Seeking advice for Plastic Residency independent/integrated?

[Aspiring_Surgeon]

Hi all

I'm an IMG, graduated in Aug, 2021. I don't need visa sponsorship. I'm aiming for plastic surgery!
My profile looks like this as of now:

USMLEs
- STEP 1: would take it in March-April, 22.
- STEP 2: Probably by July-Aug, 22.

CV
- US electives: 3 months of away/elective rotations at ONE private practice in the US (plastic surgery outpatient clinic). I worked as Surgical First Assistant (aka First Assist) as well. I only got one LoR from that plastic surgeon (he is very supportive).
- RESEARCH/PUBLICATIONS: all from home country!
^ x1 review book chapter published (Stem cells).
^ x1 cross-sectional study published (public health).
- US Experience:
^ x3 months of US electives: as a medical student.
^ x4 months of (paid) employment as Surgical First Assist at the same plastic surgery clinic in the US.
^ Jan-PRESENT: Surgical First Assist working for an agency, mainly doing shifts in Plastics, Peds surg, GYN in the US.
^ Surgical CaseLog: have a total of ~170 cases as a first assist (both at home during last year & in the US).
- COURSES/CERTIFICATIONS:
DONE
^ Surgical Assistant Certified: from the American Board of Surgical Assistants.
^ ATLS provider: have ATLS instructor potential letter.
TO BE DONE
^ Fundamentals of Laparoscopic Surgery (FLS): I have reasonable laparoscopic skills, I can work more on in our lab, and get ready for the test.
^ Da Vinci Xi Surgical Systems, First Assist Certification: scheduled to take it in May, 22.

The questions I need your thoughts about are:
- Should I keep working as a Surgical First Assist till the match 2022-2023? or till I find a Postdoc Research Fellowship to start this July, 22?
- Should I find a Postdoc Research Fellowship in Plastic Surgery or General surgery?
- Should I apply and accept whatever GS prelim I get this year? and see what happens next year?
- Should I aim for an Independent Plastic fellowship (after GS) or an Integrated program?
- Any advice or tips on how to plan my next few years to ultimately work for a plastic surgery residency?

I'd really appreciate your help!

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[doyouhaveaflag]

Based on your post, I'm guessing you're actually an FMG (a non US citizen who went to med school outside the US) and not an IMG (a US citizen who went to school outside the US, usually a Caribbean school). Unless your med school was Oxford/Cambridge (or similar), an integrated spot is not realistic for you. I would focus on general surgery. A research position will help you more than a surgical assist position.

 

[Aspiring_Surgeon]

Based on your post, I'm guessing you're actually an FMG (a non US citizen who went to med school outside the US) and not an IMG (a US citizen who went to school outside the US, usually a Caribbean school). Unless your med school was Oxford/Cambridge (or similar), an integrated spot is not realistic for you. I would focus on general surgery. A research position will help you more than a surgical assist position.

Well, I am a US permanent resident (Green Card holder). I'm sure this will help a lot as visa sponsorship is a big thing for a lot of programs.
Do you think I should focus on getting general surgery research fellowship or plastic? and if I get a plastic research fellow position, what would my odds to match to a Gen Surg residency?

 

[gyngyn]

Well, I am a US permanent resident (Green Card holder). I'm sure this will help a lot as visa sponsorship is a big thing for a lot of programs.
Do you think I should focus on getting general surgery research fellowship or plastic? and if I get a plastic research fellow position, what would my odds to match to a Gen Surg residency?

Your odds are better for GS, way better...not great, but better.
Very few non-US Seniors can compete for very competitive specialties.

 

[Aspiring_Surgeon]

Your odds are better for GS, way better...not great, but better.
Very few non-US Seniors can compete for very competitive specialties.

Thanks for your response!
1/ when you said my odds are way better for GS, is it as of now? or with a postdoc research fellowship? if with the research experience, does it make any difference if it's in Plastic or Gen?
2/ I graduated in August 2021 (6 months ago!), am I considered a non-US senior? I thought having a gap less than 3 years from the year of graduation is totally okay and wouldn't be discriminated/filtered against?

 

[NotAProgDirector]

Nobody can assess what your chances are without USMLE scores. At this point S1 is P/F. So you need to pass that, and then get a score on S2.

Your chances of getting a Plastics spot is zero. Very, very few IMG's get plastics spots, and those that do have some combination of years of research experience with lots of publications, connections to US programs, great plastics experience in their home country.

3 months of US electives is good -- but if it's 3 months in a single US position, in private practice, that may not count for as much as you think it may. Programs usually want to see experience in an academic setting, or in multiple settings with multiple LOR's. Having just a single US LOR and all the rest of your letters be international will not work well in your favor.

There is no such thing as "non-US senior". US grads are divided into those that are graduating this year (i.e. US seniors) and prior grads. IMG/FMG's are all just International grads. You're incorrect that any gap less than 3 years is "totally OK". In general, many programs have a cutoff beyond which they no longer consider international grads, often mentioned is 3 years. Programs will want to see what you've been doing in the gap -- and having a clinical position working as an assist in the OR is much better than a non-clinical position.

Not needing a visa will make things better.

Bottom line is to get your USMLE exams done on the timeline you have mentioned. The best score possible is needed -- a low passing score will be the end of your application. As already mentioned you'd be best to target GS programs, and might need to consider prelim GS programs (which only give you one year of experience, and then you need to apply all over again).

 

[gyngyn]

Thanks for your response!
1/ when you said my odds are way better for GS, is it as of now? or with a postdoc research fellowship? if with the research experience, does it make any difference if it's in Plastic or Gen?
2/ I graduated in August 2021 (6 months ago!), am I considered a non-US senior? I thought having a gap less than 3 years from the year of graduation is totally okay and wouldn't be discriminated/filtered against?

1. As noted above, if you have met (or preferably exceeded) all generally expected requirements you may have a small chance for GS. Chances for Plastics are vanishingly small. A research position will have a marginal effect. Any small potential advantage will be countered by the addional year from graduation. PD's are looking for clinical experience in an academic setting (where residents are trained). As an IMG, you will have an uphill struggle for GS categorical and will need to apply broadly even to have a chance for a Surg prelim position. Now that PD's of pre-lim residency positions are being judged by the subsequent success of their house officers, they have become reluctant to rank applicants who are unlikely to land a categorical position by the end of the pre-lim year.

2. US seniors are the primary target for PD's. Even US grads are not as desirable. When we have a student fail to match, we purposely delay graduation to give them another bite at the apple. Year of Graduation (YOG) is an important filter for all applicants.

Now that Step 1 is P/F, you will need a strong Step 2 available by September of the year you apply.

 

[Aspiring_Surgeon]

Nobody can assess what your chances are without USMLE scores. At this point S1 is P/F. So you need to pass that, and then get a score on S2.

Your chances of getting a Plastics spot is zero. Very, very few IMG's get plastics spots, and those that do have some combination of years of research experience with lots of publications, connections to US programs, great plastics experience in their home country.

3 months of US electives is good -- but if it's 3 months in a single US position, in private practice, that may not count for as much as you think it may. Programs usually want to see experience in an academic setting, or in multiple settings with multiple LOR's. Having just a single US LOR and all the rest of your letters be international will not work well in your favor.

There is no such thing as "non-US senior". US grads are divided into those that are graduating this year (i.e. US seniors) and prior grads. IMG/FMG's are all just International grads. You're incorrect that any gap less than 3 years is "totally OK". In general, many programs have a cutoff beyond which they no longer consider international grads, often mentioned is 3 years. Programs will want to see what you've been doing in the gap -- and having a clinical position working as an assist in the OR is much better than a non-clinical position.

Not needing a visa will make things better.

Bottom line is to get your USMLE exams done on the timeline you have mentioned. The best score possible is needed -- a low passing score will be the end of your application. As already mentioned you'd be best to target GS programs, and might need to consider prelim GS programs (which only give you one year of experience, and then you need to apply all over again).

I really appreciate your detailed response.

1/ Do you think getting OBSERVERSHIP opportunities in academic settings are helpful? as I can't get Medical Student electives anymore!

2/ Does my experience in the OR count as US experience (along the electives I did)?

3/ While working as First Assist in the OR, I can ask the surgeons I work with for LoRs too! How valuable these can be in your opinion?

 

[Aspiring_Surgeon]

1. As noted above, if you have met (or preferably exceeded) all generally expected requirements you may have a small chance for GS. Chances for Plastics are vanishingly small. A research position will have a marginal effect. Any small advantage will be countered by the addional year from graduation. PD's are looking for clinical experience in an academic setting (where residents are trained). As an IMG, you will have an uphill struggle for GS categorical and will need to apply broadly even to have a chance for a Surg prelim position. Now that PD's of pre-lim residency positions are being judged by the subsequent success of their house officers, they have become reluctant to rank applicants who are unlikely to land a categorical position by the end of the pre-lim year.

2. US seniors are the primary target for PD's. Even US grads are not as desirable. When we have a student fail to match, we purposely delay graduation to give them another bite at the apple. Year of Graduation (YOG) is an important filter for all applicants.

Now that Step 1 is P/F, you will need a strong Step 2 available by September of the year you apply.

Thanks for your detailed reply.
That is a point I have been thinking about lately. Should I go for a Surg prelim, work 80+/wk, and then have very limited time for Categorical interviews next year (given my busy shifts), or alternatively do a 1-yr research fellowship at a strong, reputable institution and then be competitive for PGY1 categorical Gen Surg next year!

 

[Aspiring_Surgeon]

Also, I'm wondering how valuable all these courses would be in making my CV look competitive?
- ATLS Instructor
- Da Vinci Xi Robotic Surgical System
- Fundamentals of Laparoscopic Surgery (FLS)

 

[gyngyn]

Should I go for a Surg prelim, work 80+/wk, and then have very limited time for Categorical interviews next year (given my busy shifts), or alternatively do a 1-yr research fellowship at a strong, reputable institution and then be competitive for PGY1 categorical Gen Surg next year!

You may certainly apply for both Categorical and pre-lim positions.
A research "fellowship" with have only a very modest effect.

 

[gyngyn]

Also, I'm wondering how valuable all these courses would be in making my CV look competitive?
- ATLS Instructor
- Da Vinci Xi Robotic Surgical System
- Fundamentals of Laparoscopic Surgery (FLS)

None of these are likely to have significant impact in your situation.

 

[droliver]

Would look for a prelim spot and try to leverage that into a categorical GS position.