Residency positions in US and AUS

[Feg]

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Hi all, before starting I would like to say that I've read through the threads about Australia and US. This is again, a comparison in terms of residency positions, an info which I haven't found on other threads.

I'm an international student studying in Aus, some personal reasons have prompted me to consider residency training in US or stay back in Australia(if it's possible, hopefully). Well I must say that both are good countries, and I've considered other differences such as working hours, pay etc. I've also read about the US and Aus training system. As far as I understand, I'm more than grateful for a opportunity to work in either country, but my main concern is with specialty training positions(as I'm aiming for quite a competitive specialty)

A statement I heard from my friend is that:"US has more training positions available due to more hospitals and therefore indirectly increases your chance of getting into one."
Another would be "Going through US residency training system will be much faster than specializing in Australia.
I would like to emphasize that I'm not opening this thread to argue about the training quality, curriculum etc. just to find out more about the 2 statements above as I cant find the answer anywhere else. I'm exploring the prospect of specialty training from a international student's point of view.

Thank you very much for your input!

 

[rayjay]

While I don't have the answer to your question, I'm sure it would help a lot of people who might have some insights if you told them what specialty you were thinking of getting in to (or what specialties you are interested in general) because lots of specialties are "quite competitive"

 

[Feg]

Hi Rayjay, I'm aiming for cardio or cardiothoracic surgery. I know it should deserve 'very competitive' instead but I what I heard is that because I've to o through IM or General Surg 1st, it's less competitive than other specialties(I hope I'm correct about this?)

For IM and General Surg is it true that it takes an average of 3-4 years waiting to get accepted into a program?

Thanks for your help

 

[rayjay]

I can't offer any insights into that. I know that applying to Gen Surg as an IMG in Canada is a shot in the dark really (as is the entire med application process) but I can't comment on what it will be ilke in the US sorry. Some others on here might be able to.

You might also consider asking some of the people in the Irish med forum. You and they are all considered IMG anyways for the process of residency matching (same with the Caribbean).

 

[Feg]

Hi rayjay, thanks for your suggestion 🙂, will try asking in another section.

 

[rigid]

Okay So

Cardiology required 3 years training as a 'Basic Physician Trainee' which means that after med school adn 1 year mandatory internship you can become a BPT for 3 years (this is not competitive at all and basically anybody willing to do it is able to). After 3 years of basic training and sitting the BPT exam (which i've been told is the most difficult set of exams known to man) you can then apply for cardiology as an 'Advanced Trainee'

I've been told that cardiology is the most competitive advanced training post, although still not crazy hard to get into. The hardest part is getting a job as a Cardiologist.

As for Cardiothoracic Surgery. This requires 1 year internship, 2 years residency (minimum) before you can apply for CT-surgery through the FRACS. It is a difficult position to get in and 3-4 training spots are on offer each year across the country (USA people think 20% unmatched is competitive, haha). Only after getting into the training program do you do your 1 year general surgery then 5 years cardiothoracic training.

NB Doing General Surgery training does not allow you to do a fellowship in cardiothoracic.

SOME USEFUL LINKS:

FRACS - http://www.surgeons.org/racs/education--trainees/becoming-a-surgeon

FRACP - http://www.racp.edu.au/page/educational-and-professional-development/training-pathways

 

[Feg]

Hey rigid, thanks for the useful links! I've only read the RACP website before, note the RACS web. Just wondering, is BPT equivalent to Internal Medicine? Yea it seems that by comparing the number of posts open per year Aus is much more competitive than US?

Just a rookie question: Is prevocational training equivalent to residency? It doesn't include internship as well, does it? But what's the structure of the prevocational training? I used to think that's General Surg, but if it isn't then what programme will applicants be going through?

Thank you.

 

[rigid]

Hey,

BPT does = Internal Medicine but you cannot practice as a consultant until you do Advanced Training (even if you only plan on doing general medicine) so its a long road for any Physician.

Pre-vocational are the years you do before you enter a training program so its the 1 year intern + X years Residency. You can also get unaccredited registrar jobs (you are doing a registrar job but the time doesnt count towards the training program). Generally you are contracted to a specific hospital network for these jobs.

Structure of Internship is 1 term in Medicine (any specialty), 1 term in Surgery (any specialty), 1 term in ED, 1 term in 'relief' (they can put you anywhere) and 1 term in elective where you can do anything you want.

I'm not sure about the structure of residency but it seems to be similar to an intern job whereby you are doing mostly clerical work and the registrars to the actual medicine.

Hope that helps.

 

[celling]

It sounds like you're in a similar situation that I was in around 6 years ago. I was a US citizen studying medicine in Australia and I wanted to go into Cardiothoracic surgery.

First, if you want to stay in Australia good for you. If you are able to get a training position, then you'll be set. The Austrailian CTS guys that I've worked with are pretty strong technically. However, you won't be able to go to the US afterwards unless you want to repeat your training.

Second, if you want to go to the US to train, things are going to get really difficult for you. The major problem is that the residency programs in the US don't have a lot of experience with Australian students. Therefore, we are considered wild cards and in order to secure a position, you are going to have to completely wow them. To get a categorical general surgery position in the US, you will need at least 230 on Steps 1 and 2. During your fourth year of med school, you'll need to do away rotations at the programs you're intersted in. Despite all of that the odds are against you. You'll almost have to do a Preliminary general surgery year. after that you have a 10% chance of getting a categorical general surgery position.

I'll tell you what happened to me. I graduated from Flinders in 2004. I scored 235 on step 1 and 248 on step 2. I published some research and presented in some conferences, but not a ton. I did away rotations at my top choices. I ended up applying to 35 programs for general surgery and got 4 interviews. I didn't match and ended up scrambling into a preliminary position at a small university hospital. I worked my ass off during that preliminary year and got offered a PGY-2 categorical position (which is really rare). However, I turned that down and went to a more prestigious university program as a PGY-1 categorical. I'm currently a PGY-4 in general surgery and have one year after this left. I'm applying for CTS fellowship in January. My professors are pushing me to apply to Yale, Wash U, Hopkins, Duke, Mass General, Penn, Emory among others. They tend to believe that I'll get one of these positions, but it isn't a definite yet.

I hope this doesn't discourage you, but it is an uphill road no matter what you decide. Good luck and let me know if there's anything that I can help a fellow Aussie med school graduate with.

 

[Feg]

Hey rigid, thanks again for the info! So if I'm interpreting this correctly, it seems that entering BPT is not hard, but getting into Advanced Physician training, especially into Cardiology is hard. But then again, even before all that I guess the biggest uncertainty lies in internship positions? If International students are turned down the opportunity I guess there's not even BPT to consider.

Hi celling, thanks for your input! It's definitely inspiring to hear your story and I always wondered what happens to applicants who didn't match. Not sure if this is a valid question but just wondering if situations like insufficient internship/residencies for Internationals ever happened to US? I mean in Aus seems that the possibility is just there.
But on top of all that, wish you the best! It's motivating to see an aspiring CT Surgeon.

Thanks

 

[celling]

There is a fixed number of residency positions for each specialty in the US. There are no positions specifically allotted to US grads, International grads, etc. Each program ranks the applicants according to whom they want. So, if you're desiring a competitive residency like ortho, plastics, CTS direct track, dermatology, ophtho, etc the chances of getting a residency, as an international student, are almost zero. If you are interested in internal medicine the chances are much better and a lot of international students get offered positions in IM. Surgery, is a different animal. It's much harder to get a categorical position in surgery. Almost, all international applicants have to do at least one preliminary year and most have to do multiple before getting a categorical position. Despite all that, only 10% of general surgery preliminary residents get a categorical position. A lot of the prelims go back to their own country, some try to get into another less competitive field, and some find another job outside of medicine.

 

[Feg]

Hi celling, thanks for your reply again. I guess that's all the question I can think of for now, I'll be off this site for a while to prepare for an upcoming exam, shall return after a week or 2. As for now, good luck in your training!

 

[Feg]

Hi celling, if you have the time, I want to know more about the difference in job scope between Cardiologists and CT Surgeon.

Just wondering if CT surgeons get to manage(non-surgical) patients as Cardiologists do? Or do they wait only for Cardiologists to refer patients to them? During my last elective, I saw that CT Surgeons run specialist outpatients clinic as well, is this the same for US as well?

Also, should I perceive the financial crisis in US as a negative point? I mean, as for now I don't mind the extra working hours. Unless it causes a cut-down in residency positions, is there any other reason that I should be worried?

Thanks

 

[dally1025]

Hi celling, if you have the time, I want to know more about the difference in job scope between Cardiologists and CT Surgeon.

Just wondering if CT surgeons get to manage(non-surgical) patients as Cardiologists do? Or do they wait only for Cardiologists to refer patients to them? During my last elective, I saw that CT Surgeons run specialist outpatients clinic as well, is this the same for US as well?

Also, should I perceive the financial crisis in US as a negative point? I mean, as for now I don't mind the extra working hours. Unless it causes a cut-down in residency positions, is there any other reason that I should be worried?

Thanks

I can't speak for every CT surgeon in the US but where I'm at the surgeons only see patients they are going to operate on/have operated on. Not to say they can't do outpatient stuff, the few surgeons I've met like to operate and hate clinic so it might be more of a personality thing. Figure out of if you like the OR or the clinic. For most people it's one or the other and not both.

As for the finances, they keep balking that they're going to cut funding for residency but that won't happen. Hospitals would have no doctors and there are always new programs opening up in most fields every year despite this. If you want to do CT surgery, it's not all that fast-5 years of gen surg residency (assuming you get in 1st shot which the vast majority of international grads don't do) which will probably require some research (a year or 2 during residency) and then a fellowship. Cardiology isn' quite as difficult-3 years of internal med residency followed by a fellowship. It's not nearly as competitive for international folks.

 

[celling]

Just wondering if CT surgeons get to manage(non-surgical) patients as Cardiologists do?
-Very little non-surgical management for CT surgeons. That's the realm of cardiologists.

Or do they wait only for Cardiologists to refer patients to them?
-Most referrals come from cardiologists (for cardiac surgery), pulmonologists & Hem/Onc (for thoracic surgery). Also will get referrals from the ER for aortic aneurysms, dissections, thoracic/cardiac trauma,etc. It is pretty rare to get a referral from a primary care physician for a pt that hasn't been worked up by a medical specialist.

During my last elective, I saw that CT Surgeons run specialist outpatients clinic as well, is this the same for US as well?
-Not really. Most of that is done by cardiologists. CT surgeons can be subspecialized in Adult Congenital Cardiac Surgery, Advanced Aortic Surgery, Cardiac transplantation, Pediatric Cardiac Surgery, Robotic Cardiac Surgery, etc. These require an additional 1-4 years of training after fellowship and the trainng is done through super-fellowships.

Also, should I perceive the financial crisis in US as a negative point? I mean, as for now I don't mind the extra working hours.
-The curent financial crisis shouldbe the least of your concerns. By the time you're done with training, things will have changed. As for working the extra hours, it will be a shock. I'm a definite work-a-holic and even for me the hours will wear you down. My alarm goes off at 4-4:30 AM and sometimes I don't get home until 10-11PM even when I'm not on call. I've been doing this for 4.5 years now and trust me, it gets old.

Unless it causes a cut-down in residency positions, is there any other reason that I should be worried?
-There have been some cutbacks in residency programs, but the overall number of positions has been pretty stable esp in surgery. My advice is to try and get a university affiliated training program (easier said than done for a IMG) and the chance of the residency program being shut down is much less.

I can't speak for every CT surgeon in the US but where I'm at the surgeons only see patients they are going to operate on/have operated on. Not to say they can't do outpatient stuff, the few surgeons I've met like to operate and hate clinic so it might be more of a personality thing.
-100% agree. Never met a surgeon who loves clinic. In fact, most (like me), cannot stand it. Would much rather be in the OR.

Hope this helps.

 

[Feg]

Hi dally1025 and celling, sorry for replying late. Your inputs have definitely clarified my doubts, thank you for that! And I wish you all the best in the training.