OLD IMG with BAD scores

[biojunky]

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Hi guys,
I have a family friend who graduated from a foreign medical school over 20 years ago. She took her USMLEs and BARELY passed (at the time she was not as well versed in English as she is now). She has nearly no research experience and no publications. However, she is AN AMAZING CLINICIAN with A TON OF EXPERIENCE! She does have US citizenship and US clinical experience. She is great with people and would do well in Psychiatry or Family Medicine.
I was wondering if you guys know if there are ANY US residencies that MIGHT take her. She's pretty much given up, but it's hard to see someone who truly has the art of medicine go to waste. Any sugestions for how she could improve are also welcome.
Thank you in advance for trying to help.
-biojunky
PS: If this is the wrong thread, please let me know where I should be posting this.

 

[digitlnoize]

Hi guys,
I have a family friend who graduated from a foreign medical school over 20 years ago. She took her USMLEs and BARELY passed (at the time she was not as well versed in English as she is now). She has nearly no research experience and no publications. However, she is AN AMAZING CLINICIAN with A TON OF EXPERIENCE! She does have US citizenship and US clinical experience. She is great with people and would do well in Psychiatry or Family Medicine.
I was wondering if you guys know if there are ANY US residencies that MIGHT take her. She's pretty much given up, but it's hard to see someone who truly has the art of medicine go to waste. Any sugestions for how she could improve are also welcome.
Thank you in advance for trying to help.
-biojunky
PS: If this is the wrong thread, please let me know where I should be posting this.

Aren't your USMLE scores only valid for a certain number of years? She should probably retake it, I'm thinking. Other than that, no idea, sorry I'm just a med student and not very knowledgeable about such things.

 

[heyjack70]

I think you're right about USMLE score's expiring. I'm not sure they even called them USMLE 20 years ago.

As far as residencies that will accept her, I'd recommend applying to places in small towns away from the ocean. Looks for places that no one wants to live. Low average home prices are probably a good indicator; I'm thinking less than 125K for an average home. You might also get a leg up by looking for programs that repeatedly do not fill all their spots in the match.

 

[Reductio]

I think all 3 USMLEs must be taken within a 7 year period. If she hasn't taken her step3 yet, and its been 7 years, she can start from Step1 again.

The biggest red flag is going to be that she graduated med school 20 years ago. Most places have a 5 year cut-off regardless what what research or clinical work youve done in the interim. In some places the cut-off may be different, but i doubt any program will take a degree thats 20 years out. The only exceptions might be for someone who won the Nobel Prize, or maybe practiced in the UK in the interim.

The thought of going to some po-dunk place for some undesirable residency is becoming outdated. Every region is becoming desirable. There are many initiatives and incentives in the mid-west to entice US med students to practice rural primary care, and it's working. There really are NO programs in the US that unintentionally consistently go unfilled. I know of three IM programs which go unfilled on purpose each year, and I know for a fact that they do it intentionally. They end up scrambling precisely the kind of candidates they're looking for each and every year.

My advice - having been out of med school for 20 years as a non-modifiable red flag. She needs to look elsewhere for a place to use her talents.

 

[biojunky]

Thank you all for your responses.
She took her USMLEs 2000 & on - all within a 7 year period.
Is it possible to somehow "update" formal medical education? So that the 20 year graduation doesn't automatically disqualify her?

 

[peppy]

When you say she is an amazing clinician, what has she been doing? If she has actually been involved in medicine during these 20 years then that might help her case.

 

[biojunky]

Yes. She has been actively involved with medicine. She has continuously worked full-time in a clinical or inpatient setting for the past 20 years. Over 10 of which, she practiced as a GP.

 

[Reductio]

Yes. She has been actively involved with medicine. She has continuously worked full-time in a clinical or inpatient setting for the past 20 years. Over 10 of which, she practiced as a GP.

How?

I honestly think that the 20 year gap since medical school is going to make it impossible to get a residency. All you can do is try. Apply for residency - AT LEAST 100 programs.... see if she gets interviews. If she gets some, then theres a chance. If she doesn't then its not worth trying. Instead of guessing (because this case is so unusual), lets take the first step and see what happens.

I would apply to 1-2 specialties, and no more, >100 programs, and do not assume that FP, psych, or path are any less competitive than the rest.

 

[peppy]

While she does have some strikes against her due to the length of time that has passed, I think she has a shot. I know that some psych programs (Upstate in Syracuse NY for one) have taken "career change" docs who had practiced other specialties for many years before switching to psych, so a place like that might be more forgiving of the length of time that has passed and perhaps appreciate that she has some experience and knowledge from her work as a GP.

 

[gagee]

Hello,
I am helping my dad look for a residency program for him and he has the same problem. He already applied last year but did not get ANY interviews. He graduated in 1986 which was about 25 years ago. He is also a foreign graduate. He was a surgeon for many years in Russia and moved here to the US in 2006 and has only had observership. His scores aren't really perfect they are both 79s and pass on 2CS. He has been studying the last 5 years to pass the USMLEs so he can become a doctor... at that point he did not know anything about residencies, considering that we were new in US and he did speak much english at that time. Does anyone have ANY suggestions that might help him be a doctor again.

 

[ghost dog]

Hi guys,
I have a family friend who graduated from a foreign medical school over 20 years ago. She took her USMLEs and BARELY passed (at the time she was not as well versed in English as she is now). She has nearly no research experience and no publications. However, she is AN AMAZING CLINICIAN with A TON OF EXPERIENCE! She does have US citizenship and US clinical experience. She is great with people and would do well in Psychiatry or Family Medicine.
I was wondering if you guys know if there are ANY US residencies that MIGHT take her. She's pretty much given up, but it's hard to see someone who truly has the art of medicine go to waste. Any sugestions for how she could improve are also welcome.
Thank you in advance for trying to help.
-biojunky
PS: If this is the wrong thread, please let me know where I should be posting this.

Here are my thoughts:

1. If her English has significantly improved, and this was the barrier to an improved score, why not retake these standardized tests (if this is allowed - I am Canadian and thus not familiar with the USMLE steps)?

2. If she has a lot of clinical experience now, she may be able to get a number of good reference letters?

She should ensure that she gains as much US clinical experience as possible , as I know that this is of vital importance for IMGs in the Canadian IMG residency matching process.

If she is having problems connecting with attendings for clinical electives / observerships, a possible way to network may be attending family medicine forums / updates. Just a thought.

Persistence is required in this regard. Some of the IMGs I have mentored applied 3 years in row before gaining a residency spot in family medicine.

Explaining the 20 year gap will definitely be a barrier here.

3. If a residency position is not possible, perhaps apply to a P.A. program? I would think that having an MD (with this much experience) would be an asset in the application process.

 

[nitemagi]

It'll be tough, regardless.

The 20 years is a long time. Maybe not impossible, with very good letters and maybe some phone calls on her behalf from respected clinicians. If she's been active as a GP then it's not like she hasn't had any clinical experience all these years.

The bigger red flags would be -
1. language fluency. A big big issue in psychiatry, and I've seen it really be a death knell for many IMG's.
2. Age. While intern year is going to be lighter, the rest won't be. Is the person ready to do long long hours several years from now in their 40's/50's?
3. Accurate up to date medical knowledge. Many of the medications and truisms of even 10 years ago are out of use, out of favor, or simply proven untrue. Has the person stayed up to date on this? Otherwise it's ANOTHER thing that has to be caught up on.
4. Computer fluency. EMR's are just becoming standard, and I've seen a few too many older physicians coming back and trying to type an MSE with two fingers. It's painful for them, and painful for us to watch.

 

[notdeadyet]

2. Age. While intern year is going to be lighter, the rest won't be. Is the person ready to do long long hours several years from now in their 40's/50's?

As someone who is going through residency in his 40's, I have to say that the impression that a psych residency is "long long hours" is mostly held by those who haven't careers outside of medicine. The hours just aren't that daunting, as many career changers are coming from fields with comparable hours to a psych residency.

 

[nitemagi]

As someone who is going through residency in his 40's, I have to say that the impression that a psych residency is "long long hours" is mostly held by those who haven't careers outside of medicine. The hours just aren't that daunting, as many career changers are coming from fields with comparable hours to a psych residency.

I think that depends on the program and the hospital. I have a good friend (IMG in her 40's) who stated her call experience here was far far worse than her training in south america in her 20's. Based on hours and intensity. Just another case report.

 

[notdeadyet]

I think that depends on the program and the hospital. I have a good friend (IMG in her 40's) who stated her call experience here was far far worse than her training in south america in her 20's.

Yeah, I'm sure everyone's mileage varies.

I don't personally know any older folks struggling with this. In psychiatry, that is. I have a friend who is... ahem... mature, and the hours and call in her surgery program were very difficult for her to take. Our arthritic circadian rhythms just don't bounce back as quick.

When I do hear stories of older folks struggling with psych hours, it seems to often be IMG's who came back many years out of med school. I wonder if this subset of folks might find themselves to more often be limited to malignant residency programs?

 

[cleareyedguy]

The issue is reassurance; as is the case with every applicant, your friend needs to reassure residencies that she won't be a burden--and that's an especially big issue given her being atypical.

If your friend has been working as a GP in this country, then I'd recommend trying to apply specifically to places that are near where she now lives or where she has worked. I'd try to get letters from people who have some personal contact with those specific programs. This can reassure the skeptical and can potentially turn her atypicality into a bonus.

Another approach is to identify a potential residency or two and then work there in some sort of way, preferably after connecting up with the training director. best of all would be if the program could see your friend in action, doing hard work , for an extended period.

100 random applications is likely to be a waste of money.

 

[Manicsleep]

I hate to say it but maybe go through a PA program? That way they can either stay in that field or do a residency later by getting a job in an academic center, proving themselves. Better than sitting around.