMLE to get into EM. EM is an emerging thing where I come from, and its hard to come across good PG training programs in EM back home.

I know that EM is extremely competitive in US. In 2017 only 20 IMGs matched into EM and I heard that 2018 is even grim. However, I know this for a fact that EM is what I want to go into and I want to give this my best try. I did my EM home rotations and I completed two EM away rotations in the US, one academic program and one non academic program. I think I did well in these rotations. It was a great learning experience working in a US ED and it is an experience I will cherish even if I don't get to do EM in the US. It transformed me as a physician and as a human being and molded my thought process in a very different path.

I will have three eSLOEs from these rotations and one EM LOR from a well reputed university. I will also have some EM research experience. My USMLE Step 1 score is very average(I know I messed this up). I am confident about getting a good Step 2 CK and Step 3 score before I apply.

What do you suggest that I should do in addition to what I am already doing to make me a better candidate and increase my chances? Is EM in US still a possibility? I want to be realistic about my chances, hence I decided to ask here. Any help you can provide to me in this regard will be greatly appreciated.

You seem to have done the key thing, which is get US clinical experience. The SLOE is more important than anything else. Some additional points to consider:

• Make sure your application is complete, including having your Step 2 CK and CS results, by September 15. You need to hit the ground running.
• Try to submit an abstract and go to ACEP. If you don't get an abstract in, consider going anyway. When there, network. Go to EMRA events. Join EMRA. There is often some sort of residency oriented thing (either a residency fair, or a panel of PDs). Talk to people. Show them you are a normal person. Go to people's talks. Ask questions.
• Aim to apply to most programs. At least 100 or so. Go to all programs you are invited to. Rank all programs.
• Make sure your school writes Dean's Letters in the format used in the US.
• Make sure you are doing something useful between med school graduation and intended residency start date.
• If you have any immigration options, look into them now. That will help smoothe the way at programs who are hesitant about visa applicants.
• When interview season starts, reach out to all US EM physicians you know and see if they can put in a good word for you somewhere.

Is EM in the US still a possibility? Yes, it is. It's going to be hard though and very far from a sure thing. Good luck!

 

[DocRPP]

@gro2001 Many thanks for such a detailed reply. I am glad to know that at least I am on the right path.

I will make sure to have all my step scores ready early on. I am already a member of EMRA. I joined mainly for the mentorship program and complimentary subscription to EM RAP. I will be on the lookout for ACEP. I will try to attend it this year if my VISA would allow. Unfortunately, I do not have any immigration options other than J1/H1b sponsored by the program.

Make sure you are doing something useful between med school graduation and intended residency start date.

Since there will be a one year gap between my graduation in mid-2018 till my match in 2020, anything specific you would recommend that I do?

 

[Got Em]

It may be slightly easier for you going forward. This year, there were around 1600 US seniors who applied to EM, which is the same number from last year. However, there were 231 more spots this year. Also, EM is now 7.5% of all spots, compared to 6.7% from 2014, which is the largest % increase of any specialty. As someone stated above, your SLOEs are important. However, you did them in 2017, so I'm not sure if that's still good enough for a 2020 match. Is there a possibility to do 1-2 US EM rotations in 2019?

 

[DocRPP]

It may be slightly easier for you going forward. This year, there were around 1600 US seniors who applied to EM, which is the same number from last year. However, there were 231 more spots this year. Also, EM is now 7.5% of all spots, compared to 6.7% from 2014, which is the largest % increase of any specialty. As someone stated above, your SLOEs are important. However, you did them in 2017, so I'm not sure if that's still good enough for a 2020 match. Is there a possibility to do 1-2 US EM rotations in 2019?

Thanks for pointing that out. I am waiting for the 2018 residency match category wise results to come out, but I overlooked the data you posted and it is slightly encouraging. My SLOEs are from 2018. I will graduate mid-2018 which means, in theory, I am eligible to apply for 2019 match. However I will not have my step 2 CK scores before Sept 15 2018, and I do not want to rush into my Step 2 CK especially since my Step 1 score is only average. Hence I decided to take a year off, work on research, and apply for 2020 with Step 2 CK, Step 3 and some research experience under my belt. I will not be eligible to do any rotations in 2019 since I will no longer be a medical student once I graduate in mid-2018.

 

[slurpy15]

I really, really think EM is peaking. People are realizing non-CMS, outpatient fields like Psychiatry are the way to go for the foreseeable future.

 

[gro2001]

@gro2001Since there will be a one year gap between my graduation in mid-2018 till my match in 2020, anything specific you would recommend that I do?

There will be a 2 year gap in your clinical experience between graduating from medical school and starting residency. All of the 2018-2019 and 2019-2020 academic years. This is not good and seems like an unnecessary additional, self inflicted red flag. Research doesn't really add that much to an EM application. Certainly not enough to make up for that gap. If you were my advisee, I would urge you to apply for the match this fall. You don't need a Step III score to apply for the match. You do need Step II. I don't understand why you can't have Step II done by September.

 

[Got Em]

Thanks for pointing that out. I am waiting for the 2018 residency match category wise results to come out, but I overlooked the data you posted and it is slightly encouraging. My SLOEs are from 2018. I will graduate mid-2018 which means, in theory, I am eligible to apply for 2019 match. However I will not have my step 2 CK scores before Sept 15 2018, and I do not want to rush into my Step 2 CK especially since my Step 1 score is only average. Hence I decided to take a year off, work on research, and apply for 2020 with Step 2 CK, Step 3 and some research experience under my belt. I will not be eligible to do any rotations in 2019 since I will no longer be a medical student once I graduate in mid-2018.

What exactly is your Step 1 score? Since you have 2 US SLOEs, your step 1 score doesn't matter as much as a normal IMG without US SLOEs.

Like Gro pointed above, why are you waiting another year? You don't have to have step 2 CK until later on. It's nice to have it before 10/1/2018, but it doesn't have to be. Plenty of people have gotten invites without it. Your plan may be better served by applying for 2019 cycle and apply massively, with an emphasis on newer programs, former DO programs, and programs not in major cities or associated with prestigious names. If your 2 US SLOEs are good as you stated, plus an "average step 1", someone will take you.

 

[DocRPP]

There will be a 2 year gap in your clinical experience between graduating from medical school and starting residency. All of the 2018-2019 and 2019-2020 academic years. This is not good and seems like an unnecessary additional, self inflicted red flag. Research doesn't really add that much to an EM application. Certainly not enough to make up for that gap. If you were my advisee, I would urge you to apply for the match this fall. You don't need a Step III score to apply for the match. You do need Step II. I don't understand why you can't have Step II done by September.

What exactly is your Step 1 score? Since you have 2 US SLOEs, your step 1 score doesn't matter as much as a normal IMG without US SLOEs.

Like Gro pointed above, why are you waiting another year? You don't have to have step 2 CK until later on. It's nice to have it before 10/1/2018, but it doesn't have to be. Plenty of people have gotten invites without it. Your plan may be better served by applying for 2019 cycle and apply massively, with an emphasis on newer programs, former DO programs, and programs not in major cities or associated with prestigious names. If your 2 US SLOEs are good as you stated, plus an "average step 1", someone will take you.

Thank you for the advice. I have to take Step 2 CK exam by the first week of August for me to have my score ready by September, leaving me some time to complete the ECFMG certification. If I have to write the exam by the first week of August, I will only have two months of dedicated preparation time, and since my Step 1 exam was a long time ago, I was worried that two months may not be enough time for me to prepare for CK. I was worried that I may end up with a mediocre Step 2 CK score, and since my step 1 wasn't impressive, that was a risk I wasn't ready to take. Thanks for the suggestion that a two years gap may be an unnecessary red flag. I will try to figure out a way to have my step 1 done by the first week of August and hopefully, I won't mess up my score.

 

[Got Em]

Thank you for the advice. I have to take Step 2 CK exam by the first week of August for me to have my score ready by September, leaving me some time to complete the ECFMG certification. If I have to write the exam by the first week of August, I will only have two months of dedicated preparation time, and since my Step 1 exam was a long time ago, I was worried that two months may not be enough time for me to prepare for CK. I was worried that I may end up with a mediocre Step 2 CK score, and since my step 1 wasn't impressive, that was a risk I wasn't ready to take. Thanks for the suggestion that a two years gap may be an unnecessary red flag. I will try to figure out a way to have my step 1 done by the first week of August and hopefully, I won't mess up my score.

Again, what is the range of your step 1 score? If it's above 230, I'm not sure if it even matters than much. Many schools have cut offs at 210/220 US seniors, so for IMGs, it may be set slightly higher.

You have already had rotations/clinicals, so Step 2 CK shouldn't be brand new to you. 2 months of dedicated prep time, including 4-5 months total time is plenty for step 2. Most people don't even have 1 month of dedicated prep time. I had 3 weeks. Even with 1 extra year of prep time, you may not even score 5 points higher. These step tests really require critical thinking in addition to book/clinical knowledge.

My final advice - Take your step 2 CK in August and apply 2019. If you apply for 2020 cycle, your chances will be decreased.

 

[gro2001]

Thank you for the advice. I have to take Step 2 CK exam by the first week of August for me to have my score ready by September, leaving me some time to complete the ECFMG certification. If I have to write the exam by the first week of August, I will only have two months of dedicated preparation time, and since my Step 1 exam was a long time ago, I was worried that two months may not be enough time for me to prepare for CK. I was worried that I may end up with a mediocre Step 2 CK score, and since my step 1 wasn't impressive, that was a risk I wasn't ready to take. Thanks for the suggestion that a two years gap may be an unnecessary red flag. I will try to figure out a way to have my step 1 done by the first week of August and hopefully, I won't mess up my score.

You do not need ECFMG certification prior to interview season.

 

[DocRPP]

My final advice - Take your step 2 CK in August and apply 2019. If you apply for 2020 cycle, your chances will be decreased.

Thanks! I have decided to try and apply for 2019.

 

[DocRPP]

Now I am personally interested in internal medicine and don't know much about what it takes to match EM. However it is definitely possible. No doubt about that. I have read about at least one non-US IMG who has matched at Yale in emergency medicine for match 2018. He got a catagorical position and is a visa requiring IMG from, as far as I remember, Pakistan. So I am giving this example to just demonstrate that although hard to get into and expected to stretch you and test your commitment, match for non US IMGs is definitely possible in emergency medicine as of now

Thank you for your encouraging words.

 

[DocRPP]

You do not need ECFMG certification prior to interview season.

I knew it wasn't a must have, but I was told that it was good to have as some programs ask for it. Anyway I will try to complete everything before Sept 15 as per your advice. Thanks!

 

[Tenk]

Keep in mind that several of those IMG EM spots are bought as well. The outlook is very grim currently.

 

[gro2001]

I am afraid he needs to do his utmost to have ecfmg certification by September 15 (or a week over that at max). That is because he is an IMG. And I am also an IMG at an international school which sends a lot of residents to US in IM and for the last few years I have noticed a trend that IMG applicants from my school, even those with very good scores, don't start getting interview invites until all their scores (step 1, CK and CS result) are released and updated on their application for PDs to see.

Yes, FMGs should have all their scores ready at the earliest, ideally by september 15. My very first post recommends that the OP has their entire application complete, including step scores, by the time ERAS opens. However, as the segment you quoted shows, what I was saying was that they do not need ECFMG certification by that time. That is clearly the case, since to be ECFMG certified, you need to have graduated from medical school. If ECFMG certification was required, no FMGs would be able to match during their final year of medical school. While a lot of FMGs do match in years after their medical school completion, and typically have ECFMG certification at that point, all the FMGs who match while still in school are proof that this is far from anything like a requirement.