Preliminary Surgery - To do, or not to do?

[Leukocyte]

Unfortunately, I will have to scramble this year

Here are my stats:

-US-IMG
-Step 1 = 90
-Step 2 = 84 (second attempt....Long story)
-Love surgery, and the OR.
-Age = 30 (not too many years left for me to enjoy my youth)

Would you recommend that I scramble into a Prelim. Surgery year, OVER scrambling into a non-surgical categorical residency (like Family Practice)?

I really do not know what to do. Should I take the Prelim. surgery gamble, and the loooooooooooog, and tough way to categorical surgery (I am 30 years old)? OR should I just settle for the security of a categorical Family Practice residency?

I mean, doing a Preliminary year (or years) does not guarantee that I will eventually land a categorical surgery spot in the end. I might end up where I started, and in Family Practice, even if I do 2 or 3 Preliminary Surgical years!!!! That would really suck.

-p.s. I hate "fleas", but...I might have no choice.

Any advice is greatly appreciated.

Thank You.

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[Samoa]

how do you know this already?

 

[Pilot Doc]

Consider doing a research year (or two) and then reapplying with the backing of a surgery mentor. Search my prior posts for the full sermon on why this is a great idea.

I wouldn't scramble for surgery unless a 10% shot at being a surgeon is worth it to you - the last several years and presumably this year as well have generated lots of people who wanted but didn't get categorical spots. It's a tight, tight market for the PGY2 spots that open up.

Also consider jsut taking the next year to reapply to a more reachable field in the location/program that you want so that you don't have to take leftover spots this year.

 

[surgical06]

i think pilot has the best advice. if you know someone that can go to bat for you at a certain place, that will be great.

a very close second, is, if you do a prelim, make sure you do one at a site that has traditionally taken one of their own prelims as a PGY-1 the following year. i think thats the most important thing.
good luck to you!

 

[BitterPill]

Well, let me tell you my story so far. I'm FMG, 30yo, 99/99 CS pass and getting a PhD from a US institution this June. My research was conducted under a Dept of Surgery faculty - not an MD but a PhD - but cutting edge research that has generated 3 publications with me as the 1st author. I applied to 40 general surgery programs, both cat and prelim and guess what - I got only 1 interview and that too for a prelim spot. But I'm glad I got at least that one and I have ranked it, although statistically I think I have an infinitesmal chance of getting it. If I don't, then I'm going to scramble for prelim surgery. The reason is that I have realized that for IMG/FMGs, US clinical experience is the limiting factor while being considered for an interview, especially in surgery. And what better way to get USCE than to do be in a prelim spot if thats what I get - I'll not have to worry about having an income while I work my behind off! Plus, its one shoe in the door and its only a matter of time before the other is in. True, I will have to go through the match once again, but next time around I will be armed with US LORs from surgeons (hopefully great ones) and I'll have mentors who will be willing to make some calls on my behalf! And even though I may have to repeat PGY1, I'll do it even better the second time and get better at the craft. In summary, although Pilot Doc's suggestion to get into research is one way of doing it, having been there and done that, my opinion is that doing prelim sx is a great way of securing a cat spot in the next year.

 

[dynx]

having been there and done that,

You haven't been there and done that. You're right here and about to attempt that. Next year, after the match, when you've been there and are finished...doing that. Please hit us up and let us know how it worked out. Untill you're sitting in a catagorical spot your advice on how to get a catagorical spot is purely academic, not born from real world experience.

Btw...you sound pretty damn dedicated, more so than a lot of people I know, I hope you make it.

 

[SLUser11]

Any advice is greatly appreciated.

Thank You.

If you love surgery and hate "fleas," then I think that there's really no question about what you should do. You have to try, even if it means a chance of failure. Also, 30 is not that old (although 4 years older than me).

I'm FMG, 30yo, 99/99 CS pass and getting a PhD from a US institution this June......3 publications with me as the 1st author......I got only 1 interview and that too for a prelim spot.

You're not telling us something.

 

[Winged Scapula]

You haven't been there and done that. You're right here and about to attempt that. Next year, after the match, when you've been there and are finished...doing that. Please hit us up and let us know how it worked out. Untill you're sitting in a catagorical spot your advice on how to get a catagorical spot is purely academic, not born from real world experience.

Btw...you sound pretty damn dedicated, more so than a lot of people I know, I hope you make it.

I think Bitter Pill's comment about having "been there and done that" was in reference to his long and fairly distinguished career in research and that it didn't help him secure even an interview for a categorical surgery position because he didn't have CLINICAL EXPOSURE, which a Prelim year does provide. I don't think BP was advocating from a clinically oriented position but rather that research isn't necessarily the key to getting a categorical spot.

However, I believe Leukocyte does have US clinical exposure and LORS from US surgeons so this isn't necessarily relevant to him.

IMHO, high functioning FMGs tend to:

a) overestimate their "worth" on the US market and assume that their scores and academic achievements will trump the US exposure, and knowledge of the US system. Many FMGs spend months if not years studying for the USMLE, so having scores in the 99 percentile, is not unusual.

b) apply broadly without research except to look at programs which traditionally take FMGs. While this may seem to make sense, it can backfire and those programs may get thousands of applications making the chance of getting an interview or even matching pretty low. Some, in reference to the above, only apply to big name places, feeling that their academic achievements will be impressive to a top tier - sometimes they are, but overall, the chances for anyone to match at those programs is low.

Anyway, just my two cents...

 

[BitterPill]

Thanks for clarifying on my behalf, Dr. Cox. The phrase "been there and done that" was in reference to my stint in research and how it didn't have the effect I hoped it would in the residency match process. BTW dynx, thanks for your wishes.

And yes SLUser11, I'm not telling you something. I'm not telling you that I spent 8-10 weeks each preparing for Steps 1 and 2CK and hardly 2 weeks for Step 2CS; 6yrs post graduation of which 5 have been spent in research; applied to surgery programs in all tiers; and was a fool in not applying to a backup specialty. Not blowing my own horn here - but to make the point that I have everything that makes people go "wow, you are a stellar candidate for surgery" (this coming from several surgeons, even the PD at my university who shot down my application later) - everything except clinical experience in the US.

So to reiterate my position - research is good, but USCE is the best (for FMG/IMG)

 

[Winged Scapula]

BP...

Interesting that the surgical PD at your university would tell you what a stellar candidate you were, and then not even offer you an interview for a categorical position. Would you feel comfortable talking to him/her and asking why? Is there perhaps something concerning in one of your LORs, visa issue or is the reason strictly the clinical exposure - which I agree is important, but it still seems like something doesn't add up.

 

[SLUser11]

BP...

Is there perhaps something concerning in one of your LORs, visa issue or is the reason strictly the clinical exposure - which I agree is important, but it still seems like something doesn't add up.

Well, maybe it's something that they are not telling him, and I just had it backwards.

I'm not trying to be a punk, although it does happen pretty often, but with stellar scores and no big red flag, IMGs usually get invited to many of the "lower tier" programs for interview.

 

[Winged Scapula]

Well, maybe it's something that they are not telling him, and I just had it backwards.

I'm not trying to be a punk, although it does happen pretty often, but with stellar scores and no big red flag, IMGs usually get invited to many of the "lower tier" programs for interview.

Yeah, I was suprised too. Something seems awry, I agree.

 

[BitterPill]

Yeah, I was suprised too. Something seems awry, I agree.

Of the 3 LoRs, 2 were from surgeons in my home country and the 3rd from my phd advisor. I did not have any LoR from a US surgeon, cos I had no clinical experience here. All the writers had good things to say about me. I'm sure the lack of US LoRs hurt my chances 'cos one of the interviewers mentioned something to that effect. I don't think visa should have been a problem 'cos I was open to any visa (H/J) and I applied to the so-called "FMG friendly" programs. Anyway, all thats history now. I'm wiser for the next go-around.

(my daughter wanted that here )

 

[Samoa]

Of the 3 LoRs, 2 were from surgeons in my home country and the 3rd from my phd advisor. I did not have any LoR from a US surgeon

That would do it.

 

[Winged Scapula]

Of the 3 LoRs, 2 were from surgeons in my home country and the 3rd from my phd advisor. I did not have any LoR from a US surgeon, cos I had no clinical experience here. All the writers had good things to say about me. (my daughter wanted that here )

That was probably it...well, as you say, you're wiser now.

Best of luck to you (and your shamrock loving daughter).

 

[Miyagi]

I am a US/FMG.
USMLE-1 Failled 1st time
USMLE-1 87 USMLE 2-85
ABSITE PGY-1 24%

So as you can see I am not a test taker. I did a prelim. year then a PGY-2 Prelim. at another hospital.
Last year I got a 66% on my ABSITE.Now I am a PGY-3 Cat.
The whole point to the story was that tests scores don't matter. It is how you preform as a resident and attendings can count on you to do your job and go far above and beyond.If you do a prelim. year and impress the sh@t out of everyone, they will go to bat for you when it comes time.
That is how I got my spot, no one cared that I have trouble filling in the little bubbles on a sheet. They knew I was strong clinically, had great skills and could count on me, which is going to be important when I am chief.
Do a prelim. year and do nothing else but live at the hospital and make no stupid mistakes (forget to write notes, f/u labs etc.) so when it comes time to get LOR or support, the attendings can say how top notch you are.
The only word of caution that I have is: ACGME will only fund your residency for 5 years. A hospital is a business so don't count on doing a prelim. then a PGY-1 cat. it wont work.
My word of advice only move forward, don't repeat years. You are better than most US grads and there is no reason why you should repeat just b/c US grads are fed with a silver spoon.

 

[BitterPill]

The only word of caution that I have is: ACGME will only fund your residency for 5 years. A hospital is a business so don't count on doing a prelim. then a PGY-1 cat. it wont work.

Thats an interesting one. Does anyone know if this applies to 5 years of residency in one hospital or to cumulative years of residency training regardless? Any clarification will be very much appreciated.

 

[Winged Scapula]

Thats an interesting one. Does anyone know if this applies to 5 years of residency in one hospital or to cumulative years of residency training regardless? Any clarification will be very much appreciated.

HCFA (health care financing administration or CMS as its called now) is responsible for funding residency programs at teaching hospitals. Those that receive HCFA/CMS funds (almost all) receive them for the total number of years that it takes to completely train a resident in that specialty.

So, for example, if one matches into general surgery, funding is provided for 5 years (we shall ignore the programs that are mandatory 7 years in length). This is regardless of the number of hospitals you have trained at.

However, conventional wisdom has it that residents in good standing who have exceeded their HCFA/CMS allotment will still be paid by the hospital - they will find the funds somewhere. I am not aware that there is a big problem with people going over the funded years and not receiving payment. This is not an uncommon situation, especially with those who do a prelim year and then repeat it to get a categorical position. Some programs may refuse to do so, but from what I've seen and heard, if they want to keep you, they will find the funds and "eat" the loss of the CMS funds.

The major issue now seems to be with ACS - residents who train in more than 3 programs are no longer board eligible. This means you cannot move from program to program, or repeat multiple years at different programs and expect to become BE.

 

[dynx]

Thats an interesting one. Does anyone know if this applies to 5 years of residency in one hospital or to cumulative years of residency training regardless? Any clarification will be very much appreciated.

I questioned the same line you did. It seems this must not be the case since In seven year programs with required research the contracts are written so it looks as if your pay is on a salary scale so Im guessing its the same funding source for all 7 years. Unless they do this to equalize pay between residents. If the pay was lab based or grant depedent the pay would differ right?

 

[TxMed]

that doesn't seem very nice.


-tm

 

[dynx]

that doesn't seem very nice.


-tm

When people aren't as successful as they would like they tend to assign blame or cry "favoritism" towards another group so they don't have to face their own failings.

 

[surgiwho]

I guess I am wrong, but I thought the funding was 2 years more than what your residency is. eg. 5 years for IM, 7 years for Gen Surg.

 

[Winged Scapula]

I guess I am wrong, but I thought the funding was 2 years more than what your residency is. eg. 5 years for IM, 7 years for Gen Surg.

YOu can get funding for longer times if you are in a residency which has research time or common fellowship training.