Please help me in the steps to Residency!!!

[Jappy]

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Hello,
I am an Indian medical student from Poland. I will graduate in June 2006. I haven't taken any of the USMLE steps yet. I am planning to take Step 2 few months after my graduation and then Step 1. I haven't done any research so far.

I would like some advice on increasing my chances of getting a residency.
1. Is some research necessary? What kind of research and how long?
2. How much should I score on the USMLEs to have a chance as an IMG?
3. I heard some of the specializations are not available for IMGs. Can someone tell me which specializations are very competitive and which ones I will have a chance to get in.
4. Should I do the Step 1 in less than a year after the Step 2? Does the time matter?

I hope someone will be kind enough to answer my questions even if they are a bit silly. Thank you in advance.

 

[f_w]

> 1. Is some research necessary? What kind of research and how long?

If you mean studying, the anser is yes. The USMLEs don't require 'research'. How long ? As much time as you can possibly spare.

> 2. How much should I score on the USMLEs to have a chance as an IMG?

Better than a US graduate applying for the same type of residency. It highly depends on the specialty and the type of residency program you are aiming for. Nobody will be able to give you a binding list of scores for different programs.

> 3. I heard some of the specializations are not available for IMGs.
> Can someone tell me which specializations are very competitive
> and which ones I will have a chance to get in.

Neurosurgery
Dermatology
Urology
Orthopedic surgery
Radiation Oncology
ENT
Ophthalmology
General Surgery
Radiology

and a couple more are very difficult to impossible to match into if you come from abroad. This doesn't mean that there are not a couple of people who make it into these specialties every year, but the lucky few usually have some other factors going for them such as a career in the same field abroad or published research etc.

Emergency medicine
Anesthesiology
PMR
OB Gyn
Internal Medicine (top programs)

are also very hard to get into. But you will regularly find FMGs who make it into residencies in these fields. Again, they tend to have very good USMLE scores and often a background that makes them desireable for some program.

Internal Medicine (average to lower desireability programs)
Family Practice
Pediatrics
Pathology

are the specialties where FMGs tend to have the best chances of success in finding a residency. Again, the more prestigious programs in each specialty (usually university based) are harder to get into. The less desireable (smaller, often community based) programs are wide open.

> 4. Should I do the Step 1 in less than a year after the Step 2? Does
> the time matter?

Whatever you do, you want to have less than 7 years between step 1 and step 3. The order of step1 and step2 doesn't matter so much. Except that you need your step1 score if you want to apply for residencies through the match (and as a FMG it is advisable to have step2ck and step2cs passing scores at the time of application. many programs only look at you if you have the ECFMG certificate)

Hope this helps. Good Luck.

 

[Jappy]

> 1. Is some research necessary? What kind of research and how long?

If you mean studying, the anser is yes. The USMLEs don't require 'research'. How long ? As much time as you can possibly spare.

> 2. How much should I score on the USMLEs to have a chance as an IMG?

Better than a US graduate applying for the same type of residency. It highly depends on the specialty and the type of residency program you are aiming for. Nobody will be able to give you a binding list of scores for different programs.

> 3. I heard some of the specializations are not available for IMGs.
> Can someone tell me which specializations are very competitive
> and which ones I will have a chance to get in.

Neurosurgery
Dermatology
Urology
Radiation Oncology
ENT
Ophthalmology
General Surgery
Radiology

and a couple more are very difficult to impossible to match into if you come from abroad. This doesn't mean that there are not a couple of people who make it into these specialties every year, but the lucky few usually have some other factors going for them such as a career in the same field abroad or published research etc.

Emergency medicine
Anesthesiology
OB Gyn
Internal Medicine (top programs)

are also very hard to get into. But you will find FMGs who make it into residencies in these fields. Again, they tend to have very good USMLE scores and often a background that makes them desireable for some program.

Internal Medicine (average to lower desireability programs)
Family Practice
Pediatrics
Pathology

are the specialties where FMGs tend to have the best chances of success in finding a residency. Again, the more prestigious programs in each specialty (usually university based) are harder to get into. The less desireable (smaller, often community based) programs are wide open.

> 4. Should I do the Step 1 in less than a year after the Step 2? Does
> the time matter?

Whatever you do, you want to have less than 7 years between step 1 and step 3. The order of step1 and step2 doesn't matter so much. Except that you need your step1 score if you want to apply for residencies through the match (and as a FMG it is advisable to have step2ck and step2cs passing scores at the time of application. many programs only look at you if you have the ECFMG certificate)

Hope this helps. Good Luck.

Thank you f_w. Your reply was very helpful. You answered all my questions. Thank you for taking the time and answering my questions. It is very much appreciated. Good luck to you too.

 

[Miklos]

Great reply. I'd only like to add the following.

OB Gyn

are also very hard to get into. But you will find FMGs who make it into residencies in these fields. Again, they tend to have very good USMLE scores and often a background that makes them desireable for some program.

Considering that last year's NRMP stats in Ob/Gyn were:

1,144 PGY1 offered; 772 US Seniors matched; 1,083 filled (thereby 310 independent applicants matching AND 61 unfilled), I would not place it in the very hard category anymore. Competitive, for sure.

Another way to judge competitiveness is to look at the number of ranks per position. The higher the number, the more competitive the specialty.

> 4. Should I do the Step 1 in less than a year after the Step 2? Does
> the time matter?

Whatever you do, you want to have less than 7 years between step 1 and step 3. The order of step1 and step2 doesn't matter so much. Except that you need your step1 score if you want to apply for residencies through the match (and as a FMG it is advisable to have step2ck and step2cs passing scores at the time of application. many programs only look at you if you have the ECFMG certificate)

Hope this helps. Good Luck.

I'd recommend completing Step 1 prior to Step 2.

 

[f_w]

The reason I put OB/gyn in there is because I know of a couple of people from overseas who had good scores and prior experience but didn't manage to get into OB/gyn (despite the favourable statistics). Many of the 'independent applicants' are US citizens who went to ireland australia or the caribbean. The OP is a 'indian medical student from poland', so he is in the 'non-citizen fresh of the boat FMG' category.
In the past OB/Gyn was impossible to get into as an FMG, more up there with urology and neurosurg. It doesn't seem to be that bad anymore, but I wouldn't put it into the same category as lower-tier peds or lower-tier IM.

 

[Miklos]

The reason I put OB/gyn in there is because I know of a couple of people from overseas who had good scores and prior experience but didn't manage to get into OB/gyn. Many of the 'independent applicants' are US citizens who went to ireland australia or the caribbean. The OP is a 'indian medical student from poland', so he is in the 'non-citizen fresh of the boat FMG' category.

Fair enough.

An applicant without USCE or other clinical experience in that (or many other) fields, in addition to possible cultural and practical (e.g visa) disadvantages, will have more of an up hill battle than a USIMG with USCE.

 

[f_w]

I think one has to be careful to use the NRMP statistics to deduce anything about the competitiveness of the various specialties. All of the different measures they produce have one flaw or another. And most importantly, the stats don't have too much of a predictive value for an individuals chances to get a position (I know 'fresh of the boat FMGs' who managed to get positions in EM and GS while others had to scramble for a back-woods community hospital IM position).

 

[f_w]

Oh, one more thing.

It is common for FOTBFMG's (fresh off the boat FMGs) to take a prelim IM or FP positions initially. Later, when a PGY-2 position opens up in the specialty they want to do, they transfer into that program (programs will take PGY-2 residents in the middle of the year for a variety of reasons: residents leaving, additional funding etc.) This is how people make it into specialties which are hard to get into if you come directly from abroad. It probably won't get you from FP to neurosurg, but with some luck it is entirely possible to get from IM to EM or prelim surg to OB-Gyn.

 

[Miklos]

All good points.