Is it really that impossible?

[Omiganlode]

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Hi everyone!

I'm a US citizen IMG that studied in Costa Rica. I got a 213/90 on step 1 and a 238/86 on Step 2 CK and passed the CS on my first try....

Other than that, I was an RN in the US before going to medical school but I have no USCE as a physician or any research or publications. Ranked high in my class though...

Graduating med school at the end of this year and so I'm planning on applying to the 2014 match. Looking around these posts, it's pretty impossible for a FMG to get into EM... How true is this? I was planning on applying to 147 programs, (every program except the ones in Cali) but like I said, it's looking pretty scary. What say you?

Thanks in advance...
L.
😕

 

[K31]

Without any US EM rotations or SLORs--yeah, pretty much impossible. Would it be possible for you to rotate at a US EM program or two before you graduate?

 

[Omiganlode]

Without any US EM rotations or SLORs--yeah, pretty much impossible. Would it be possible for you to rotate at a US EM program or two before you graduate?

Nope... Our last year of med school here in CR we work for the government as an intern (80 hours a week) so I have no free time for a year. I wish I could but I won't be free until December 31st. 🙁

 

[Omiganlode]

207 views and no replies... Come on guys, help a sister out!!!!!! 😀

 

[UnderwaterDoc]

Echo what was said above, with no SLORs or US rotations I would think that it is next to impossible, unless you have connections 🙂

 

[Akail]

It's a pretty steep uphill battle and you have to have something in your favor to make it work (high board scores or several great SLORs or personal connections) at the risk of being mean, I think if you applied to 147 programs, you have to deal with the high probability that you would receive <5-6 interviews. Balancing that with the fact that you may not like some of the programs you interview at, I would seriously question if it would be work spending the 3-5k+ in application fees trying to apply. If you do apply, I think you'll have to be very proactive about emailing/calling programs. I think there are a couple other people on here in a similar position that could give you better input. Regardless, good luck with everything!

 

[Vizio2010]

OMIGANLODE,

While it I agree that it is a challenge as other people have answered to your question, remember that nothing is impossible, the first step is to dream and the next is to work towards it, not letting yourself be disillusioned by those that say different to what they may think is accomplishable. Follow your dream!


I also believe we may have a similar background....Pura Vida!!!! you can email me if you like at [email protected] if you would like to discuss your pursuit of EM...good luck with INTERNADO! in the meantime

 

[Hypomanics]

I have posted my stats on here before. But just to let you know how difficult it is for anyone with deficits on their app...

- AMG
- 1st year - C's & B's
- 2nd year - more B's than A's
- 3rd year - more A's than B's
- 4th year - all A's
- Step 1 - failed first attempt, scored just below you on 2nd attempt
- Step 2 - scored just below you
- No home EM program
- Did 2 aways (GWU & SUNY Downstate), did good
- Last year (as a US senior) - applied to every single EM program, 5 interviews, didn't match
- Applied to prelim IM as back up, matched
- As an intern this year, got an early EM rotation with the program at my hospital - did really well, got letters
- Busted my ass to do well in my IM program, PD wrote glowing rec
- Applied to every program again. This time I added some EM/IM but not all.
- Got 6 interviews, including 1 EM/IM
- "Sorry, you did not match."

Now I'm waiting it out for SOAP.

There are ways that your app will be "better" than mine, but in other ways won't be. For instance, IMG vs AMG and the fact that you didn't fail step but your scores aren't really high enough for an IMG.

Now that it's over, it would be easy to say I would have done things differently. If I would have just went for IM initially, I'd likely have ended up in a pretty decent place, which may not happen now. But even knowing this outcome I couldn't have done anything but what I did. I had to take all the chances because EM is what I love.

I guess what I'm saying is, I think it's highly unlikely that you will match in EM. But how hard are you willing to try, and how do you feel about the options if it doesn't work out?

 

[fahimaz7]

I have posted my stats on here before. But just to let you know how difficult it is for anyone with deficits on their app...

- AMG
- 1st year - C's & B's
- 2nd year - more B's than A's
- 3rd year - more A's than B's
- 4th year - all A's
- Step 1 - failed first attempt, scored just below you on 2nd attempt
- Step 2 - scored just below you
- No home EM program
- Did 2 aways (GWU & SUNY Downstate), did good
- Last year (as a US senior) - applied to every single EM program, 5 interviews, didn't match
- Applied to prelim IM as back up, matched
- As an intern this year, got an early EM rotation with the program at my hospital - did really well, got letters
- Busted my ass to do well in my IM program, PD wrote glowing rec
- Applied to every program again. This time I added some EM/IM but not all.
- Got 6 interviews, including 1 EM/IM
- "Sorry, you did not match."

Now I'm waiting it out for SOAP.

There are ways that your app will be "better" than mine, but in other ways won't be. For instance, IMG vs AMG and the fact that you didn't fail step but your scores aren't really high enough for an IMG.

Now that it's over, it would be easy to say I would have done things differently. If I would have just went for IM initially, I'd likely have ended up in a pretty decent place, which may not happen now. But even knowing this outcome I couldn't have done anything but what I did. I had to take all the chances because EM is what I love.

I guess what I'm saying is, I think it's highly unlikely that you will match in EM. But how hard are you willing to try, and how do you feel about the options if it doesn't work out?

Out of curiosity, how did you fail step 1 the first time and then score "right below the average" on the second attempt? If anything I would venture to guess that it's that mark on your application that hurts?

 

[DreamingTheLive]

Out of curiosity, how did you fail step 1 the first time and then score "right below the average" on the second attempt? If anything I would venture to guess that it's that mark on your application that hurts?

Kick 'em while they're down much?

 

[Apollyon]

Kick 'em while they're down much?

On SDN for 4 1/2 years, and are you just noticing this? It's like the official hobby of SDN.

 

[JShephard]

On SDN for 4 1/2 years, and are you just noticing this? It's like the official hobby of SDN.

Lol

 

[DreamingTheLive]

On SDN for 4 1/2 years, and are you just noticing this? It's like the official hobby of SDN.

Lol, on other sub-forums, sure. I like to think that for the most part this EM forum keeps it pretty real, but also pretty civil (mostly).

 

[EMquest3]

Out of curiosity, how did you fail step 1 the first time and then score "right below the average" on the second attempt? If anything I would venture to guess that it's that mark on your application that hurts?

I think he was speaking to the OP, so when he said "scored just below you' I think he actually meant just below the OP's score of 213 on step 1.

Either way, it doesn't seem all that unlikely to me that a person could fail for any number of reasons and then score very well on a second take.

 

[Hypomanics]

Yep that's what i meant - that I scored just below the OP. And lol to the 'kicking me when I'm down.' I didn't take it that way. Any idiot can tell that my failed step is the reason I haven't matched. I didn't think I had to point it out.

I barely failed the first time, and then improved by >20 points by - *surprise* - learning from my mistakes and how to correct them. I had a hard transition into medicine, as I come from an electrical engineering and math background. Nearly all of my undergrad sciences were free response, even biology. I wasted a lot of time my first 2 years trying to conceptually understand everything rather than understanding big picture and most importantly (when it comes to step 1 scores at least) understanding how medical education is tested. I would consistently run out of time on exams, being forced to leave blank or randomly chosen answers. I ran out of time on multiple sections of my first step 1.

My initial solution was to increase my amount of studying, but no matter how much I did it just would not help. Eventually, I realized that you had to think like the test maker, that there were many clues in each question, and that certain questions were always asked certain ways. Studying with this mindset is completely different. The first time I really realized what I was doing wrong was while I was studying for step 1 the first time, but by that point I was so behind. But from then on, there was a stark difference. I scored above average on all shelf exams 3rd year and did well on my step 2 as I mentioned previously.

I had hoped that programs would see this upward trend and give me a chance. A few did, but the majority of programs see the fail and just filter my app from the start.

 

[Hypomanics]

Maybe I should clarify why I tell my story in this situation.

I have a few friends who are IMG's and applied to EM. While I don't know their entire app - because why should I? - I do know that they scored above average on the steps and otherwise have no deficits. However, they get 1-2 interviews, while I get 5 & then 6. I'm not going to argue what is fair and what isn't, but it seems from my very anecdotal evidence that especially in recent years it is likely just as hard or harder for an IMG to get a spot than someone like me. Perhaps it is easier for an IMG to "redeem" his or her self through something like really high board scores, which the OP clearly does not have. I don't know.. But in general, I think it's just getting harder for anyone with any mark on their record to get a spot.

 

[EMquest3]

Yep that's what i meant - that I scored just below the OP. And lol to the 'kicking me when I'm down.' I didn't take it that way. Any idiot can tell that my failed step is the reason I haven't matched. I didn't think I had to point it out.

I barely failed the first time, and then improved by >20 points by - *surprise* - learning from my mistakes and how to correct them. I had a hard transition into medicine, as I come from an electrical engineering and math background. Nearly all of my undergrad sciences were free response, even biology. I wasted a lot of time my first 2 years trying to conceptually understand everything rather than understanding big picture and most importantly (when it comes to step 1 scores at least) understanding how medical education is tested. I would consistently run out of time on exams, being forced to leave blank or randomly chosen answers. I ran out of time on multiple sections of my first step 1.

My initial solution was to increase my amount of studying, but no matter how much I did it just would not help. Eventually, I realized that you had to think like the test maker, that there were many clues in each question, and that certain questions were always asked certain ways. Studying with this mindset is completely different. The first time I really realized what I was doing wrong was while I was studying for step 1 the first time, but by that point I was so behind. But from then on, there was a stark difference. I scored above average on all shelf exams 3rd year and did well on my step 2 as I mentioned previously.

I had hoped that programs would see this upward trend and give me a chance. A few did, but the majority of programs see the fail and just filter my app from the start.

I was an electrical engineer prior to med school as well. I think an engineering background definitely helps with some aspects of medicine.

 

[Hypomanics]

I was an electrical engineer prior to med school as well. I think an engineering background definitely helps with some aspects of medicine.

It's definitely not the interacting with patients part. 😉


By the way, I'm a she.

 

[EMquest3]

It's definitely not the interacting with patients part. 😉


By the way, I'm a she.

Woops, my bad on the pronouns.

 

[cf817]

I had three classmates from Ross match into EM this year. But they where all 250+ on step 1 and 2, all had SLORs and are super sharp. Those are the kind of stats that are needed for an IMG to match into EM and it's not getting any better.

 

[Omiganlode]

Thanks to everyone who answered... I'll def think about everything and I'll see you guys in the match posts at the end of this year.

Pura vida!
L.

 

[jkmph]

Thanks to everyone who answered... I'll def think about everything and I'll see you guys in the match posts at the end of this year.

Pura vida!
L.

If you're dead set on EM you could always do a transitional year somewhere and spend all your time in an ER to get the necessary SLORs and apply the following cycle.

 

[Apollyon]

If you're dead set on EM you could always do a transitional year somewhere and spend all your time in an ER to get the necessary SLORs and apply the following cycle.

You can't do the same thing twice during a TY; also, most TYs have a required EM month. As such, it would have to be a place with a dedicated Peds ED, and would help for an ultrasound month, a tox month, and, what else? An EMS month? Those are those that I can see getting opportunity to be in the ED. Hyperbarics and hospice? Not so much.

 

[DreamingTheLive]

If your dead set on EM, and can't get a residency slot, I'd argue that perhaps going the FM route and then working in an ER. Of course, this is contingent on being content with working in areas commonly viewed at as less desirable or boonies....And there is the risk that certain groups may try and eventually phase you out....

This is probably a last resort-type of option. But if you REALLY want to work in the ER....

 

[Belleza156]

I have posted my stats on here before. But just to let you know how difficult it is for anyone with deficits on their app...

- AMG
- 1st year - C's & B's
- 2nd year - more B's than A's
- 3rd year - more A's than B's
- 4th year - all A's
- Step 1 - failed first attempt, scored just below you on 2nd attempt
- Step 2 - scored just below you
- No home EM program
- Did 2 aways (GWU & SUNY Downstate), did good
- Last year (as a US senior) - applied to every single EM program, 5 interviews, didn't match
- Applied to prelim IM as back up, matched
- As an intern this year, got an early EM rotation with the program at my hospital - did really well, got letters
- Busted my ass to do well in my IM program, PD wrote glowing rec
- Applied to every program again. This time I added some EM/IM but not all.
- Got 6 interviews, including 1 EM/IM
- "Sorry, you did not match."

Now I'm waiting it out for SOAP.

There are ways that your app will be "better" than mine, but in other ways won't be. For instance, IMG vs AMG and the fact that you didn't fail step but your scores aren't really high enough for an IMG.

Now that it's over, it would be easy to say I would have done things differently. If I would have just went for IM initially, I'd likely have ended up in a pretty decent place, which may not happen now. But even knowing this outcome I couldn't have done anything but what I did. I had to take all the chances because EM is what I love.

I guess what I'm saying is, I think it's highly unlikely that you will match in EM. But how hard are you willing to try, and how do you feel about the options if it doesn't work out?

When you say you applied to ALL the programs....are you being literal? That's 161 programs...how much $$$$ was that in ERAS? Based on your stats you are an average (ie not stellar, but not failing either) AMG who failed step 1.....I don't see why you only got 5-6 interviews? Yes failing step 1 is a deterrent but I didn't think it was such a roadblock. I'm confused, I thought EM was not really competitive compared to other residencies.....did things change?

How many EM spots were left open after the match ?

 

[racerwad]

When you say you applied to ALL the programs....are you being literal? That's 161 programs...how much $$$$ was that in ERAS? Based on your stats you are an average (ie not stellar, but not failing either) AMG who failed step 1.....I don't see why you only got 5-6 interviews? Yes failing step 1 is a deterrent but I didn't think it was such a roadblock. I'm confused, I thought EM was not really competitive compared to other residencies.....did things change?

How many EM spots were left open after the match ?

This year? 3. Last year? 0.

 

[PaddyMelt]

When you say you applied to ALL the programs....are you being literal? That's 161 programs...how much $$$$ was that in ERAS? Based on your stats you are an average (ie not stellar, but not failing either) AMG who failed step 1.....I don't see why you only got 5-6 interviews? Yes failing step 1 is a deterrent but I didn't think it was such a roadblock. I'm confused, I thought EM was not really competitive compared to other residencies.....did things change?

How many EM spots were left open after the match ?

I applied to about 80 programs in 2009-2010 for EM. It was expensive and painful, but worth it when I matched.

That being said, EM has become super-competitive. Last year, there were no unmatched positions in the country. I was told by my PD that there were a total of 14 unmatched spots this year, but that number is misleading since 12 of those are in a program which didn't receive its ACGME accreditation until after the rank lists were certified. I can't confirm those numbers yet, though.

Finally, as an IMG, its super-frustrating to read someone like Hypomanics give their information and say that they actually got interviews. I had a 3.75 through my first two years, 4.0 my second two years, scored above the mean on all my steps, killed my rotations/SLORS, and only got 6 interviews. The fact that she got any interviews at all is just a testament to the ridiculous bias against American-FMG's. An IMG's application like that wouldn't make it through my program's secretary's assistant...

 

[Belleza156]

I applied to about 80 programs in 2009-2010 for EM. It was expensive and painful, but worth it when I matched.

That being said, EM has become super-competitive. Last year, there were no unmatched positions in the country. I was told by my PD that there were a total of 14 unmatched spots this year, but that number is misleading since 12 of those are in a program which didn't receive its ACGME accreditation until after the rank lists were certified. I can't confirm those numbers yet, though.

Finally, as an IMG, its super-frustrating to read someone like Hypomanics give their information and say that they actually got interviews. I had a 3.75 through my first two years, 4.0 my second two years, scored above the mean on all my steps, killed my rotations/SLORS, and only got 6 interviews. The fact that she got any interviews at all is just a testament to the ridiculous bias against American-FMG's. An IMG's application like that wouldn't make it through my program's secretary's assistant...

Ordinarily, I would probably agree with you but since things are getting so competitive I'm glad there's a preference to AMGs. I'm definitely thinking I should restructure my match strategy now after seeing this post and people's match results yesterday. Found out about 2 so far who didnt match EM, had 235+ step 1 and higher on step 2, never failed any class, did well on clerkships, never took any breaks and applied as US Senior to the match. Need to investigate further what more there is to these stories, because it just seems unbelievable that people fitting that profile didnt match. Guess now ill apply to a prelim or transitional year just in case. From the preSOAP results seems you had better odds of getting into rads than EM.

Anyone know when the NRMP data will be out for this years match?

 

[Brigade4Radiant]

Ordinarily, I would probably agree with you but since things are getting so competitive I'm glad there's a preference to AMGs. I'm definitely thinking I should restructure my match strategy now after seeing this post and people's match results yesterday. Found out about 2 so far who didnt match EM, had 235+ step 1 and higher on step 2, never failed any class, did well on clerkships, never took any breaks and applied as US Senior to the match. Need to investigate further what more there is to these stories, because it just seems unbelievable that people fitting that profile didnt match. Guess now ill apply to a prelim or transitional year just in case. From the preSOAP results seems you had better odds of getting into rads than EM.

Anyone know when the NRMP data will be out for this years match?

It comes in late July or August.

 

[nyerdoc]

Finally, as an IMG, its super-frustrating to read someone like Hypomanics give their information and say that they actually got interviews. I had a 3.75 through my first two years, 4.0 my second two years, scored above the mean on all my steps, killed my rotations/SLORS, and only got 6 interviews. The fact that she got any interviews at all is just a testament to the ridiculous bias against American-FMG's. An IMG's application like that wouldn't make it through my program's secretary's assistant...

Perhaps its because your school takes everyone that applies, takes their money, forces you to take an exam to see how you'll do on your boards prior to taking them (cuts you if you do poorly--keeps your money), preps you to take the boards (rather than teaching you medicine), gives you time off built into the curriculum to take your boards (not to mention internal grade inflation), and then sends you off to US institutions without direct affiliations with your school and expects them to do the work of turning you into physicians.

Your grades mean little compared to a US physician at an LCME school.

I'm sure you are smart and hard-working. I know a few excellent IMGs---however the prejudice in the ED community is anything but irrational.

 

[tima]

According to the 2013 NRMP data, EM filled at least 80% of positions with US seniors.

 

[SserPrun95]

US seniors meaning US MD's right?

 

[tima]

Yes.

US seniors meaning US MD's right?

 

[jbar]

Perhaps its because your school takes everyone that applies, takes their money, forces you to take an exam to see how you'll do on your boards prior to taking them (cuts you if you do poorly--keeps your money), preps you to take the boards (rather than teaching you medicine), gives you time off built into the curriculum to take your boards (not to mention internal grade inflation), and then sends you off to US institutions without direct affiliations with your school and expects them to do the work of turning you into physicians.

Your grades mean little compared to a US physician at an LCME school.

I'm sure you are smart and hard-working. I know a few excellent IMGs---however the prejudice in the ED community is anything but irrational.

I think this is why people need to be realistic when looking at medical schools. The international schools are going to tell you those stories of the guy who match in neurosurgery, but the stats say that one is much better off taking an extra year after college, doing research, retaking the MCATs and reapplying to US schools rather than going to a overseas school.

I feel bad for the IMGs, but I don't know what to tell them. I was at a residency fair awhile ago and people were asking if my program was friendly to IMGs. They are welcome to apply, some of them get interviews. But we've matched 2 in the last 4 years. It stinks but looking at it from a program's point of view, programs say "I have a stack of 60 applications of US grads coming from good schools with 240s on their boards, good letters and no red flags, who seem like normal people when we interview them, why should I take a chance on someone who went to a school the indicates there was an issue getting into US med schools, a school that I don't personally know well."

The biggest lesson i've seen is that the IMGs that my program has taken have all been people who rotated with us, because the program could say "yeah, they are an IMG, but we spent a month with them and we LOVE them." It's hard to make somewhere feel that way about you from a 4 hour interview day.

So think wisely about your rotations. Maybe it's a better idea to do an away rotation at somewhere that is a bit of a "second tier" residency where they may actually take an IMG. I know all residencies are good, but I think it's a bit of a waste of a month rotating at a "top" program that hasn't matched an IMG in 10 years. And it doesn't really matter how good your letter is from that rotation because you are competing against US grads with similarly good letters from similarly good rotations.

 

[jbar]

Finally, as an IMG, its super-frustrating to read someone like Hypomanics give their information and say that they actually got interviews. I had a 3.75 through my first two years, 4.0 my second two years, scored above the mean on all my steps, killed my rotations/SLORS, and only got 6 interviews. The fact that she got any interviews at all is just a testament to the ridiculous bias against American-FMG's. .

1: It's not how you do against the average, it's how you do against the average of people who matched in the field you are going into. In EM a few years ago the average step 1 score for people who matched was 220, quite a bit above the total average. And I'm sure it's even higher this year.

2: I don't understand why you are frustrated. Someone else had to apply to twice as many programs as you to get the same number of interviews. You matched with better scores and they didn't. So it seems the systems works.

3: You can call it bias, and it sounds like you think you are a good applicant. But almost everyone who is applying in EM got good grades, has good letters, has honors on their rotations, and has solid step 1 and 2 scores. You don't know what your SLORs say (or shouldn't, they aren't supposed to show them to you) so it's hard to compare how you really did on rotations. And remember, the above is the average. There are plenty of kids who got 250s on their boards, have 2-3 publications in med school, are coming from top schools, and have strong EM specific applications (EMS, tox, anesthesia, ultrasound elective etc).


Call it unfair, but there is no real incentive for programs to go after IMGs. And this sounds harsh but I wish more premeds really thought about this before going overseas. These med schools make a lot of money cashing in on stressed out premeds and desperate people who really want to be doctors but are struggling for whatever reason. Those schools make money by telling you "it's going to be okay, you can go into whatever field you want." But I think it does a disservice to those who have their hearts set on competitive fields. I think in the next 10 years emergency medicine is going to become more like derm or optho where there are just not enough spots for the US students who want them, let alone IMGs.

 

[RustedFox]

1: It's not how you do against the average, it's how you do against the average of people who matched in the field you are going into. In EM a few years ago the average step 1 score for people who matched was 220, quite a bit above the total average. And I'm sure it's even higher this year.

2: I don't understand why you are frustrated. Someone else had to apply to twice as many programs as you to get the same number of interviews. You matched with better scores and they didn't. So it seems the systems works.

3: You can call it bias, and it sounds like you think you are a good applicant. But almost everyone who is applying in EM got good grades, has good letters, has honors on their rotations, and has solid step 1 and 2 scores. You don't know what your SLORs say (or shouldn't, they aren't supposed to show them to you) so it's hard to compare how you really did on rotations. And remember, the above is the average. There are plenty of kids who got 250s on their boards, have 2-3 publications in med school, are coming from top schools, and have strong EM specific applications (EMS, tox, anesthesia, ultrasound elective etc).


Call it unfair, but there is no real incentive for programs to go after IMGs. And this sounds harsh but I wish more premeds really thought about this before going overseas. These med schools make a lot of money cashing in on stressed out premeds and desperate people who really want to be doctors but are struggling for whatever reason. Those schools make money by telling you "it's going to be okay, you can go into whatever field you want." But I think it does a disservice to those who have their hearts set on competitive fields. I think in the next 10 years emergency medicine is going to become more like derm or optho where there are just not enough spots for the US students who want them, let alone IMGs.

There is also no incentive for programs to go after AMGs.

A meritocracy is a meritocracy. There is bias in the selection process.

 

[la gringa]

my program has taken a few non-citizen IMG's, but never an US citizen IMG. the non-citizen IMG's had 1. great stories (think, Cuban refugee), 2. great scores and 3. great people. they also, iirc, matched into spots when the program was a 2-4 and they kept a couple of spots to give to such folks b/c the residency hospital is so international and they had good experiences w/ non-citizen IMG's.

most US citizen IMG's have something "off" w/ their app... i know a few folks who apparently chose to go to med school in India to start earlier... never understood that move.

not ALL though... i have had physicians who were US citizen IMG's who were great docs (IM and PMR/pain), but as far as a more competitive field like EM - as stated above, no reason to take the risk.

 

[la gringa]

and as far as bias - this isn't a totally "fair" process. a well-known program in my home state is NOTORIOUS for NOT interviewing "locals"...??? classmates of mine and i matched at Pitt, Cook, and Boston Medical, and none of us even got an INTERVIEW at "highly ranked community hospital".

my med school never even interviewed a DO til there were local DO schools. now they have taken a few and i guess they did well, b/c they take a couple now and then. but for YEARS... NOT ONE DO. PD said basically what was said above - i've got all of these apps, why would i take a risk w/ unknown?

 

[Lambofbob]

In terms of applications, everyone on SDN really seems to focus on numbers (steps, preclinical grades, publications, etc). Every program is different, and is looking for different things. In general, however, programs care the most about your EM rotations. Doing 2 solid EM months and getting a great SLOR is what it is all about. The grades are important, extracurriculars, etc, but the biggest thing for me is doing an EM rotation and getting consistent, solid SLORs. If you don't have EM rotations and SLORs, we have no way of comparing you to your peers.

Also, I hear people on here all the time describing "crushing my EM rotations." Or so you may think. As someone posted above, you should not have any idea what is on your SLOR. No one is supposed to show you. I have seen many residents who tell me they did great on an EM rotation, and when I see their SLORs they far from crushed it.

Finally, I always see people focused heavily on numbers as if a 250 on step 1 means you are owed a spot. you have to remember a few things. Every program is different and looking for something different. Some want researchers, some want people with a rural interest, some want locals. The bigger name schools are less likely to look at DOs and IMG's. I have seen applicants at my program who have stellar board scores, honors everything, but their EM rotations commented on social-personal interaction problems, and were so off putting/arrogant that we did not rank them. As a resident, I have to work with you closely for 3-4 years. Residency, more than anything, is about the fit of the applicant with the program. Every program that is accredited will give you solid training, so it really comes down to do you fit in to the program. Preclinical scores, step scores, and research are far from any kind of guarantee.

EM has become incredibly competitive (2 unmatched spots this year, 0 last year, I think 6 the year before). There are a ton of great applicants out there. Unfortunately not everyone is going to cut it.

 

[RustedFox]

Its not a fair process by any means. Its not a pure meritocracy, but then again, so was the process for medical school admission. If I could "redo" it all, sure... it would be a pure meritocracy. People's "story" wouldn't matter a lick. But that's just not the way it is right now.

 

[bubbles!]

Hi everyone!

I'm a US citizen IMG that studied in Costa Rica. I got a 213/90 on step 1 and a 238/86 on Step 2 CK and passed the CS on my first try....

Other than that, I was an RN in the US before going to medical school but I have no USCE as a physician or any research or publications. Ranked high in my class though...

Graduating med school at the end of this year and so I'm planning on applying to the 2014 match. Looking around these posts, it's pretty impossible for a FMG to get into EM... How true is this? I was planning on applying to 147 programs, (every program except the ones in Cali) but like I said, it's looking pretty scary. What say you?

Thanks in advance...
L.
😕

I was in a similar situation with similar-ish board scores, scored more interviews that I had imagined, and matched to my first choice.

Here's what you need:
-2 standardized letters of recommendation from two American ED electives at hospitals with an EM residency program, preferably from a program director.

-You still have time to pad your resume a bit more. Submit a case report or an interesting picture or a reflective writing article to a resident publication (both EMRA and AAEM-RSA have opportunities like this) as do most of the national conferences (ACEP, SAEM, AAEM). You could write a piece on how it feels to be an FMG entering the match and what your experience has been like. This kind of publication dedicates an interest in contributing to American Emergency Medicine.

If you do not get any interview requests right away, get on the phone and email and sell yourself, explain why you chose to attend medical school abroad, what skill sets you would bring to the residency, and why you're passionate about EM. They may be willing to give your application a second look if you market yourself well. You might even consider emailing PDs at your favorite programs prior to submitting your application to ask for advice on your personal statement. Many would be happy to advise you and give you some honest feedback and then they'll know your name and remember that you expressed interest. (Just knowing that you can spell and use grammar appropriately and be pleasant can go a looong way).

Will it take more work that for an equivalent US student, yes. Is it impossible, absolutely not.

 

[QuackaDO]

I'm actually fairly sad to read about your GPA claims because it means that people like me or at least at schools like mine are being cheated. See, where I'm at, a 4.0 is virtually IMPOSSIBLE to achieve and a 3.75 is essentially just about as impossible. Why? Because A doesn't equal 4.0, B a 3.0, and so on... EVERY SINGLE QUESTION on every single test lowers your GPA just a little. You would literally have to not miss a single question on any test for an entire year in order to get a 4.0. The math of it is confusing to me, but they take your final percentage score and multiply it and come up with your GPA, not just that you got a B so as an 80 is NOT equal to an 86 when all is said and done. It makes me REALLY sad to know that my "average" GPA will be compared against people who are not having their GPA reported the same way (simply because I absolutely do not believe you didn't miss a single question on any test your 2nd year) and that they will look superior even if we had the same grades. Oh well, such is life.

I applied to about 80 programs in 2009-2010 for EM. It was expensive and painful, but worth it when I matched.

That being said, EM has become super-competitive. Last year, there were no unmatched positions in the country. I was told by my PD that there were a total of 14 unmatched spots this year, but that number is misleading since 12 of those are in a program which didn't receive its ACGME accreditation until after the rank lists were certified. I can't confirm those numbers yet, though.

Finally, as an IMG, its super-frustrating to read someone like Hypomanics give their information and say that they actually got interviews. I had a 3.75 through my first two years, 4.0 my second two years, scored above the mean on all my steps, killed my rotations/SLORS, and only got 6 interviews. The fact that she got any interviews at all is just a testament to the ridiculous bias against American-FMG's. An IMG's application like that wouldn't make it through my program's secretary's assistant...

 

[QuackaDO]

I think nothing is more true about the process than what I bolded below. I can personally think of a few people in my class who killed the boards and they LITERALLY think that just by that they are set. Some went on to get kicked off a couple of rotations in 3rd year for attitude/personality and they think that won't come back to bite them simply because "I got a 250 something on my boards". LOL! Yes, the key is when you see these high scorers that don't match at all often times it IS because of attitude/personality. Think about it... when someone has compatibility issues they never think it's "their fault"... they identify the people that were the issue and then find someone they related well to and say "I got along well" because one person was able to tolerate them. Often times these really high scorers that don't come across well just simply don't realize that they are... well... douchey. There are a number of high scoring applicants who DO realize that boards aren't everything and those are the truly awesome candidates that are highly coveted... not just because of the scores but because they are good people. I think A LOT of people forget just how far being "good people" can get you when other things lack...

In terms of applications, everyone on SDN really seems to focus on numbers (steps, preclinical grades, publications, etc). Every program is different, and is looking for different things. In general, however, programs care the most about your EM rotations. Doing 2 solid EM months and getting a great SLOR is what it is all about. The grades are important, extracurriculars, etc, but the biggest thing for me is doing an EM rotation and getting consistent, solid SLORs. If you don't have EM rotations and SLORs, we have no way of comparing you to your peers.

Also, I hear people on here all the time describing "crushing my EM rotations." Or so you may think. As someone posted above, you should not have any idea what is on your SLOR. No one is supposed to show you. I have seen many residents who tell me they did great on an EM rotation, and when I see their SLORs they far from crushed it.

Finally, I always see people focused heavily on numbers as if a 250 on step 1 means you are owed a spot. you have to remember a few things. Every program is different and looking for something different. Some want researchers, some want people with a rural interest, some want locals. The bigger name schools are less likely to look at DOs and IMG's. I have seen applicants at my program who have stellar board scores, honors everything, but their EM rotations commented on social-personal interaction problems, and were so off putting/arrogant that we did not rank them. As a resident, I have to work with you closely for 3-4 years. Residency, more than anything, is about the fit of the applicant with the program. Every program that is accredited will give you solid training, so it really comes down to do you fit in to the program. Preclinical scores, step scores, and research are far from any kind of guarantee.

EM has become incredibly competitive (2 unmatched spots this year, 0 last year, I think 6 the year before). There are a ton of great applicants out there. Unfortunately not everyone is going to cut it.

 

[K31]

I'm actually fairly sad to read about your GPA claims because it means that people like me or at least at schools like mine are being cheated. See, where I'm at, a 4.0 is virtually IMPOSSIBLE to achieve and a 3.75 is essentially just about as impossible. Why? Because A doesn't equal 4.0, B a 3.0, and so on... EVERY SINGLE QUESTION on every single test lowers your GPA just a little. You would literally have to not miss a single question on any test for an entire year in order to get a 4.0. The math of it is confusing to me, but they take your final percentage score and multiply it and come up with your GPA, not just that you got a B so as an 80 is NOT equal to an 86 when all is said and done. It makes me REALLY sad to know that my "average" GPA will be compared against people who are not having their GPA reported the same way (simply because I absolutely do not believe you didn't miss a single question on any test your 2nd year) and that they will look superior even if we had the same grades. Oh well, such is life.

This is EM, not derm or integrated plastics. Nobody cares what your preclinical grades are like as long as you didn't fail any courses or have to repeat a year.