Not sure if I want to do Surgical training in the US

[greatsaphenousv]

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I have a question to which some of you can give me some input. Lets assume that I do not match into integrated VS, but given my interview offers and stats, Im sure I will match into a categorical surgical program somewhere, should I accept it or return to England and complete a houseman-ship there in England, and thereafter do surgical training there with a surgical program under the Royal College of Surgeons?

I am very worried/scared about how my performance will be as a PGY 1 in an American surgical program. The surgery rotation that American graduates do in their third and fourth year of medical school is far more rigorous than what we what do in Britain for our surgical wards as medical students. A Houseman-ship, which is certainly more rigorous than a 3rd year American med grad workload and responsibility, I have heard however it is not even comparable to the workload and responsibilities of a PGY 1 resident in an American program. I know that entering a surgical program as a PGY 1 without having complete a houseman ship position, surrounded by fellow American graduates, that I will start off with a deep learning curve and behind in both practical and knowledge skills as compared to my American counterparts. Im worried that it may take too much time/become to late to meet the surgical residency expectations and may result in my dismissal from a surgery program. Is this a OCD concern or a realistic concern I should have?

With doing surgical training in Britain, I am very sure that I will do just fine as my British counterparts will come into the first year of training with the same level of knowledge and practical skills as I currently have and the playing ground will be equal. Also I have heard horror stories about how long the working hours are in an American surgical program, as compared to a British surgical program which worries me as well.

However, my ultimate goal is to practice in the US as a VS. I'm very confused on where I want to next year around this time, so any input any of you all may have would be helpful

 

[stronghold]

That's correct. American residency is more brutal than other places in Europe and the whole world. Almost all IMGs found it difficult at first couple of months in US residency. Given the different system they came from and less working ours they used to work. However, most of them coped with that and improved to be paralled to their peers in residency, but there are few of them who could not improve and their contracts were not renewed.
Since your ultimate goal to practise in US, you should do residency in US to be board eligible. You can NOT be board eligible/ certified without doing reidency in US, even if you completed a residency somewhere else.

 

[greatsaphenousv]

That's correct. American residency is more brutal than other places in Europe and the whole world. Almost all IMGs found it difficult at first couple of months in US residency. Given the different system they came from and less working ours they used to work. However, most of them coped with that and improved to be paralled to their peers in residency, but there are few of them who could not improve and their contracts were not renewed.
Since your ultimate goal to practise in US, you should do residency in US to be board eligible. You can NOT be board eligible/ certified without doing reidency in US, even if you completed a residency somewhere else.

If I get an integrated VS spot, that I simply cannot turn down and the potential advantages slightly outweigh the disadvantages of things such as contract not being renewed. But since no one can be sure of matching into VS, GS has to be considered. And the potential downfall is a realistic possibility (contract not being renewed, not being able to get a VS fellowship, losing out on opportunities in the UK). What usually is a time to celebrate for most prospective residency applicants, has all of a sudden for me become a stressful and slightly fearful for the future experience 🙁

Is it not at all possible to do surgical training in a Royal College Program of the UK, and then try do a fellowship in VS in the US, and be able to practice in the US afterwards being a US Citizen? Some people have suggested I look into that, since the American College of Surgeons looks very highly upon the Royal College of Surgeons of the UK

 

[stronghold]

What I meant with contract renewal that even if the residency is 5 years, the contract is renewed each year. The NRMP commitmant is just for the first year.
Regarding your question: even if you do a US fellowship after an international residency, you will not be eligible to set for boards, regardless of your citizenship. Most international graduates who do US fellowships after completing international residency, usually return back to practise in their countries.
However, you can get an institutional work permit to practise without completing US residency, but you will never get a state license or be board eligible. In addition to less salary and job offers because malpractice insurance companies are not happy to cover non board eligible physicians.

My advice is go for interviews and you will get VS. In case you did not, you would match in VS fellowship. Few extra years by conpleting GS is not a problem.
IMGs pray to get just ab interview from one of those institutions.
Go for your interviews!

 

[greatsaphenousv]

What I meant with contract renewal that even if the residency is 5 years, the contract is renewed each year. The NRMP commitmant is just for the first year.
Regarding your question: even if you do a US fellowship after an international residency, you will not be eligible to set for boards, regardless of your citizenship. Most international graduates who do US fellowships after completing international residency, usually return back to practise in their countries.
However, you can get an institutional work permit to practise without completing US residency, but you will never get a state license or be board eligible. In addition to less salary and job offers because malpractice insurance companies are not happy to cover non board eligible physicians.

My advice is go for interviews and you will get VS. In case you did not, you would match in VS fellowship. Few extra years by conpleting GS is not a problem.
IMGs pray to get just ab interview from one of those institutions.
Go for your interviews!

oh of course I'm going to the interviews. And the institutional work permit is exactly what I was thinking of. Generally how difficult are those to obtain? I understand it would result in lower salaries and job offers but Im OK with that. I'm just worried all this airfare and time I am spending may not be worthwhile at the end, if I end up choosing to stay in the UK because I know I simply would nowhere near as anxious joining a housemanship position and then a surgery training program in the UK as compared to joining a US surgery program. thanks for your input. 🙂

 

[Miami_med]

Since no one is willing to say it, I'll just come out and say it. Your head is entirely in the wrong place. If what you want is to become a vascular surgeon in the US, the best way to do that is to train in the US. The systems are not that comparable. The training is not just different in terms of work hours, but in terms of styles of practice. If you want it, work hard for it and do what you need to do. If not, that's fine, but expecting some institution to get a special permit for you to come work there at reduced pay after you complete a non-traditional approach is a little crazy as a primary strategy. If you want to work here, come here. If you want to work there, train there. US residency is done successfully every day. Our training may be more intense than some, but we honestly work less now than many of our latin american or indian counterparts. You'll be fine if you dedicate yourself, but you have to want to put in the work. Fear is not an effective strategy.

 

[Winged Scapula]

Since no one is willing to say it, I'll just come out and say it. Your head is entirely in the wrong place. If what you want is to become a vascular surgeon in the US, the best way to do that is to train in the US. The systems are not that comparable. The training is not just different in terms of work hours, but in terms of styles of practice. If you want it, work hard for it and do what you need to do. If not, that's fine, but expecting some institution to get a special permit for you to come work there at reduced pay after you complete a non-traditional approach is a little crazy as a primary strategy. If you want to work here, come here. If you want to work there, train there. US residency is done successfully every day. Our training may be more intense than some, but we honestly work less now than many of our latin american or indian counterparts. You'll be fine if you dedicate yourself, but you have to want to put in the work. Fear is not an effective strategy.

Bravo.

The OP would hardly be the first foreign trained medical student to get into a US surgical residency program and many of us have survived and even finished successfully.

The facts are:

1) despite what you may have heard about how the ABS "feels"/regards the Royal College, they have not approved Royal College training or FRCS membership for anything other than the "possibility" of approving up to 2 years of training. This process requires you to be in a US surgical residency training program and for your program to apply for that waiver.

2) you will not be Board Eligible or Board Certified without doing a US surgical residency at this time

3) without being BE/BC you will find it difficult to find employment or malpractice insurance

4) without US residency training (generally a minimum of 3 years for IMGs), you can only obtain an institutional medical license

5) these facts do not change because you are a US citizen

6) if you want to be a surgeon in the US, your best chance is via a US surgical residency

7) fear is not an effective strategy.

If you want to work here, then you need to train here. If you can't hack it, then move on to Plan B. You will be behind in many aspects when you start residency simply because you haven't had the same US hospital experience as your colleagues, I speak from experience. But it is possible to learn and do well in training here. You just have to work harder.

I have no idea whether you'll find a US position and if so, whether you'll thrive. But to assume that you'll fail is setting yourself up for said failure and may I say, very un-surgeon like.

 

[mimelim]

100% in agreement with the two posts above me. If you want to practice here, train here. The GS + fellowship route is a great way to get into vascular.

 

[Perhaps]

hi gsv, so i think that while training may be more rigorous, my two cents are as follows:
1. instead of being afraid of the workload, looking at it as an immersion experience that affords you great open surgical experience and will make you an excellent surgeon is a better perspective imho
2. you keep saying 'if i get in and i decide to go to the residency program', as if you are considering matching and then NOT going to a program. if you do that, you will be violating the match rules, and cannot participate in the US NRMP/match for at least 3 years if i am correct. it is extremely poor form and you may be remembered (definitely will be by the program you nix) and it may be difficult for you to return to the US in a reputable academic center with that on your record. its pretty dishonorable to break match rules and leave a program hanging like that. additionally, vascular is such a small field that the program may let other program directors know about it and that would further darken your prospects of ever getting a job here.
3. just for your protection, since we all know you're from manchester (which will make it really easy to find you on the interview trail) i wouldnt post these kinds of comments on SDN which may be read by residency program directors. if they read that "the manchester candidate" is 'afraid' of rigorous training they may have a negative impression of you and it'd be a real waste of your interview money.

 

[Perhaps]

Bravo.

The OP would hardly be the first foreign trained medical student to get into a US surgical residency program and many of us have survived and even finished successfully.

The facts are:

1) despite what you may have heard about how the ABS "feels"/regards the Royal College, they have not approved Royal College training or FRCS membership for anything other than the "possibility" of approving up to 2 years of training. This process requires you to be in a US surgical residency training program and for your program to apply for that waiver.

2) you will not be Board Eligible or Board Certified without doing a US surgical residency at this time

3) without being BE/BC you will find it difficult to find employment or malpractice insurance

4) without US residency training (generally a minimum of 3 years for IMGs), you can only obtain an institutional medical license

5) these facts do not change because you are a US citizen

6) if you want to be a surgeon in the US, your best chance is via a US surgical residency

7) fear is not an effective strategy.

If you want to work here, then you need to train here. If you can't hack it, then move on to Plan B. You will be behind in many aspects when you start residency simply because you haven't had the same US hospital experience as your colleagues, I speak from experience. But it is possible to learn and do well in training here. You just have to work harder.

I have no idea whether you'll find a US position and if so, whether you'll thrive. But to assume that you'll fail is setting yourself up for said failure and may I say, very un-surgeon like.

very well put. 👍 i just came back from (recovering) from a GS interview where i was pimped for 30 minutes on medical knowledge, followed by a question on how i plan to 'balance family with residency' . fear was not an effective strategy.

 

[Perhaps]

If I get an integrated VS spot, that I simply cannot turn down and the potential advantages slightly outweigh the disadvantages of things such as contract not being renewed. But since no one can be sure of matching into VS, GS has to be considered. And the potential downfall is a realistic possibility (contract not being renewed, not being able to get a VS fellowship, losing out on opportunities in the UK). What usually is a time to celebrate for most prospective residency applicants, has all of a sudden for me become a stressful and slightly fearful for the future experience 🙁

Is it not at all possible to do surgical training in a Royal College Program of the UK, and then try do a fellowship in VS in the US, and be able to practice in the US afterwards being a US Citizen? Some people have suggested I look into that, since the American College of Surgeons looks very highly upon the Royal College of Surgeons of the UK

just to add, it is also stressful for US grads although i can imagine it must have many additional stresses for you. i do have a good number of vascular interviews and some GS interviews as well, but honestly, between the cost of interviewing and med school financial aid keeping us on a tight leash, plus the fact that my medical school actually makes us take rotations all of fourth year, it hasn't been easy either (plus taking step 2 CS and CK, admittedly CK easier) with all this going on. its not necessarily a time for celebration until we open our match envelopes, so you have a healthy cohort of similarly worried students.

 

[greatsaphenousv]

hi gsv, so i think that while training may be more rigorous, my two cents are as follows:
1. instead of being afraid of the workload, looking at it as an immersion experience that affords you great open surgical experience and will make you an excellent surgeon is a better perspective imho
2. you keep saying 'if i get in and i decide to go to the residency program', as if you are considering matching and then NOT going to a program. if you do that, you will be violating the match rules, and cannot participate in the US NRMP/match for at least 3 years if i am correct. it is extremely poor form and you may be remembered (definitely will be by the program you nix) and it may be difficult for you to return to the US in a reputable academic center with that on your record. its pretty dishonorable to break match rules and leave a program hanging like that. additionally, vascular is such a small field that the program may let other program directors know about it and that would further darken your prospects of ever getting a job here.
3. just for your protection, since we all know you're from manchester (which will make it really easy to find you on the interview trail) i wouldnt post these kinds of comments on SDN which may be read by residency program directors. if they read that "the manchester candidate" is 'afraid' of rigorous training they may have a negative impression of you and it'd be a real waste of your interview money.

My understanding was that that the program you match into, is where you will go for that year, and will not try to get into another program (such as out of the match) or anything like that with any other program in the US. And I totally agree with that. but I'm also applying to housemanship positions in the UK, so would it be considered a match violation that assuming I get matched to a US program, I say no and accept a housemanship position in the UK? Its not like I'm joining another American program. If thats the case, after finishing up the interviews, I decide I want to stay in the UK, then I may a few days before the deadline in which all applicants have to submit the rank list, tell the programs that I'm withdrawing my application from consideration as I have decided to stay in the UK. Then that should not be a match violation.

 

[Smurfette]

If you match and don't go to the program, it is considered a match violation. So you would have to withdraw from the match if you decide to take the housemanship.

 

[Pir8DeacDoc]

Don't take this the wrong way and with my sincerest apologies to the female members of the forum because it's just a figure of speech:

It's time to man up. Starting residency is stressful for everyone. You can tip toe around this anyway you want but you're being a huge wimp.

 

[Buzz Me]

but I'm also applying to housemanship positions in the UK, so would it be considered a match violation that assuming I get matched to a US program, I say no and accept a housemanship position in the UK? Its not like I'm joining another American program.

It's a Match violation if you matched into a residency spot and then decided not to take it. Your program director would (rightfully) be upset not because you're going to another American program, but because you'd be leaving him/her in a bind with an empty spot and very little time to fill it.

 

[greatsaphenousv]

I bought the Kaplan Lecture Notes and Master the Boards by Conrad Fischer for step 3 in September and have been studying for this exam in my time off and plan to complete step 3 right after graduation and before beginning residency.

Will having completed Step 3 before residency make residency slightly easier as I will not have to be worried about studying for Step 3, and can focus on the in service exams in Surgery? And seeing there are many attendings and residents on this forum, I wanted your personal advice.

From what I've heard, many American medical students when studying for their "shelf exams" on clinical clerkships go much more into detail than what Step 2 tests, as the shelf exams are much more detail oriented. But I did not take any shelf exams, but did well on Step 2 and hope to do well on step 3. Is the knowledge that I obtained from studying for these exams going to put me in an equal standing when residency starts as compared to my american counterparts purely knowledge wise? Also, I have barely had any anatomy practicals. Most american medical schools do dissection in their first years. However, here in Manchester when we took anatomy, we just used prosections and the dissections were very neatly done by faculty. And during my rotation in surgical wards, I did not pick up a scalpel and cut or anything. Will the lack of practical experience be a severe disadvantage, and if so, can it be learned fast enough?

As you maybe able to tell, I'm far more worried about my lack of practical experience as compared to my theory knowledge, and is a large factor why I'm debating if I want to do surgical training in the US. In the UK, I know that my level of medical knowledge is a lot more than most of my English medical student counterparts, and our practical experiences coming into housemanship and postgraduate training will be equal. So my chance of succeeding are far better training in an English program, when looking at it from this perspective.

btw I am 24 and having met some fellow applicants, many of whom were accomplished surgeons in their home countries, and now interviewing at US surgery programs makes me slightly worried to say the least about my performance in a surgical program in the US. Surgical program training is restricted in the UK now to mostly EU citizens, so there are barely any people who are coming from lets say Japan or India who are surgeons all ready trying for surgical programs in the UK

 

[Pir8DeacDoc]

You may want to consider ativan..... 🙂

Relax dude. You are making me nervous and I'm not a nervous type. Residency is bad but I can tell you the rules and restrictions have made it way more humane and do-able than it used to be.

 

[Winged Scapula]

Will having completed Step 3 before residency make residency slightly easier as I will not have to be worried about studying for Step 3, and can focus on the in service exams in Surgery?

Step 3 is not a difficult examination for most US residents, even those of us trained abroad. IMHO most surgical residents don't give it much thought or worry, even though there is hardly any surgical content on the examination. I don't think it will make a significant difference either way, but getting it out of the way would be nice.

From what I've heard, many American medical students when studying for their "shelf exams" on clinical clerkships go much more into detail than what Step 2 tests, as the shelf exams are much more detail oriented. But I did not take any shelf exams, but did well on Step 2 and hope to do well on step 3. Is the knowledge that I obtained from studying for these exams going to put me in an equal standing when residency starts as compared to my american counterparts purely knowledge wise?

I thought you were worried about your clinical exposure. IMHO students educated in First World countries often have excellent theoretical knowledge.

Also, I have barely had any anatomy practicals. Most american medical schools do dissection in their first years. However, here in Manchester when we took anatomy, we just used prosections and the dissections were very neatly done by faculty.

That can be true at US medical schools as well; cadavers are expensive and many times they are prosected.

And during my rotation in surgical wards, I did not pick up a scalpel and cut or anything. Will the lack of practical experience be a severe disadvantage, and if so, can it be learned fast enough?

Most US medical students aren't wielding a scalpel either. They may suture and retract but that's generally about it in most cases. There is no way we can know if and how much disadvantage you would be at, it any at all.

btw I am 24 and having met some fellow applicants, many of whom were accomplished surgeons in their home countries, and now interviewing at US surgery programs makes me slightly worried to say the least about my performance in a surgical program in the

Students are actually preferred over fully trained surgeons who may be resistant to relearning things the US way.

And yes, please relax.

 

[Dr.LeoSpaceman]

To the OP, I think there are many people (including US grads) who are (or should be) concerned about the practical matters of "how to be an intern". This is a separate discussion, but many med schools don't do a very good job of preparing you for that...especially in surgical subspecialties. All you can do is show up with an attitude that you're willing to give the majority of your time and effort to learning how to do it.

The only thing I showed up feeling at least semi proficient in were blood draws, subcuticular stich and driving camera for basic cases (appys and choles). Some people seem to show up with less than that, some with more. Where you start isn't important, though. Ultimately, there is so much to master that without that drive to practice and learn, you won't ever make it to where you should be.

 

[thedrjojo]

yeah, you have to really **** up for a program not to keep you around, ie, your concern about not getting a renewal contract, is, generally, not a problem, if you are a categorical resident. Attrition rates are important, and so, unless you draw a target on your back, most programs try very hard to keep you around... some people need some remediation, but generally, you do what you need to do and you will keep going through your program. The likelihood of you being fired after your intern year is very, very low, and you'd be more likely to want to quit then you would be actually fired.

And, if you get a general surgery residency, you will essentially (if current trends stay unchanged) be guaranteed to get a VS fellowship spot, as they are "easy" to get in general, as they are abundant and in demand. Quality varies, but availability is good.