Two questions regarding residency in the us.

[sunlessea]

Hi there. New member, long time observer. I' m an FMG thinking on embarking on the usmle journey. Before investing in the massive amounts of time, effort, and money needed for american residency, I would please like two questions answered.

1. I graduated in 2014, had a travelling gap year, and after that two years of clinical work in my country (and am still working as a doctor). If I start studying now, and if all goes well, I should be able to apply at the 2018 sept. matching programs, and therefore would be 4 years away from graduation, with one of those years unaccounted for. I have read elsewhere that this is a red flag, or even a no-no for most programs. Could you please verify/refute this?

2. I have read and heard about the good things in us residency, and the highest standard of education. Could you please school me on the negative side of the us system?
And I am not talking about exhausting work hours etc, which some people find conducive to learning and so are not objectively bad. I speak of the objectively bad stuff, e.g. careless prescription of opioids, that has turned many Americans to addicts. I think one should be informed about the good and the bad before making such a big step.

Thanks in advance.

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[hamstergang]

1. I graduated in 2014, had a travelling gap year, and after that two years of clinical work in my country (and am still working as a doctor). If I start studying now, and if all goes well, I should be able to apply at the 2018 sept. matching programs, and therefore would be 4 years away from graduation, with one of those years unaccounted for. I have read elsewhere that this is a red flag, or even a no-no for most programs. Could you please verify/refute this?

Your year wouldn't be unaccounted for; you'd be traveling for a year. If you couldn't explain what you were doing for that year people would worry you maybe were in prison or rehab.

The other worry is that spending time in non-clinical activities will lead to atrophy of clinical skills. But since your most recent years were spent working as a doctor, you're fine.

I speak of the objectively bad stuff, e.g. careless prescription of opioids, that has turned many Americans to addicts. I think one should be informed about the good and the bad before making such a big step.

I'm not sure I get the relevance of this. Why would other doctors in this country prescribing too many opioids have a negative impact on your training?

 

[bashwell]

Hi there. New member, long time observer. I' m an FMG thinking on embarking on the usmle journey. Before investing in the massive amounts of time, effort, and money needed for american residency, I would please like two questions answered.

1. I graduated in 2014, had a travelling gap year, and after that two years of clinical work in my country (and am still working as a doctor). If I start studying now, and if all goes well, I should be able to apply at the 2018 sept. matching programs, and therefore would be 4 years away from graduation, with one of those years unaccounted for. I have read elsewhere that this is a red flag, or even a no-no for most programs. Could you please verify/refute this?

2. I have read and heard about the good things in us residency, and the highest standard of education. Could you please school me on the negative side of the us system?
And I am not talking about exhausting work hours etc, which some people find conducive to learning and so are not objectively bad. I speak of the objectively bad stuff, e.g. careless prescription of opioids, that has turned many Americans to addicts. I think one should be informed about the good and the bad before making such a big step.

Thanks in advance.

1) Yes, some or many programs explicitly state they will not accept applications from people who have graduated from med school > x years ago. I've seen x = 3, 5, perhaps other values. Anyway, it just depends on the program.

That said, if you've been doing something clinical, then maybe some programs would be willing to take that into consideration. However, that will likely depend on the rest of your application (e.g., which country you did your medical education and/or training in, USMLE Step 1/2 scores, your visa status).

And you will still likely need some USCE as well as strong LORs from US physicians. Since you've already graduated, you could look into observerships, but many programs won't consider observerships as USCE. Otherwise, I'm not sure what other options you have? Perhaps externships through certain companies where you pay for the experience? However, some US residency programs won't look at this favorably either (e.g., I've heard some say that you're essentially "buying" a good LOR).

2) Do your own research on this. Don't ask others to do your research for you. It would take a book length treatment to talk about the US healthcare system including the "good" and the "bad." Either that or ask a more focused question.

 

[PlutoBoy]

Hi there. New member, long time observer. I' m an FMG thinking on embarking on the usmle journey. Before investing in the massive amounts of time, effort, and money needed for american residency, I would please like two questions answered.

1. I graduated in 2014, had a travelling gap year, and after that two years of clinical work in my country (and am still working as a doctor). If I start studying now, and if all goes well, I should be able to apply at the 2018 sept. matching programs, and therefore would be 4 years away from graduation, with one of those years unaccounted for. I have read elsewhere that this is a red flag, or even a no-no for most programs. Could you please verify/refute this?

2. I have read and heard about the good things in us residency, and the highest standard of education. Could you please school me on the negative side of the us system?
And I am not talking about exhausting work hours etc, which some people find conducive to learning and so are not objectively bad. I speak of the objectively bad stuff, e.g. careless prescription of opioids, that has turned many Americans to addicts. I think one should be informed about the good and the bad before making such a big step.

Thanks in advance.

1) It may be a problem depending on how specific programs see it. Some programs may see your work experience as valuable and it would strengthen your application. What all programs see as a red flag is someone that has been doing nothing but studying for the USMLE at home for years, thus the "filter" that bashwell referenced above. The more strict programs would reject your application solely based on years since graduation but some of those programs are out of reach for most IMGs anyway. As long as you have been doing something productive with your life in the past few years, you have a shot.

Training in the United States is superb so there is that.

2) Bad stuff... a big problem is the medico legal environment. It affects everything we do, from the way we talk to patients to the way we approach common complaints, to how we are credentialed and screened, etc... This is a high stakes profession and you need to perform at your best at all times. Slacking off is not accepted. Depending on where you come from, you may find that the way we relate to patients is very different. In many countries, medical paternalism is still a thing. Here it is frowned upon, which can be good or bad - sometimes we push patients to make a decision regarding their own health that they do not understand.

If you want money and technology this is the place to be. The trade off is high burn out rates. If you put more value on your time off and working in a more relaxed environment your home country (?), Europe or Australia may be a better fit.

Good luck!

 

[sunlessea]

Thanks for the replies. One more question.
Do competitive programs have low max years from graduation? And if so, does this mean that surgical specialties are practically out? Because an IMG also needs research years and the chance to secure LORs from Americans.. And so if I go down that path, it will be 2020 at least until I can apply for surgery programs, and by then I will have graduated for 6 years.

Sorry about the rant, just trying to figure it out.

Your year wouldn't be unaccounted for; you'd be traveling for a year. If you couldn't explain what you were doing for that year people would worry you maybe were in prison or rehab.

And how would I prove that? I was camping in the mountains of my country, not doing stuff like voluntary work in Nigeria...

I'm not sure I get the relevance of this. Why would other doctors in this country prescribing too many opioids have a negative impact on your training?

I guess I thought it would be an indication of corruption and a broken system, but ok it does not make sense.

2) Do your own research on this. Don't ask others to do your research for you. It would take a book length treatment to talk about the US healthcare system including the "good" and the "bad." Either that or ask a more focused question.

I wasn't referring to the us healthcare in general, more to the residency part. I have this impression from what I read that in the US you get the best possible training, working hard with little rest to become the most focused and capable physician that you can be. I mean the hours are exhausting compared to Europe. And I am looking for opinions that counter this claim, that say maybe it's not all that it's hyped up to be. I don't know maybe it is.

 

[Cura_te_ipsum]

One more question.

You have a great deal of information at your disposal. Your initial post expressed interest in training in the US. Few FMGs are accepted and fewer still follow through.

Training to be a physician in the US confers upon the physician skills that are the envy of many in the global medical world. There is a reason for that. You might want to stay in your current situation

 

[PlutoBoy]

Thanks for the replies. One more question.
Do competitive programs have low max years from graduation? And if so, does this mean that surgical specialties are practically out? Because an IMG also needs research years and the chance to secure LORs from Americans.. And so if I go down that path, it will be 2020 at least until I can apply for surgery programs, and by then I will have graduated for 6 years.

Sorry about the rant, just trying to figure it out.





And how would I prove that? I was camping in the mountains of my country, not doing stuff like voluntary work in Nigeria...




I guess I thought it would be an indication of corruption and a broken system, but ok it does not make sense.



I wasn't referring to the us healthcare in general, more to the residency part. I have this impression from what I read that in the US you get the best possible training, working hard with little rest to become the most focused and capable physician that you can be. I mean the hours are exhausting compared to Europe. And I am looking for opinions that counter this claim, that say maybe it's not all that it's hyped up to be. I don't know maybe it is.

1) If you play your cards right doing research can open the doors to even the most competitive specialties despite the issue with graduation date. There are many IMGs matching into ENT and other very competitive surgical fields after doing research. I can tell you of two cases that I know of: Matching ENT after two years of research at UPenn and Plastics after research at Harvard.

2) You don't need to prove it. Just state it.

3) Most physicians that over prescribe opioids do it out of ignorance and not out of malice. In the late 90s and early 2000s physicians were taught to treat pain aggressively with these drugs. Habit is hard to break. There are pill mills out there but this is not the norm.

4) Residency is much more taxing in America. This is true.

 

[bashwell]

Thanks for the replies. One more question.
Do competitive programs have low max years from graduation? And if so, does this mean that surgical specialties are practically out? Because an IMG also needs research years and the chance to secure LORs from Americans.. And so if I go down that path, it will be 2020 at least until I can apply for surgery programs, and by then I will have graduated for 6 years.

Sorry about the rant, just trying to figure it out.

NRMP Charting Outcomes for the IMG should have relevant data for you to consider if you wa t to know your chances of matching into a specialty:

Main Residency Match Data and Reports - The Match, National Resident Matching Program

But in general, as an IMG, it is unlikely you will be able to match into (1) a competitive residency (e.g., Hopkins, Harvard/MGH, UCSF, Stanford, Duke) or (2) a competitive specialty (e.g., dermatology, any and all of the surgical subspecialties) unless you have some significant achievement as well as a strong application (e.g., good USMLE scores, good LORs). For example, what I mean by achievements are things like, if you're already an attending surgeon in your own nation, if you've done significant research with significant publications such as first author papers in a high impact journal, etc.

And how would I prove that? I was camping in the mountains of my country, not doing stuff like voluntary work in Nigeria...




I guess I thought it would be an indication of corruption and a broken system, but ok it does not make sense.



I wasn't referring to the us healthcare in general, more to the residency part. I have this impression from what I read that in the US you get the best possible training, working hard with little rest to become the most focused and capable physician that you can be. I mean the hours are exhausting compared to Europe. And I am looking for opinions that counter this claim, that say maybe it's not all that it's hyped up to be. I don't know maybe it is.

Originally you gave the example of the "careless" prescription of opioids in the US. That's not specific to US residency programs, but applicable to US physicians and healthcare in general.

But to answer your question, yes, US residencies will work you very hard, with very long hours, etc. That's not "hype," but truth. This is especially true in surgical specialties. It's much worse than hours in Europe or many other developed nations like Australia and New Zealand. More work, less vacations, etc. All that and more is true (e.g., we haven't even talked about the volume of patients US physicians see per day or week, the amount of paperwork that's done on a daily basis, the malpractice costs).

However, you are generally finished much faster. For example, it could potentially take someone 10 years or sometimes even more to become an attending radiologist in the UK or Australia, but in the US it would be 5 years plus a year of fellowship if you choose (which most do now) so 6 years total. Same with becoming an attending emergency physician, which could take close to 10 years in nations like Australia, but will only take 3 or 4 years in the US.

 

[rokshana]

if your goal is a surgical subspecialty, then realize that it even more of an uphill battle than if you were looking for FM, IM, Psych, etc...the NRMP has data on the match rates for FMGs requiring visas. And the match for those going into surgical subspecialties are a bit skewed since many of those people have probably spent a number of years in research to finally be able to match in those specialties.

Given that you graduated in 2014 and have only spent the last 2 years working, I doubt that you have had much time to make much of a reputation (i.e. publications, faculty status, etc) so unlikely that will be able to help you. Since you haven't take your Steps, it will be very important that you have the highest score you can get...even for AMGs high Step scores are important for the surgical subspecialties.

You could potentially look to do GS residency and then do a surgical subspecialty, but obviously that will take at least 5 years for the GS and then however many years for the surgical sub (3-4 additional years).

 

[sunlessea]

Thanks everyone for the info, you were very helpful. I did not expect so many replies on my first thread. I am Greek btw.