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My success story as a US-IMG applying for cardiology

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Egghead34

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Hello,
I’m writing this for fellow US IMGs who dream of matching into cardiology. Having now successfully matched, I wanted to share my experiences with the murky and labyrinthine process of the specialty match. Perhaps reading this can bring you some direction or clarity where I had none.
I went to one of the “big four” Caribbean medical schools. As a medical student I was unremarkable, without notable extracurriculars. I flunked a class my first semester and had to repeat it, then went on to get high B’s and low A’s as my remaining marks. I graduated in the middle of my class without special accolades or recognition, and matched into my 8th choice FM residency. Yes, you read correctly. Family medicine.
6 months into FM I had a change of heart and decided to try and subspecialize. To that end I reentered the match, got 1 interview, failed to match, and successfully scrambled into the one program that reached out to me. This is a small, community program of little repute, but in a big city surrounded by major academic centers.
As a resident I was excellent, and declared early on that I was interested in cardiology. I had the full support of my cards attendings and PD, though they themselves had no real pull or connections in the small world of cardiology. Yes, nepotism is alive and well in such a tight-knit field. I presented posters every year at our local ACGME competitions. I also presented grand rounds and M&M at our hospital, but nothing broader.
My third year I was chief resident and applied for cards. I got three interviews, all three from which I had great vibes. Didn’t match, which was crushing. I threw my hat into the ring for unmatched spots and didn’t get a single response. Dejected, I sought an unaccredited fellowship spot and again didn’t match. Through sheer happenstance, I had made friends with one of the head doctors of a nearby major academic center (like, top 3 nationwide in reputation) who hooked me up with a job as a cardiology hospitalist.
With this feather in my cap I reapplied to cards, got 5 interviews (1 major university center, 4 reputable community hospitals). The cardiology attendings with whom I comanaged patients wrote emails of support to my top choice, but not formal letters of recommendation. A few months later and here we are, having matched into my second pick: an excellent, reputable community hospital.

In summary:
US-IMG
Med School Grades: mediocre, failed a class. Graduated 2015. Did a year of FM before rematching into IM
USMLE Scores: first pass on everything. Step 1 mid 220’s, Step 2 CK low 230’s, Step 3 high 220’s
IM Residency: excelled, strong LOR from people with no pull. Chief resident. Lowish-tier community hospital that accepts mostly IMGs.
Research: none!
Posters/Oral presentations: 4 posters at non-cardiology conferences. Gave 1 GR and 1 MM at my hospital
Other CV stuff: cardiology hospitalist at top 3 institution, started a number of cardiology initiatives while in residency (EKG teaching, bedside US curriculum, ran code simulations)
Match #1 (failed): 3 interviews at all low-tier community hospitals
Match #2 (success): 5 interviews, 1 university, 4 mid-tier community hospitals. Matched at a large community hospital.
Difference between matches: 2 more poster presentations, completed year of chief, currently cards hospitalist.
Intangibles: my personal statement was commented by everyone as being captivating, honest, and moving. Having done a cards attending year also made me more interesting, as I actually had something concrete to talk about during interviews that caught peoples’ attention rather than just “I love cardiology because it’s great”! I also think I interviewed well, and though I had no personal connections to the program into which I matched I do have family nearby (which they brought up several times on our interview day). I'm also married with children. It seemed to matter, and was a topic that always made for good conversation on interviews. In the [paraphrased] words of Alec Baldwin from The Departed, "Marriage is an important part of getting ahead...A married guy seems more stable. People see the ring, they think ‘at least somebody can stand the son of a bitch.’"

Final thoughts:
  • Had I not matched, I think I would’ve called it quits. Too emotionally draining, too expensive. I applied to ~120 programs each time. I know a few people with more impressive CVs who took 3 and even 4 times before matching. I guess know thyself.
  • You really need something to make you interesting. I was such a good resident, but everybody on the interview trail is as well. And everyone is a chief. And everyone has research.
  • Research…I was honest and told them I had none. It did come up a lot, but I always redirected the subject into my work in QI and teaching initiatives. Probably would’ve helped a lot
  • My board scores are weakish for the average applicant. With better score and more publications would I have matched? I dunno, probably yes my first time around. Probably more interview offers too
  • The majority of the advice on the website, especially with “what are my chances” topics, are complete garbage. Nobody knows how this works.
  • I had a resident at the major academic institution where I work tell me he knew where he would match. When I asked how he knew he became awkward (maybe he realized I wasn’t in on the wink-wink, untold secret) and changed the subject. Gave me a strong sensation that, while pre-match arrangements behind closed doors are a violation of rules, that they must happen all the time amongst high tier candidates and institutions.
  • Nepotism is alive and well! Had I had more connections through attendings, I feel as if I would’ve gotten more interviews or matched earlier.
  • I am SO glad to be done with this. Literally counted down the hours and minutes for the last 2 weeks waiting on match day. Feels good man
Again, these are my personal experiences. Make of them what you will, but know that there is hope out there for us degenerate IMGs. I'm happy to answer questions that don't reveal too much personal information, though I'm sure some people will know who I am by what I've written. For you other success stories, feel free to share too and help our fellow applicants. Happy matching!
 
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Phospholipid

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Congrats. I am also similar in yr shoes, USIMG, SGU grad, nothing special, but I was fortunate to match my first time.
I also matched at a mediocre IM program with nobody really that has any pull in Cardiology. I immediately realized this early, thus did not invest excess time to "suck up" to my in house Cardiologist. I made connections with attendings at university programs, worked my butt off outside of residency, and was able to match.
In summary, connections is huge, Cardiology though is a large field, you'd be surprised who knows who. If you are in a program that does not have any connections, reach out and get outside of yr program. Doesn't help to be the best resident of a program that nobody in Cardiology knows. You'd probably get better chance being a terrible resident with tons of connections than a best ever resident with no connection. Just my 2 cents.
 
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Ogbuefi

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Congrats. I am also similar in yr shoes, USIMG, SGU grad, nothing special, but I was fortunate to match my first time.
I also matched at a mediocre IM program with nobody really that has any pull in Cardiology. I immediately realized this early, thus did not invest excess time to "suck up" to my in house Cardiologist. I made connections with attendings at university programs, worked my butt off outside of residency, and was able to match.
In summary, connections is huge, Cardiology though is a large field, you'd be surprised who knows who. If you are in a program that does not have any connections, reach out and get outside of yr program. Doesn't help to be the best resident of a program that nobody in Cardiology knows. You'd probably get better chance being a terrible resident with tons of connections than a best ever resident with no connection. Just my 2 cents.

Thanks for sharing. If you are in a mediocre program, how do you make connections? Through outside electives?
 
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drrambo

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great story I m glad you are following your dreams.
 
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