unmatched-any suggestions??

[drmaya]

I'm an IMG,non-u.s citizen who did not match this year.I thought everything went on well until I got my results! I'm getting over it slowly and want to ensure that I match this coming year-I realize I don't have that much time left,I'm looking for some advice.I'm looking into doing a research with a well-known person in a big university in the U.S(in psychiatry),it could give me the possibility of or atleast working toward-a publication plus a good recommendation. I'm also looking to do some other clinical work like shadowing someone at the university. Does anyone recommend anything else that would increase my chances?

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[Anasazi23]

Why don't you scramble into a spot?

 

[mgdsh]

if you haven't taken your step 3... do so

 

[whopper]

Don't know what the requirements are to become a US citizen, but if you can become one, do it. At least get a green card.

Research will help, but for the most part it will not open the door wide open unless you do some very impressive research which is unlikely. Research often times does not pay or if it pays, does not pay well. Doing some clinical work can help. Several inpatient units need therapists and depending on the state, the minimum requirement is a bachelor's degree.

And as mentioned above, if you haven't passed Step III, get on it.

I have some friends in your position and I can understand their frustration.

 

[drmaya]

Thanks for the replies.Scrambling as an IMG is easier said than done-I've tried my hardest..but Anasazi..if you could recommend me anywhere for a spot now,I'll be happy to call and talk to you!!
Whopper,I'm looking to do volunteer research since its hard to get a paid one especially at a good place and that is okay with me.I'm in Northern California.Its really hard to get much clinical experience here especially at any UC.But,volunteer research is easier-maybe getting into it and then networking my way to some clinical work would help?
Also,I have a greencard,but my citizenship could take a while-maybe another year!
Any more suggestions from anyone?

 

[TheWowEffect]

So, the reasons for your not matching are something other than a visa status. I think you do have the right plans in mind about doing volunteer research, shadowing etc. If you are able to impress your mentor, you might be able to get a paid research assistant/fellow position.

Other than taking step 3, I would seriously advise you to take another look at your personal statement and work on your interview skills. These can sometimes make or break your chances. Good luck for next year.

 

[drmaya]

Hi,I was called by one program mainly based on my personal statement(that's not good,I'm thinking now) and also I was told by several interviewers at other places that my personal statement was indeed very impressive! As soon as I finished each interview,I was praised by the interviewers about how simply superb my spoken English was to how honestly I answered their questions and what a fun time they had talking to me,to keep in touch, to please consider their program highly and they hoped they would see me there in July! If someone can explain to me what happened,it would be a bit easier to take after all this!
Most of the places I went to,people either had very high scores or they had a degree from another country,or top research and publications.(IMGs)My scores are on the lower side so when the review committee reviews our stuff in the end,I have neither but I thought I had my writing and my talking to keep me going,however I realise it does not work that way! I got hit really hard and underwent all of Kubler-Ross stages over the past couple of weeks..honestly! Now,I'm more determined than ever though-that's why I don't want to do small(observing at county hospitals etc) things anymore..if I can get into a research position it would help me find my way inside for more clinical work.(I'm good at networking but never thought it was necessary until now!) Also,not getting paid is fine with me for now..I have support.
Can someone also tell me if an internship in women's health (mood and hormone clinic etc) would help if its at a big institution?

 

[whopper]

I don't know what may have thrown a wrench in your works but here's some things I & other people in my program saw as red flags.

1-a personal statement that did not mention interest in psychiatry
2-letters of reccomendation--none by a psychiatrist
3-any problems mentions in a letter of reccomendation (people who write these letters often times know that mentioning a problem is the kiss of death)
4-a criminal history
5-a resident that was removed, kicked out from a program or medschool (we would investigate why--e.g. some people get out of a program because they realize they didn't want to do surgery & wanted to do psyche--in which case we wouldn't hold it against them. If they were kicked out due to poor performance, that's another story)
6-poor interview skills (poor eye contact, flat affect, alogia, anhedonia--yes I've actually had 2 candidates that looked like strong negative sx schizophrenics)
7-no visa (for non US citizens)
8-multiple failures on USMLE (more than 2, the more failures--the worse). This could be offset a bit if the person passed Step III.
9-no IMG would be considered who did not pass USMLE Step II, however if a US grad did not take it, it would be weighed against them. We have had US grads not yet pass the exam, take it before residency started, then while in residency get a failing score--prompting their removal.

Not 1 applicant I interviewed had poor speaking English. However I have heard several programs holding this against a candidate.

In terms of extra-curricular activity during time off, the activities I was most impressed with were--clinical work, leading to a letter of reccomendation stating something to the effect that the person was just as good as what they'd expect from a psychiatrist. Had a few of those. One of the applicants worked on a PACT Team and got a letter of reccomendation saying although the person could not practice as a psychiatrist on their team, the person's clinical skills were excellent. That same applicant during interview was able to talk about his experiences as if he was a senior resident.

Research--if its done with a notable psychiatrist, with a strong letter of reccomendation and with a publication.

I need to tell you however that I have seen several people work in research, bend over backwards for some ridiculous amount of money (nothing, $1 an hour, $3 an hour) and then seeing it not help them much, if at all.

If you got a real prick doctor you're under when doing research, they're going to treat you like trash while basically working for them for less than minimum wage, and then the joker won't even write you a good letter of reccomendation. I've seen that happen to lots of medstudents who worked under a narcissistic "I believe being rude to students teaches them best" researcher.

A guy I knew got into plenty of D.O. schools but wanted an M.D. He spent 4 years working for free at NYMC under one doc who told him he'd get him into NYMC. Then on the day they decided who got in, that doc didn't show to the admissions meeting, that guy I knew didn't get in. He ended up going to NYCOM-a school he had got into previously. He spent 4 years, working for nothing. The doctor that didn't show to the meeting acted as if it was no big deal. Oh yeah he learned some research (he wanted to be a clinical doc) but the intellectual benefit plateaus after about a few months.

If you do research, make sure its going to be worth it.

 

[mgdsh]

Hi,I was called by one program mainly based on my personal statement(that's not good,I'm thinking now) and also I was told by several interviewers at other places that my personal statement was indeed very impressive! As soon as I finished each interview,I was praised by the interviewers about how simply superb my spoken English was to how honestly I answered their questions and what a fun time they had talking to me,to keep in touch, to please consider their program highly and they hoped they would see me there in July! If someone can explain to me what happened,it would be a bit easier to take after all this!
Most of the places I went to,people either had very high scores or they had a degree from another country,or top research and publications.(IMGs)My scores are on the lower side so when the review committee reviews our stuff in the end,I have neither but I thought I had my writing and my talking to keep me going,however I realise it does not work that way! I got hit really hard and underwent all of Kubler-Ross stages over the past couple of weeks..honestly! Now,I'm more determined than ever though-that's why I don't want to do small(observing at county hospitals etc) things anymore..if I can get into a research position it would help me find my way inside for more clinical work.(I'm good at networking but never thought it was necessary until now!) Also,not getting paid is fine with me for now..I have support.
Can someone also tell me if an internship in women's health (mood and hormone clinic etc) would help if its at a big institution?

Just a couple points to remember:
- the matching process is largely a political game. A lot of program directors will tell people that they'd love to see them there, and ask for their program to be ranked highly.
- Research is great and probably helps at the larger institutions, or it gives you something to talk about during interviews, but in the end...
- I think for you taking and passing your step 3 is the most important thing. As you've mentioned your scores are on the lower end. You can eliminate a lot of concerns by simply passing your Step 3. Not only would you eliminate a lot of concerns, but you'd be preferentially ranked because of it.

I'm also assuming that you have US CE. That's also important, but I figure you probably could knock Step 3 out in a few months and have plenty of time left over to do research or work in a psych related facility.

 

[Faebinder]

Just a couple points to remember:
- the matching process is largely a political game. A lot of program directors will tell people that they'd love to see them there, and ask for their program to be ranked highly.
- Research is great and probably helps at the larger institutions, or it gives you something to talk about during interviews, but in the end...
- I think for you taking and passing your step 3 is the most important thing. As you've mentioned your scores are on the lower end. You can eliminate a lot of concerns by simply passing your Step 3. Not only would you eliminate a lot of concerns, but you'd be preferentially ranked because of it.

I'm also assuming that you have US CE. That's also important, but I figure you probably could knock Step 3 out in a few months and have plenty of time left over to do research or work in a psych related facility.

All what Whopper said I agree with 100% and it's right to the point. I would agree with mgdsh and Whopper that the next step for you is Step III then start thinking research/clinical experience.

 

[TheWowEffect]

6-poor interview skills (poor eye contact, flat affect, alogia, anhedonia--yes I've actually had 2 candidates that looked like strong negative sx schizophrenics)

LOL...are u serious? I hope you are joking but I agree that one of the main personality traits you want to have is to be engaging. Even if you are not so naturally, you have to appear to be that.

 

[drmaya]

My personal statement spoke so much about my life and how it all lead to me wanting to do psychiatry.3 of my LORS are from Psychiatrists.I always make good eye contact and no-I don't exhibit any schizophrenic traits!
I don't see much else except my scores and not very good clinical experience in the U.S. I also have a gap after my graduation and I was asked about this by almost everyone-did not have a great reason to give for this too.
Thanks for all your suggestions and input. I will do what I can but I'm definitely going to be a much better candidate next year! And yes,if I feel the particular research is not useful,I won't pursue it any further.

 

[TheWowEffect]

My personal statement spoke so much about my life and how it all lead to me wanting to do psychiatry.3 of my LORS are from Psychiatrists.I always make good eye contact and no-I don't exhibit any schizophrenic traits!
I don't see much else except my scores and not very good clinical experience in the U.S. I also have a gap after my graduation and I was asked about this by almost everyone-did not have a great reason to give for this too.
Thanks for all your suggestions and input. I will do what I can but I'm definitely going to be a much better candidate next year! And yes,if I feel the particular research is not useful,I won't pursue it any further.

After all is said & done, you just have to saddle up for the next year. What happened with you can happen to best of the candidates.

I think your idea about women's health and mood disorders research is a good one. And yes, an unexplained gap is a big red flag. So, may be if you can 'find' a good explanation, it'll serve you well.

 

[drmaya]

Also,I want to add that I know for certain I was liked by a couple of programs but I know we IMGs are ranked mostly after the AMGS in particular programs. So,even if we connected really well-I know that my top 2 choices matched their own graduates and a couple other people known to them/had strong family ties there/did rotations there-the programs had just 4 or 5 spots,so in the end I was competing just for one spot(even of that I'm not too sure)
So,is it better as an IMG to apply this year to more community programs which are mostly filled with IMGS and leave out the more AMG friendly programs?

 

[OldPsychDoc]

Also,I want to add that I know for certain I was liked by a couple of programs but I know we IMGs are ranked mostly after the AMGS in particular programs. So,even if we connected really well-I know that my top 2 choices matched their own graduates and a couple other people known to them/had strong family ties there/did rotations there-the programs had just 4 or 5 spots,so in the end I was competing just for one spot(even of that I'm not too sure)
So,is it better as an IMG to apply this year to more community programs which are mostly filled with IMGS and leave out the more AMG friendly programs?

I think that experience of others would bear out that you should apply as widely as you can stand to. I don't know whether you need to or wish to limit yourself geographically or on some other criteria, but your chances are probably better in smaller community programs.

How many programs did you apply to? Get interviews for? Rank?

Step 3 will definitely help.

 

[Anasazi23]

Thanks for the replies.Scrambling as an IMG is easier said than done-I've tried my hardest..but Anasazi..if you could recommend me anywhere for a spot now,I'll be happy to call and talk to you!!
Whopper,I'm looking to do volunteer research since its hard to get a paid one especially at a good place and that is okay with me.I'm in Northern California.Its really hard to get much clinical experience here especially at any UC.But,volunteer research is easier-maybe getting into it and then networking my way to some clinical work would help?
Also,I have a greencard,but my citizenship could take a while-maybe another year!
Any more suggestions from anyone?

I agree with OPD. Step III is huge in your case.

Can I ask from what country you're coming from med school, and is that different from your country of origin? We might be able to steer you to a more specific location if we knew.

 

[GATORANALYST]

I'm an IMG,non-u.s citizen who did not match this year.I thought everything went on well until I got my results! I'm getting over it slowly and want to ensure that I match this coming year-I realize I don't have that much time left,I'm looking for some advice.I'm looking into doing a research with a well-known person in a big university in the U.S(in psychiatry),it could give me the possibility of or atleast working toward-a publication plus a good recommendation. I'm also looking to do some other clinical work like shadowing someone at the university. Does anyone recommend anything else that would increase my chances?

How many did you apply to?

 

[SamusLives]

Sorry to hear that you did not match. Don't give up though. If you need to apply to a lot of community-based "safe" programs, do it!! Maybe the programs are not considered as good as a university-based program, but so what. When you finish your residency, get licensed, and board-certified, your patients won't care were you did your residency. I give this advice assuming you want to be a clinician.

Unless you know for a fact that you only want to do research, you don't need to do your residency in an academic setting.

Getting your residency started is the most important thing, you'll end up with the same board-certification as everyone else.

I wish you the best of luck.

 

[drmaya]

Thanks for all the replies. I went for 7 interviews and ranked all 7.All of them had between 3-6 spots,not more.(only one was a community hospital in the midwest) I'm from India and did my medical school there too. What are the community programs that are considered easier to get into for psychiatry?
And yeah,Samuslives,what you say is true-as a doctor,not where we train but what we make of ourselves is what is important-I did not see that as clearly as I do now.I feel I have the passion and the ability to be an excellent psychiatrist-now all I need is the opportunity: one program to train at.
Anyone who knows/gets to know in the future of any open positions available for this year,please keep me in mind.

 

[Anasazi23]

Try the third tier psychiatry residencies in New York City.

i.e. harlem hospital, jamaica hospital, metropolitan hospital, creedmore, Brookdale, Maimonides, Elmhurst, etc. I know that they have plenty of Indian-born docs there, and they have more spots in most cases than what you described.

 

[SamusLives]

You can try looking on FREIDA online. It tells you if the program is university or community based, how many positions they have, etc. I used it when selecting programs. I also sought advice from the PD and associate PD at my school about my picks, they were able to tell me which "tier" my picks were--1st, 2nd, 3rd.

 

[whopper]

went for 7 interviews and ranked all 7.All of them had between 3-6 spots,not more.(

7 isn't a bad number. I'd still reccomend more, but I've seen several people get in to a decent program on 7.

You might not be in as bad a siutation as you might think you are.

Yep, I did get 2 interviews where I got a strong clinical impression that the applicant had some type of psychotic illness. I didn't want to ask them if they had mental illness because that IMHO is too pointed a question & too personal. We chose not to rank those 2, not only because I sensed it but so did the attendings who interviewed them and the program coordinator who mentioned their phone calls were "out there".

 

[goodmedi]

I totally agree with whopper and Faebinder!

I think you just fell short in the match.
Just as everyone says, take the Step 3 to compensate your low scores.
If you did get 7 interviews for this year, you will get much more with passing step 3.

And bear in mind that the match is a game. As an IMG myself, you should think you will be ranked in the third tier. Apply broadly next year.

 

[drmaya]

Thanks everyone. Yeah I guess I just fell short in the match-that is a good way to put it!
I was wondering if whopper or someone else who is familiar with this ranking can post how exactly its done-just so we can have a general idea. I know everyone has 1 vote/2 votes and all that-what does this mean? Like they start discussing one candidate-and people can choose to vote for that person or not and in the end the total votes are counted up? i'm just guessing-I have no clue! Also,how much does the PD's word have effect on this process? thanks.

 

[OldPsychDoc]

Thanks everyone. Yeah I guess I just fell short in the match-that is a good way to put it!
I was wondering if whopper or someone else who is familiar with this ranking can post how exactly its done-just so we can have a general idea. I know everyone has 1 vote/2 votes and all that-what does this mean? Like they start discussing one candidate-and people can choose to vote for that person or not and in the end the total votes are counted up? i'm just guessing-I have no clue! Also,how much does the PD's word have effect on this process? thanks.

I think it varies by program. We start our ranking meeting with a list already ranked by applicant's "scores" from interview day--ratings by the interviewers. We then run through every one in order, looking at relevant interviewers' comments--pluses and minuses--and basically decide whether to place someone in the top, middle, or bottom third, or to drop them entirely. We try to rank enough so we don't go into our bottom third--where the question usually is, "would we rather take on this 'project' or hope to do better in the scramble". Lately, that hasn't been an issue--I think our lowest was toward the bottom of the middle tier. There's always some lobbying to move Ms. B above Mr. G for various subjective reasons, but we work it out without fisticuffs. The PD's word may have a somewhat greater weight, but that's because they have actually talked to all of the applicants, whereas the rest of us have only met a portion of the total.

 

[whopper]

I think it varies by program.

It certainly does.

While I too have the general impression that IMGs are ranked lower than AMGs, the 2 worst residents my program ever had were AMGs.

One of the biggest ironies is these 2 residents hated each other & bickered all the time, were in the same year & we thought they were going to be 2 great residents.

............and my program kicked them out.

Anyway, I digress. Sorry, I'll get back on topic.

My own program doesn't seem to put AMGs on a higher pedastal then IMGs so long as the IMGs we feel would be good residents. In general, most of the AMGs that applied we thought would be good residents, while about 25% of the IMGs that applied we thought would be good. However once IMGs got past that cut, we didn't think of them as any worse.

And it wasn't as if it was difficult to make it past that cut. Several IMG applicants for example didn't even mention their interest in psychiatry in their personal statement, or had any letters of reccomendation from psychiatrists.

Several of the IMGs that applied we felt were our top applicants, even more so than several AMGs.

How the process worked I'm sure varies because our own program didn't have a set in stone process that was overseen by any standards entity. Several things we used as criteria were subjective. It never got the point where we even had to vote. We put all of our top applicant's faces on a projector, talked about all of them as a group and ranked them in a manner where everyone agreed.

 

[drmaya]

Thanks for the replies. OPD: How much do people's interview scores vary from the other-a lot or just a subtle difference between some?
What else does the committee look at when deciding mainly? Do you go through individual personal statements/CV etc again?
And for example- someone with poor scores and less usce did somewhat better on the interview than someone with higher scores and more usce-how would that be decided?

 

[OldPsychDoc]

Thanks for the replies. OPD: How much do people's interview scores vary from the other-a lot or just a subtle difference between some?
What else does the committee look at when deciding mainly? Do you go through individual personal statements/CV etc again?
And for example- someone with poor scores and less usce did somewhat better on the interview than someone with higher scores and more usce-how would that be decided?

Some vary a lot, others just a little.

We look at commitment to psych, clear communication skills, academics (including board scores--I've said it before, we don't want to lose a resident because they can't pass licensing exams!), and US clinical experience. And if you have poor scores and no usce, it we might still rank you, but you'll be a bottom third. Unless your a complete jerk, in which case we may bottom third (or even no-rank) you even if you have phenomenal scores!

 

[drmaya]

..

 

[drmaya]

Thanks OPD. These answers have been of immense help to me. I'm pretty sure this is what happened to me-my scores are above the 80th percentile,but Imgs who have less than that,hardly get called for interviews! Also,I did have some USCE-but more like county observerships .So,either way tons of people had more of scores or usce than I did. I thought since I was called for an interview and each of my interviews went simply great,I did have a good chance. Now,I need to to put something on my CV that makes me get ranked higher. I've scheduled a research interview next week with someone at a big university who is very well-known and has several publications/textbooks written in psych-hopefully I get it-do you think that would help any??

 

[whopper]

A good letter of reccomendation would help, especially if you got in some publications. Also if that researcher knows anyone personally, he/she might be able to open a few doors here or there.

However research IMHO is highly variable as to how much it'll help and it it tends to weigh on the not helping much side. A passing USMLE III IMHO is a stronger thing to help your application, and will make like much easier once you're in residency.

Interviews also highly vary as you may have already noticed. Some programs have you interviewed by a battery of doctors, only 10-15 minutes each. Some will have you spend a long time--like an hour with only a few, others will have you interviewed as a group by several all at once.

My own program does the 10-15 minute thing which I am neutral on. IMHO you really can't scrape the superficial surface in that much time & you're only going to be able to rate some of the more superficial aspects such as eye contact, speech, interview skills, but you won't be able to talk about some of the more in depth things.

I would still pursue research if you have a good feeling that the researcher you will work with will be a good mentor (remember my warning above, several researchers I've seen are out to get people like you as cheap labor), but get USMLE III out of of the way too, and focus more on that.

 

[Nika]

Cedars-Sinai has externship program. You can find information about it on their site.
Get high score on step 3. I think it would be helpful.
I'm an old IMG with experience as a psychiatrist in my home country. My English is not very good yet, but I have great scores on steps 1&2. I've applied in 19 programs (just West coast) and got 9 interviews. I got into my #2. The program that I liked a lot. Actually my #1 was #1 only because of geographical reason. I think scores really matter, epecially for IMG.

 

[RRoguish]

Hi drmaya. I'm assuming you really wanted to get into Psychiatry which is why you posted here. Hope you've put together a great plan based on all the suggestions so far, but if you haven't, I would really recommend looking into the last post by Nika (externship). I'm also an IMG, matched into Psych this year thankfully, and based on my experience, I think US Clinical experience with very strong LORs from this experience is an absolute essential -- because it's really the only thing that assures the PDs of actual performance that they can expect of you as a resident. I didn't do any shadowing upon the advice of an IMG internist who pointed out that anyone can shadow, it won't say anything about your skills. I didn't do the research route as it didn't seem it would be helpful from what I gather, also I don't have personal interest in it, it wouldn't make sense to say in my interview that my goal is to be a great clinician and yet opted to take a research associate job while in the States. Also, try to get into jobs or volunteerships that are psych-related -- rehab facilities, suicide help lines, behavioral therapist (I taught autistic kids for a while since I have an interest in child psych).

So my best advice in a nutshell is get into an externship from a respectable institution and absolutely EXCEL in it to get great LORs. I think it will help a lot to offset low USMLE scores. Take and pass the Step 3 if you haven't. If you have a way to get sponsored for a green card, do so if you don't have one already.

Also I got a hold of this book "Successful IMG" and it was extremely helpful in helping me formulate my strategy. In fact I'm selling my copy right now along with a bunch of other helpful books (shameless plug-in).

Best of luck and feel free to PM me if you wish.

 

[FURY 161]

Try the third tier psychiatry residencies in New York City.

i.e. harlem hospital, jamaica hospital, metropolitan hospital, creedmore, Brookdale, Maimonides, Elmhurst, etc. I know that they have plenty of Indian-born docs there, and they have more spots in most cases than what you described.

She will get better training in India than in the NY slums mentioned . With scores in the low 80-ties it is quite possible to get a 2nd tier program in the midwest. She has to apply to more community hospitals and less university hospitals next year, pass step 3 and she will be fine. There is no need to go for the mentioned programs unless you have a criminal record.

 

[drmaya]

Thanks for all the very valuable suggestions. Fury-LOL,that is so funny-thankfully I don't have a criminal record! But I honestly don't think those hospitals are soo bad
I have got two research positions(one of them is a research cum observership),am planning to split the week so as to cover both and will be starting soon once the orientation and paperwork are done. Both are at highly reputed institutions in California under very big people and I have already been given the papers to work on for publications(an IMG who started to work there 2 months back has already finished a paper),so I'm hoping something good comes out of it! I'm also studying for step 3.
With a month and a half having passed since the match results-I'm not as distressed as I was and have comfortably settled back into my old life. I feel that something good is going to come out of this ,after all everything happens for a reason! I think I can only be a better candidate next year than this one- I will sure be back to post my success story next year!
Roguish,thanks -I will PM you.

 

[drmaya]

Also-I contacted Cedars Sinai-they do not offer externships anymore,thats what they said over the phone. The other places in NY where the formal externships are offered have already started in Feb/March and the applications and interviews for those were in Nov-Feb or so,while I was interviewing for residency and expecting to match! I've tried for externships everywhere and it looked like its a closed door hence my decision to pursue the next best thing I could.

 

[Ritz]

Try the third tier psychiatry residencies in New York City.

i.e. harlem hospital, jamaica hospital, metropolitan hospital, creedmore, Brookdale, Maimonides, Elmhurst, etc. I know that they have plenty of Indian-born docs there, and they have more spots in most cases than what you described.

Narcissism? coming from the moderator. Naaah may be just trying to help...