Need an expert opinion

[zasokyam]

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First of all, this is a throw-away account for various reasons
Second of all, I need a brutal honest reality check and brutal honest solid advice, no sugar coating.

Now my story. I am an IMG who has applied to IM this year. I graduated last year December, and am ECFMG certified. My scores aren't stellar, 220-230 and 210-220. I applied to 80 odd programs, and have not been offered even a single invite, which isn't what I was expecting at all. I don't have any published research and the research that I did, I don't think is of the caliber of American grads/student. It wasn't a lab research, no mice, no genomes etc. Nothing advanced. It was based on cross sectional survey of a section of population recording their predisposition to a communicable disease (certain details omitted) at certain point in time when the danger of setting off the chain of transmission was real. Other than that, I did a 1 month elective at a University Hospital when I was in US for the CS. The attendings and fellows there told me that they really liked me and that I was at least as competent if not better than american students and way better than other International students that rotate there. That rotation got me 3 LoRs from them, all of them waived, so I don't know whats written inside.

I also feel I should mention that I belong to a middle class income household of a third world country where currently there is a global conflict (I am not too proud of naming that country, but you get the idea). Which means dolling out money is a real problem for me. Why I chose to pursue USMLE pathway was because the future of this region is extremely bleak and the healthsystem is clogged. I have no political backup, which is almost the basic way to survive out here, since I am as middle class as it gets. I took a gamble and thought if it pays, I start a new life. So I took the Step 1 while I was still a student, just as American med students do, unlike many other IMGs and followed the suit with CK.

Now my questions;
1) Are there any suggestions I can leech a few interviews this year?
2) Since I've been told that older your graduation date gets, the slimmer become your chances of getting in. So would it be worth leaving the USMLE Pathway altogether, and move on? I know I can't change my scores or medical school or the fact that I am an alien, but what points could realistically speaking improve my application if I choose to apply next year. Also, I have in mind the fact that enrollment in US schools is on the rise and residency slots are more or less the same, so next year wouldn't be "easier" than this year.
I welcome any other comment overall
Thank you all, for reading this long rant. Geez, this felt good.

 

[septoplasty]

I also feel I should mention that I belong to a middle class income household of a third world country where currently there is a global conflict (I am not too proud of naming that country, but you get the idea). Which means dolling out money is a real problem for me. Why I chose to pursue USMLE pathway was because the future of this region is extremely bleak and the healthsystem is clogged. I have no political backup, which is almost the basic way to survive out here, since I am as middle class as it gets. So I took the Step 1 while I was still a student, just as American med students do, unlike many other IMGs and followed the suit with CK.

Based on numerous threads around SDN, sob stories don't go too well.

Also, the thing that's also making you less competitive is the fact that you don't have clinical experience in the US as compared to US IMGs who have 2 years worth. I think, that and the fact you need a visa.

There are tons of people with better CV's than yours who meet the above two who PD's can pick from, so why should they pick you?

Try and improve those (obviously you can't improve the visa situation, but you can fix the clinical experience). Lets see what others suggest.

 

[shan564]

Based on numerous threads around SDN, sob stories don't go too well.

Agreed, but I think his intention was to point out the fact that he doesn't have the funds to apply repeatedly (rather than to get empathy for his sob story).

Also, the thing that's also making you less competitive is the fact that you don't have clinical experience in the US as compared to US IMGs who have 2 years worth. I think, that and the fact you need a visa.

There are tons of people with better CV's than yours who meet the above two who PD's can pick from, so why should they pick you?

Try and improve those (obviously you can't improve the visa situation, but you can fix the clinical experience). Lets see what others suggest.

Also agreed. I think that the most important thing for you is to get more US clinical experience. Your LORs are much less meaningful if they all come from the same place over a one-month period... anybody can suck it up and work super-hard for a month, and I think PDs would like to see a bit more diversity in your LORs.

Your CK score is also hurting you. Most people score ~10 points higher on CK, so since your score dropped, a PD might be concerned about your chances of passing Step 3. So I'd think that it might help if you do well on Step 3 also.


I can't tell you what you should do with your money, but I don't think you need to give up. Still, it can be a long road if you have below-average Step scores, although you could think about applying to family medicine.

 

[Sheldor]

Agreed, but I think his intention was to point out the fact that he doesn't have the funds to apply repeatedly (rather than to get empathy for his sob story).


Also agreed. I think that the most important thing for you is to get more US clinical experience. Your LORs are much less meaningful if they all come from the same place over a one-month period... anybody can suck it up and work super-hard for a month, and I think PDs would like to see a bit more diversity in your LORs.

Your CK score is also hurting you. Most people score ~10 points higher on CK, so since your score dropped, a PD might be concerned about your chances of passing Step 3. So I'd think that it might help if you do well on Step 3 also.


I can't tell you what you should do with your money, but I don't think you need to give up. Still, it can be a long road if you have below-average Step scores, although you could think about applying to family medicine.

I know an IMG personally who got 3 interviews one year with a package similar to yours and didn't match. Took Step 3 and got a couple more months of US clinical experience and this cycle he is up to 14 interviews. I think its mostly the Step 3 since he also went down on Step 2, but those two things are the only changes they made.

Good luck!

 

[picasso777]

Thank you all for taking the time to comment and express your opinions. I understand that the biggest handicap is the visa, and CK score. Thank you for pointing out that one month of clinical experience does not count much. Now, it's not like I don't have clinical experience at all. I mean all medical schools require students to have mandatory core and clinical clerkships and electives in tertiary level teaching hospitals where you act as a medical student or a sub intern. So I have those. I believe that should count for something. In addition, the opportunities for gaining hands-on clinical experience for a graduate in US are next to none. There are observership that the general consensus on SDN describes as "useless clinical experience". Besides, that would mean a program would prefer a relatively older graduate over a fresh out of the school graduate with good performance on the single chance he had to work in the US health care setup implying his ability to adopt.
The case with Caribbean IMGs is different as they have their core clerkships in US for various reasons. So there is no comparison at all. Also for Indian IMGs, they get their diploma after a year of internship and not after passing their last year of curriculum at medical school. So a lot of them would take 6 months of elective in their internship year after taking a leave from the internship duties. So, there isn't much homogeneity when it comes to clinical experience and IMGs.
This post is not meant to fight the system or to belittle the points you all raised. This is for the sake of understanding, my own understanding.
I would appreciate any input. Thanks.

 

[DocBlin]

There is ALWAYS hope, that is why you need to keep trying. In my son's personal experience, you need to make your self stand out from other applicants. He graduated May 2010, 90% STEP I, 85% STEP II, passed CS, applied for 2010 match FM (50 programs), Prelim Surg. (20 programs). Interviewed at 3 (2 FM, 1 Prelim. Surg) Matched Prelim Surg. Worked his ass off in 1st year Surg. Was offered CAT SURG. but he wanted FM. So for 2011 match applied 20 FM, interviewed at 5, pre matched at 3, chose the prematch he wanted. To me the 1 year of a hard Gen Surg program was the game changer plus the LOR from the Surg PD, attendings about 3 or 4. Now in the mid of second year FM, he is resident liaison for his program, most likely be administrative chief resident in 4 months. Has passed STEP III, applied for license in 3 states. So my point is never give up.

 

[shan564]

Thank you all for taking the time to comment and express your opinions. I understand that the biggest handicap is the visa, and CK score. Thank you for pointing out that one month of clinical experience does not count much. Now, it's not like I don't have clinical experience at all. I mean all medical schools require students to have mandatory core and clinical clerkships and electives in tertiary level teaching hospitals where you act as a medical student or a sub intern. So I have those. I believe that should count for something. In addition, the opportunities for gaining hands-on clinical experience for a graduate in US are next to none. There are observership that the general consensus on SDN describes as "useless clinical experience". Besides, that would mean a program would prefer a relatively older graduate over a fresh out of the school graduate with good performance on the single chance he had to work in the US health care setup implying his ability to adopt.
The case with Caribbean IMGs is different as they have their core clerkships in US for various reasons. So there is no comparison at all. Also for Indian IMGs, they get their diploma after a year of internship and not after passing their last year of curriculum at medical school. So a lot of them would take 6 months of elective in their internship year after taking a leave from the internship duties. So, there isn't much homogeneity when it comes to clinical experience and IMGs.
This post is not meant to fight the system or to belittle the points you all raised. This is for the sake of understanding, my own understanding.
I would appreciate any input. Thanks.

You're right that there are a lot of paradoxes in the issue of clinical experience, but unfortunately, that's the situation. The PDs aren't trying to do you any favors... they just want to be sure that you're a good candidate, and the best way to do that is to get LORs from attendings at several different rotations. It's up to you to decide whether or not that's feasible for you.

Also, Step 3 makes a big difference if you need a visa. I'm not sure of the details of the visa process, but I'm under the impression that Step 3 somehow helps.

I'm not sure where you're from, but you might also consider trying to tap in to the network of alumni at your school who are now in the US.

 

[picasso777]

Step3=eligible for H1b if the program sponsors that.

 

[Andreji]

Actually as a J1 holder I think step 3 can be an impediment for many reasons. Of course, if you're pursuing H1 visa (and therefore most likely wanna stay here in the end) it's the only choice. however my thoughts are:

-Pursuing an H1b spot narrows your field extremely. and it's the same game when you reapply for fellowship, whereas J1 is sponsored by the ECFMG, and they sort of have a 'carte blanche' to sponsor as many as desired. and many excellent programs in all specialties do take J1 holders, as opposed to H1.
-Taking step 3 before applications for the sake of improving may backfire, if you aren't confident your scores will be at least as good (if step 1 and 2 were good) or much better (if 1 or 2 were poor). many people rush and get poor scores...which will count towards your application. this certainly is not the case in the rather pleasant pass/fail scenario for step 3 once you match.
-Not sure about this, but I think having a step 3 for applications could have programs 'profile' you a bit. why'd he take step 3? is he here to pursue residency for the sake of greencard or is he passionate about his specialty? i'll let others comment on that one.

 

[picasso777]

Ignore me

 

[splik]

Actually as a J1 holder I think step 3 can be an impediment for many reasons. Of course, if you're pursuing H1 visa (and therefore most likely wanna stay here in the end) it's the only choice. however my thoughts are:

-Pursuing an H1b spot narrows your field extremely. and it's the same game when you reapply for fellowship, whereas J1 is sponsored by the ECFMG, and they sort of have a 'carte blanche' to sponsor as many as desired. and many excellent programs in all specialties do take J1 holders, as opposed to H1.
-Taking step 3 before applications for the sake of improving may backfire, if you aren't confident your scores will be at least as good (if step 1 and 2 were good) or much better (if 1 or 2 were poor). many people rush and get poor scores...which will count towards your application. this certainly is not the case in the rather pleasant pass/fail scenario for step 3 once you match.
-Not sure about this, but I think having a step 3 for applications could have programs 'profile' you a bit. why'd he take step 3? is he here to pursue residency for the sake of greencard or is he passionate about his specialty? i'll let others comment on that one.

Um... you can always change from H1b to J1 for fellowship if need be so doesn't make a difference there. Obviously there are few programs that sponsor visas but you can always have others as fall backs. As for your step 3 score, no one cares, just that you pass. Because most people don't have it, it is not generally used to compare applicants unlike step 1 and 2, so no one cares how you do. obviously it looks bad if you fail. Quite frankly the stuff about people thinking someone is pursuing residency for a greencard is nonsense! It would be easier to marry a US citizen! If programs really want you, and the GME office can be twisted to sponsor, then H1B is the way to go. Hell, one program even offered to sponsor a green card for me (but in an aggressive, "no one else will" sort of way)