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Residency matching question

Discussion in 'Caribbean' started by ocwaveoc, Feb 27, 2007.

  1. ocwaveoc

    ocwaveoc Banned Banned

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    Jan 15, 2007
    Hey guys.
    I've heard numerous times that grads from the Caribbean schools have difficulties (foreign schools in general) coming back to the US and obtaining residencies. However, on AUC and SGU's websites, numerous "normal looking" residency matches are found. What's up with that?
     
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  3. halal meat

    halal meat 2+ Year Member

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    Jan 30, 2007
    They can match easily into primary care.
     
  4. ocwaveoc

    ocwaveoc Banned Banned

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    Jan 15, 2007
    Right. In addition, I've noticed that 30% of AUC and SGU matches were specialty residencies including radiology, dermatology, surgery (ortho/gen/neuro) and anesthesiology which is no different from many of the DO schools. So, in essence, is going to AUC and SGU pretty much similar in terms of residency matches (getting into specialties) as it is for DO grads?
     
  5. halal meat

    halal meat 2+ Year Member

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    I not familiar with specific information but it depends on which DO school you are talking about. You can check the osteo faq sticky in regards to specific match percentiles for PC for various DO programs.

    Some specialize in primary care an so on, like MSUCOM and WVSOM which have something like 80% matching into Primary Care.

    PCOM on the other hand has under 40% going into primary care.

    Im not sure about the the carrib match lists and so on, but I think you are more likely to get a more popular/competitive residency in a Osteopathic school then a foriegn school.

    The program sites are probably better too.
     
  6. KBoogie311

    KBoogie311 Gettin' Down Wit.. 2+ Year Member

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    Just so you guys know my background. I am a Jersey guy, who went to Undergrad in Pa, followed by SGUSOM in Grenada. I graduated in 2003 from SGU and went into Internal Medicine. I finished that in 2006 and currently I am doing my chief resident year, before i start Gastroenterology in July 2007.

    I know and understand all the issues that a FMG will deal with coming back from the Caribbean....one cause I have done it, but now also cause I am administration within a residency program (also because of my fellowship applications).

    While its true that more and more SGU grads are getting into more competitive residencies, this is not the standard. At the University that I am currently at in a class of 150-200 students its not uncommon to hear 6-8 people going into Ortho, 3-4 going into Neurosurg, 2-4 into Derm, so on and so forth. Of course its an American Med school, but the scores that all these kids have on their USMLE are not all 240s. The kids at SGU have very competitive board scores.....absolutely no doubt about it. There are so many of my classmates who scored in the 230s-260s ranges on all the steps I couldn't possibly list them all. Of course not all of them want to be in an something like Ortho or Derm, but non-the-less they intellectually are more than up to snuff. In terms of them getting these residencies, it happens a handful of times each year. This is simply because of some of the discrimination that still exists. On some level it exists within all the residencies and residency programs...but of course its worse in some subspecialities as opposed to others. Every year the SGU kids are proving themselves worthy and more and more doors are being kicked down.

    I am willing to answer any questions from the curious.

    Take Care.
     
  7. KBoogie311

    KBoogie311 Gettin' Down Wit.. 2+ Year Member

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    Feb 28, 2007
    Just so you guys know my background. I am a Jersey guy, who went to Undergrad in Pa, followed by SGUSOM in Grenada. I graduated in 2003 from SGU and went into Internal Medicine. I finished that in 2006 and currently I am doing my chief resident year, before i start Gastroenterology in July 2007.

    I know and understand all the issues that a FMG will deal with coming back from the Caribbean....one cause I have done it, but now also cause I am administration within a residency program (also because of my fellowship applications).

    While its true that more and more SGU grads are getting into more competitive residencies, this is not the standard. At the University that I am currently at in a class of 150-200 students its not uncommon to hear 6-8 people going into Ortho, 3-4 going into Neurosurg, 2-4 into Derm, so on and so forth. Of course its an American Med school, but the scores that all these kids have on their USMLE are not all 240s. The kids at SGU have very competitive board scores.....absolutely no doubt about it. There are so many of my classmates who scored in the 230s-260s ranges on all the steps I couldn't possibly list them all. Of course not all of them want to be in an something like Ortho or Derm, but non-the-less they intellectually are more than up to snuff. In terms of them getting these residencies, it happens a handful of times each year. This is simply because of some of the discrimination that still exists. On some level it exists within all the residencies and residency programs...but of course its worse in some subspecialities as opposed to others. Every year the SGU kids are proving themselves worthy and more and more doors are being kicked down.

    I am willing to answer any questions from the curious.

    Take Care.
     
  8. halal meat

    halal meat 2+ Year Member

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    Hiya

    How difficult was it for you to get a GI fellowship?

    I hear its difficult US grads let alone FMGs.
     
  9. KBoogie311

    KBoogie311 Gettin' Down Wit.. 2+ Year Member

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    I am not going to say it was easy....it certainly wasn't. I put a lot of time into it but I had a goal in mind from my 2nd or 3rd year of medical school and I planned it out. I was lucky enough that things worked out.

    Being from SGU helped only in that people ahead of me became successful GI fellows in numerous programs. My numbers on my USMLEs were good enough to get me interviews at those programs including others....Yale being one of my best ones. But aside from that I did research and presented a fairly decent sized study at the American College of Gastroenterology meeting that I had worked on for a year and half.

    My letters of recommendation were strong (I got a chance to read the one from my Program Director - I am sure my mother doesnt even think of me that highly). Being named a chief resident was certainly a help...as I am sure it made the application stand out a bit more.

    In the end...I was fortunate to get one of the 200 GI spots that were up for the match this past year. Several of the US grads in my program didn't match anywhere.

    In the end I am more than just happy with where I am in my career....I'm exactly where I want to be in life. Though the road wasn't easy...then again nothing in life thats worth attaining is easy to get....but I am here and I am thankful to SGU for giving me the chance at.
     
  10. billydoc

    billydoc Senior Member 10+ Year Member

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    Lost in Nu Yok
    Hey KBoogie311! Congrats on your achievement! That's really great. SGU is by far the most recognizible brand among the Caribbean schools. I know it's a hypothetical question but do you think the same was also possible if you've graduated from a lower tier, or in relation to Carib rather less known school? I personally know quite a few guys who are now specialists, after doing IM + Fellowship. All true "FMGs" : graduates of domicile medical schools mostly from former USSR. But they all got in like within the past 7-10 years. I hear it's waaaaaay more difficult now, even for the U.S grads to get in those specialties.

    Thanks

     
  11. KBoogie311

    KBoogie311 Gettin' Down Wit.. 2+ Year Member

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    First things First. All the subspecialities from Internal Medicine have gotten dramatically more competitive within the last 3 years. Cardiology and GI for the last 10 - 12 years have battled for the number one spot as most competitive each year. The biggest example of these turn arounds have come in Rheum and Heme - Onc. As recently as two years ago, Heme-Onc applicants would get multiple interviews and great matches. All of sudden the same quality of applicant aren't getting interviews. I think some of the programs are just as shocked. Some of the rejection letters (from my co-chief for example) talk about the unexpected volume of applicants that they are all of sudden getting.

    This could be for several reasons. One is that these programs have made it easier to apply via an electronic application....so more people apply. Two, and probably more realistically is that the subspecialist are being re-imbursed better by medicaid and medicare...perhaps this driving an average interest that someone has in a field to something much more and now people are applying. Another issue is that the number of spots per subspeciality is very different...some have many spots and others have a few. This makes the application process inherently more competitive. For example, Rheum had only 162 matchable spots (from 94 programs) this past year. With so few spots across the country (on avg 1-2 per program)...even just 100 applications to a fellowships drops your chances to 1% right off the bat. Unfortuately it appears that fellowships are getting much much more than just 100 per spot. Talking with my University's Endocrine physcians this past month. Their fellowship got 200 applicants for just 1 spot!!!!! They were blown away--they havent seen volume like this before.

    So what does this volume of applications mean to the FMG? The obvious. The easiest way to filter out someone is to look at the educational pedigree. If someone is from a Foreign school, regardless of how they did their..its easy to kick out their application. The fellowship program directors don't know how to handle the situation any differently....there isnt enough time for them to effectively discriminate one application from another. They just boot FMGs to make life easier on themselves. 200 applications to the program now means having to look at only 100 of them instead.

    So don't worry there is good news ahead.

    There are a couple of types of Foreign Grads. There are what I call Foreign-Foreign grads...aka they hold a foreign passport and are from a foreign school. Then there is the type like me...US born (American Passport) from a foreign school--the US-Foreign Grads. There is a difference in how they are viewed by the administration for fellowships vs residency or at least it seems to me. FACT -->There are a higher number/percentage of Foreign-Foreign grads getting into pretty much all the fellowships spots. So the grad from the Russian school (presumably a Russki National) tends to be looked at in a positive light. Prehaps the Fellowship program directors are sayin to themselves--"This guy was good enough to get into school in his own country--kick ass and then come to the US and kick more ass--->Lets Take Him!" Keep in mind these guys are scoring 99/99/99 on USMLE Step 1,2, and 3.

    Why are there fewer people like me matching into these fellowship programs? I am not entirely sure. US-Foreign Grads are definitely favored in residency...that I am positive about. We just submitted our rank list. The Ross / AUC/ SGU crowd were ranked higher than those who were Foreign-Foreign. I don't know if these Caribbean grads (after residency)for example no longer want fellowships or if they are looked at US born people who were not good enough to get into a US school...so why take them into fellowship now? I really don't know. Its anyones guess.

    The bottom line is this...quite simply. Its all do-able. Takes effort regardless of which school you go to. Its a piece of cake for no one, but only slightly easier for the US grads because of pedigree.

    In terms of the specific caribbean schools I don't know if SGU grads get more fellowships than Ross or AUC. My classmates have generally done pretty damn well.

    Lemme know if this helps

    -KBoogie

    By the way...all the information that i have listed (numbers/programs etc.) this is all coming from NRMP (National Residency Matching Program) and their stats. None of this anecdotal unless I have said otherwise.
     
  12. oldpro

    oldpro MS IV 5+ Year Member

    Here are some real stats from the NRMP for the FMG's and IMG's and the 1st ranked Match (ot the 2nd,3rd, 4th, ect....)

    The 2005 results for FMG/IMG Matches was ( for those who matched):
    Internal Med and Peds about 68%
    Peds 64%
    Family Med 59%
    Rehab 58%
    Internal 58%
    EM 58%
    Anesthesia 57%
    OB GYN 56%
    PSYCH 52%
    Radiology 50%
    Pathology 48%
    General Surgery 40%
    Derm 38%
    Plastics 32%
    Rads Onc 30%
    and Ortho about 30%

    This the result for the 1st ranked by the Grad....................
     
  13. ocwaveoc

    ocwaveoc Banned Banned

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    Hey KBoogie
    Thanks for all the great info and congrats on your achievements.
    I have another question. As of now I'm mainly interested in physical medicine/rehab. Where can I find out the numbers of residency spots:applicants ratio numbers for something like that?
    And another question....it's sort of a newbie question. What exactly is a fellowship?
    thanks
     
  14. oldpro

    oldpro MS IV 5+ Year Member

    Sorry to but in.............You can get the program info from FREIDA

    http://www.ama-assn.org/vapp/freida/srch/
     
  15. KBoogie311

    KBoogie311 Gettin' Down Wit.. 2+ Year Member

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    Oldpro answered for first question. A fellowship is, in simple terms, a subspecialization. For example, to do Cardiology you must complete a residency in Internal Medicine. Obviously, while in residency you are a resident. When you start your sub-speciality training you are called a fellow. It means you are an attending in one field while training in a subspeciality of that field. I have graduated from residency (thus I am an attending in Internal Medicine)...I will start my training in Gastro at which point I will be a fellow.

    Most fields have sub-specialities, including PMnR (Like Pain Management and EMG). Neurology can do Epilepsy or Interventional Stroke (Among other things). ER has Toxicology...I can go on forever with this stuff.

    I think that about sums it up.

    -KBoogie.
     
  16. KBoogie311

    KBoogie311 Gettin' Down Wit.. 2+ Year Member

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    I responded to your message buddy.

    -KBoogie.
     
  17. ocwaveoc

    ocwaveoc Banned Banned

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    Hey KBoogie,
    Thanks for the info again!
    Haha....I get so much information from this network. I do try to identify objective ones (like what a fellowship is) to subjective ones (how some school sucks/chances of getting in).
    So, my assumption is that not all resident grads go into fellowship. Is it mostly because it's so competitive that they can't get into what they want or is it mostly because they choose not to subspecialize? I'm sure there is a mixture of both reasons. I'm wondering which predominates. Also, in general, how many additional training does a fellow go through?
     
  18. KBoogie311

    KBoogie311 Gettin' Down Wit.. 2+ Year Member

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    Feb 28, 2007

    So basically there is a mix of people going to fellowships and going into General Medicine. My graduating class of 35 residents went roughly 60%-40% into fellowships vs Gen Med. Outside of the 60% that are going on for subspeciality work, the rest wanted to "get on with their lives", though there were a handfull that wanted a particular fellowship and didn't get in anywhere. The trend in Gen Med is to stay on a Hospitalist (basically only doing In Hospital work) no outpatient or clinical work. The advantage is no office hours or overhead to worry about. The pay is great and its shift work. Basically you work 14 days a month and are off 14 days month.

    As for how many years of additional training? It depends on the fellowship of choice.

    Geriatrics and some Critical Care Fellowships - 1 year after residency

    Infectious Disease, Endocrine, Allergy/Immunology, Nephrology and Most Critcal Care Fellowships - 2 years after residency

    GI/Cardiology/Heme-Onc/Pulmonary and Critical Care - Are 3 additional years after residency. People may even go on for another sub-sub-speciality afterwards. For example - once done with Cardiology - a person might go on to do Electrophysiology or Interventional Cardiology which is one extra year.

    Hope this Helps
    -KBoogie
     
  19. prefontaine

    prefontaine Senior Member 10+ Year Member

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    Northern Liberties
    PM&R, not PMnR.

     
  20. KBoogie311

    KBoogie311 Gettin' Down Wit.. 2+ Year Member

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    Feb 28, 2007

    Uh... the "n" was slang for "&". Didn't mean to offend....We do know its Physical Medicine AND Rehab.
     
  21. SabaMed

    SabaMed 2+ Year Member

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    What you said is exactly correct. Congrats on getting the chief res and GI move.

    I've heard that MD's from India are regarded higher than any other FMG. Have you seen that? Is it because the program is extremely difficult (even more so than US schools)?

    As you said SGU board scores have always been high and continue to keep pace and even beat US schools. At Saba our recent class is averaging a 96% 1st time pass rate of Step1. I hope I won't fall into that 4%:scared: , I guess that would equal 2 students per term of a class of 50.

    Anyway congrats and good luck.
     
  22. KBoogie311

    KBoogie311 Gettin' Down Wit.. 2+ Year Member

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    Indian Grads are not considered higher than anyone else....its all about the individual application. That being said - The kids that get into medical school in india are the best of the best. Because they are so bright to begin with they tend to do well on the board exams (in some cases they score 99s on all the steps). I can tell you that generally speaking when we formed our rank list the caribbean grads tended to be ranked higher (for the most part).

    -KBoogie
     
  23. GOGETA

    GOGETA SuperSaiyan 2+ Year Member

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    Dear KBoogie311

    Sorry to take advantage of you and ask all this questions that I have in mind.
    What happens to the IMG that have fail couple of times and then pass their test with low grades? Are they never getting into residency?

    What happens if you dont showup for the test, does it appear in your records?

    Is it true that there are some places that even if you have a low grade, you can get in because "supposly" usmle grades are not intended for that?

    If you are a US IMG and you are teaching wile you pass the boards, will that at list help a little ?

    I read an article saying that overweight MD are less likely to get a spot. its that true?

    And what about the accent, if you have a strong accent but you can still understand the person, does it look bad?

    Why there is a tendecy of MD not liking FP
     
  24. GOGETA

    GOGETA SuperSaiyan 2+ Year Member

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    Feb 4, 2007
    Another question is

    what happens to the people that have been out of medschool for more than 6 years:confused:, and with out practicing for more than 3?
    where can they apply?
    what programs?
     
  25. KBoogie311

    KBoogie311 Gettin' Down Wit.. 2+ Year Member

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    I will do my best to answer...some of your questions I just don't have an answer to.

    1). The IMG that fails the boards a few times/does poor - there is a risk of not getting residency. I had a friend that went to school in india. Failed Step 1 a couple of times and just got by on Step 2. He didn't get into residency after 2 attempts....after a huge research effort and some calls on his behalf he got in to a community program. Failing the boards is always a red flag no matter where the graduate is from. Being an FMG makes the situation much more difficult. The non-competitive residencies might be more accepting of a failure in an FMG. Internal Medicine, despite having a large number of spots nation wide may still not be willing to give up a spot just because there still such a large number of applicants.

    2). Not showing up for test ---> I have no idea if shows up on your record.

    3). USMLEs are looked at..period. All programs..even the smallest community program....take into account the USMLEs on the applicants (and occasionally will refer back to them as the person progresses through their residency). Again I am speaking from an Internal Medicine point of view here, but I can't imagine that the other residency programs aren't looking at them as well. Keep this in mind...the USMLE is NOT an apititude test like the MCAT. The USMLE exams are tests of knowledge...not a test of how much you can/or your ability to learn. There is an arguement that people are not good test takers. Most PDs despite trying to be understanding about this...have a bottom line of running a program....they will look for the best overall candidates...including ones that do well on the boards. In-Training Exams which are exams that residents take once a year during residency as a practice for the Boards....are not to be looked at for major decisions like fellowships. The results of that exam are only to be shared between the PD and the resident as a learning tool. This is the only "ignored" exam on anyones record (but I am sure this influences decisions with PDs as well - in an off the record type of way).

    4). Any job will help - adds some diversity. However this will not replace the scores. The scores are the bottom line.

    5). We have plenty of overweight residents in our program....Where did you read this? Has no influence.

    6). Accents are just there - doubt they will overtly cause a problem unless someone is biased/racist. I am not sure what to say about it. We have plenty of people in our progrram with accents. While I am sure most people what "americans" and no accent would be ideal...its not the reality for all the applicants. Its there..no decision is made on it.

    I have never been in a meeting that we have said...."We are not taking this guy/girl he is overweight and has an accent". We have said something to the effect of..."This person got 75 on step 1 and step 2...and was ranked low in their medical school class...do we want to rank him/her?"

    7). By FP do you mean family practice? I am not sure I understand the question.

    8). Being out of the system maaaaay hurt. It depends on what you were doing. If you were totally out of medicine all together it could be a negative. If you made a temporary career change and now are coming back it might acutally help....adds some diversity and makes you interesting. This will not kill an application all together. It could help as long as you weren't just sitting on the couch all day and eating donuts.

    I hope that this helps a bit.

    -KBoogie
     
  26. KBoogie311

    KBoogie311 Gettin' Down Wit.. 2+ Year Member

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    No reason to not apply everywhere. See where the application process takes you. Again see above. Explain what you were doing for 3 years...this can help your efforts out a great deal.

    -KBoogie
     
  27. GOGETA

    GOGETA SuperSaiyan 2+ Year Member

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    Yes with FP I meant Family practice.

    Why I see alot of residents in FP trying to change to IM, and talking so bad about FP:confused:, what is wrong with FP?


    So if I have been teaching in a community college since my arrival to the US, can I say that having already experience as a teacher in my university back home, I decide to teach and help the people in the community reach their educational goals in the health care field, but now I just decided to go back to medicine:D.

    1-Do you think this is a good answer?
    2-Do you think this look + in a teaching hospital, that I have US teaching experience?
    3- I heard about doing US clinical externship or obser. is a really good thing to do. Do you guys look on this? how important is this?

    Thank you for your time
    God Bles


     
  28. halal meat

    halal meat 2+ Year Member

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    Reimbursements have been decreasing for years for primary care. I think this is the main reason for the lack of interest.
     
  29. sumozmom

    sumozmom Senior Member 5+ Year Member

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    i went to school in PA too....where did u go?
     
  30. KBoogie311

    KBoogie311 Gettin' Down Wit.. 2+ Year Member

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    So its not that anyone "dislikes or hates" FP. Transferring residencies is not any easy thing because the Hospital who accepts you will loose funding for the years you have already done. Its easier to do when a program requires a pre-lim year...like ER. So people jump from a year of Internal Med to ER....the other way is more difficult. FP is completely different from Internal Medicine. The time done in FP will not give credit towards Internal Medicine (and thus the hospital loses money). You will have to start your residency from scratch again. It would be no different than flipping from surgery to neurology.

    FP has a few fellowships (womens health and maybe one or two others)...however the major fellowships cannot be obtained from FP. You have to do Internal Medicine for that. FP doesn't re-imburse well, which is a huge complaint once people are out in the real world. Other than that I am not sure what people hate about it. The biggest market for FP is rural medicine, where knowing a little bit about all the fields allows a successful practice. In large cities there are enough specialists that people don't always follow with FP phycians.

    As for your career...the reason sounds honest enough and seems like a good thing. Plus its truthful which is always the best thing. I am sure that this is a positive thing at University program...it will certainly help the application ...though as I said before it will not clinch anything by itself. The rest of the application has to hold its own weight.

    Externship/Observerships are good for those who have no experience within the American health care system. With it you can say that once you start as an intern, your time spent learning how the new hospital works will be minimal. For those who have never done a rotation in the US..not knowing how things work can be big hurdle for the first few months of residency...it slows everything down including other members of the staff and patient care as well. That being said, the obsevership is not crucial to getting a residency. Again its a help..but will not make up other parts of the application. PDs will never look at this on an application and say this is the reason that the person was accepted into a residency. Same as the teaching thing above. It doesnt hurt at all..in fact it helps a little...but by itself means little.


    -KBoogie
     

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