unmatched in FM: need some help analysing

[medicienne]

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I didn't match for 2008 residency and I need some help to analyze my mistakes and improve my profile for 2009 match.

Main points:

1. FMG, Grad year 2005 (+ 1 year transitional internship)
2. Scores: Modest, ecfmg certified
3. US clinical experience: 3 months with 3 great letters of reference
4. Experiences: 2005-2006: 1 year work exp as GP in India
2006-2007: Some gaps on CV. Studied for USMLEs Step 1, 2-CK and CS, volunteered, made contacts, CME, then got clinical experience.
2007-2008: research experience but not clinical ( can't get it as of now only getting rejections).

Whats the best way to improve my application?

(A) Step3 + continue research, CME
(B) Clinical experience full-time, no step3 ( some sort of observership/assistant?)
(C) Step3+ research+ 1 day at free clinic ( thats the closest to 'clinical' experience I could get as of now)?

I need your inputs. I need some leads and ideas on 'how' to get clinical experience or 'off cycle' positions I may be able to apply. I have graduated so I am finding it very hard to get a formal rotation.

Thanks for your suggestions.

 

[mlw03]

i don't know how much research is going to bolster your application for family medicine; it's not really a research-intense field. things i would ask you is: how broadly did you apply? were you applying to competitive programs in desireable locations? how well do you speak English? - this one is key, because if your interviewers think you have poor communication skills, nothing else will matter, especially in primary care. i do think passing step 3 would be helpful. also, make it known you'd consider signing outside the match (assuming you would, which you probably should since you already failed to match once).

 

[gng930]

I hate to say this but your graduation date will continue to have adverse affect on your application. A lot of places don't consider anyone who's been out of school for more than 5 years, and that's a very generous statement.

 

[Top Gun]

You also need to think about how well you interviewed. We don't know you, so we can't say how your interview skills are. Did you feel that you established some sort of rapport with your interviewers? Interviewing can make or break you. The interview can be used as a factor in deciding how you will be ranked.
Also, apply to a wide range of programs, particularly ones that are IMG friendly. There are websites that will give you information about IMG-friendly residencies and also about criteria for being considered by these programs.
Having graduated from med school 3 years ago may have had a negative impact on your application as well. The longer you are out of med school, the less likely you are to be considered. But give it another try for next year. Try to get a family practice externship or at least shadow a family physician in clinic. At least the programs will know that you have tried to keep your hand in clinically all this time.

 

[BabyPsychDoc]

IMHO, it is far more important that you are currently out of clinical practice than your year of graduation. I know someone who graduated in 2003 and matched in psych last year, and I also know someone who graduated in 1999 and matched in psych this year. BUT, they both have been in active clinical practice in the UK right through the match season.

Are you actually able to get some clinical experience in a free clinic? If yes, then by all means go for it. I am a little confused though: i thought you still need to have US licence to do that.

Also, the fact that you have been shortlisted and interviewed means that the programs are probably not that concerned with you clinical experience (otherwise they would not have shortlisted you in the first place!). So, do look into your interviewing skills. Your English seems pretty good, based on your post, so it might be your accent (I think I can say this, since I have an accent myself!) or your general attitude (which may be fine as far as Indian culture is concerned, but may be out of ordinary as far as you are seen in the US).

How did you work as a GP in India? I thought you needed to do some PG training to do that (based on what my Indian friends tell me). Was that your internship?

 

[MushieCookie]

take step 3 and ROCK it...

if you can get clinical experience here in free clinics...go for it.
Research is less important if your applying to FM at this point in the game.

Good luck.

 

[iamcatwoman]

Keep in mind that some programs require clinical experience at hospitals with ACGME residency programs, and the clinical experience at a free clinic will not count. However, it is a really good way to learn about local healthcare and sociology. It's also a great way to meet local physicians and nurses, which may help if you're applying to nearby residency programs. You may get some good LORs too.

 

[BlondeDocteur]

Agree with above. Are you set on FP? It sounds like you worked at a GP in India, which will go a long way towards assuaging program directors that you're not just applying to 200 programs in any specialty in an attempt to match.

Secondly, where are you living in the US? Do you have family here, anywhere? If you apply to the rural states-- which are medically underserved and would love a competent, passionate doctor such as yourself-- it goes a long way if you can prove you have some ties to the region. The reason is that they don't want to just train people and have them move away, but rather to actually provide doctors for their area. So if you can come up with a great reason to live in, say, Mississippi ("the weather reminds me of home!") it will greatly aid your chances in the match.

(And as someone who comes from the middle of the country-- AKA "flyover country"-- I can tell you that the region has its charms, and is very welcoming to immigrants).

Lastly, I think your third option is the best. If you have the time, money and inclination, earning a degree like an MPH is a valued option, particularly for FP.

 

[medicienne]

IMHO, it is far more important that you are currently out of clinical practice than your year of graduation. I know someone who graduated in 2003 and matched in psych last year, and I also know someone who graduated in 1999 and matched in psych this year. BUT, they both have been in active clinical practice in the UK right through the match season.

Are you actually able to get some clinical experience in a free clinic? If yes, then by all means go for it. I am a little confused though: i thought you still need to have US licence to do that.

Also, the fact that you have been shortlisted and interviewed means that the programs are probably not that concerned with you clinical experience (otherwise they would not have shortlisted you in the first place!). So, do look into your interviewing skills. Your English seems pretty good, based on your post, so it might be your accent (I think I can say this, since I have an accent myself!) or your general attitude (which may be fine as far as Indian culture is concerned, but may be out of ordinary as far as you are seen in the US).

How did you work as a GP in India? I thought you needed to do some PG training to do that (based on what my Indian friends tell me). Was that your internship?

Thanks for your input! I did have GP experience at a supervised level b/c my school required an additional 1 year rural service option which was good for me b/c I knew I wouldn't be staying there long enough to do residency.

Free clinic work is at the level of a 4th yr medical student under an attending.

 

[medicienne]

You also need to think about how well you interviewed. We don't know you, so we can't say how your interview skills are. Did you feel that you established some sort of rapport with your interviewers? Interviewing can make or break you. The interview can be used as a factor in deciding how you will be ranked.
Also, apply to a wide range of programs, particularly ones that are IMG friendly. There are websites that will give you information about IMG-friendly residencies and also about criteria for being considered by these programs.
Having graduated from med school 3 years ago may have had a negative impact on your application as well. The longer you are out of med school, the less likely you are to be considered. But give it another try for next year. Try to get a family practice externship or at least shadow a family physician in clinic. At least the programs will know that you have tried to keep your hand in clinically all this time.

I only got few interviews ( applied only in 2 states b/c of personal reasons)and it didn't help that my application was complete only in November.
I thought one of the interviews went well and I got to know I was ranked but not high enough to match in a program of 4.
I am looking for an externship but the clinic experience is all I can get right now.

 

[medicienne]

Agree with above. Are you set on FP? It sounds like you worked at a GP in India, which will go a long way towards assuaging program directors that you're not just applying to 200 programs in any specialty in an attempt to match.

Secondly, where are you living in the US? Do you have family here, anywhere? If you apply to the rural states-- which are medically underserved and would love a competent, passionate doctor such as yourself-- it goes a long way if you can prove you have some ties to the region. The reason is that they don't want to just train people and have them move away, but rather to actually provide doctors for their area. So if you can come up with a great reason to live in, say, Mississippi ("the weather reminds me of home!") it will greatly aid your chances in the match.

(And as someone who comes from the middle of the country-- AKA "flyover country"-- I can tell you that the region has its charms, and is very welcoming to immigrants).

Lastly, I think your third option is the best. If you have the time, money and inclination, earning a degree like an MPH is a valued option, particularly for FP.

I actually applied to 40 programs and I thought that was a lot 🙁
I am looking for programs in midwest this time-Wisconsin, Minnesotta and others depending on their criteria.

 

[medicienne]

Yes, I noticed that in the criteria of a lot of programs. I know some internal medicine programs that offer such experience but I simply have not seem FM programs offering this.
If anyone knows or can give me a lead, please post here!

Keep in mind that some programs require clinical experience at hospitals with ACGME residency programs, and the clinical experience at a free clinic will not count. However, it is a really good way to learn about local healthcare and sociology. It's also a great way to meet local physicians and nurses, which may help if you're applying to nearby residency programs. You may get some good LORs too.

 

[iamcatwoman]

Yes, I noticed that in the criteria of a lot of programs. I know some internal medicine programs that offer such experience but I simply have not seem FM programs offering this.
If anyone knows or can give me a lead, please post here!

Clinical Experience in Internal Medicine would still be really good for FM.

 

[jennyboo]

- Take Step 3.

- Apply to more programs.

- Get your application uploaded September 1, not November. This makes a huge difference and is possibly the most important thing. You will get interview offers in September that you would not get in November.

- Have someone look over your CV, personal statement and any supplemental materials you wrote yourself. Try to pick someone who's smart with good writing skills and a knack for selling things (like a friend who's a smart MBA or works in marketing, and/or a US medical grad who's matched competitively and has good English). They may have a better eye for things you can market about yourself than you do.

 

[medicienne]

Thanks for your advice. I think I especially need to look at # 3 closely this time.

- Take Step 3.

- Apply to more programs.

- Get your application uploaded September 1, not November. This makes a huge difference and is possibly the most important thing. You will get interview offers in September that you would not get in November.

- Have someone look over your CV, personal statement and any supplemental materials you wrote yourself. Try to pick someone who's smart with good writing skills and a knack for selling things (like a friend who's a smart MBA or works in marketing, and/or a US medical grad who's matched competitively and has good English). They may have a better eye for things you can market about yourself than you do.

 

[medicienne]

I hate to say this but your graduation date will continue to have adverse affect on your application. A lot of places don't consider anyone who's been out of school for more than 5 years, and that's a very generous statement.

I moved to here from a different country and had to take the USMLEs. That automatically sets you back by couple of years. There was nothing anyone could have done in this situation.

 

[turquoiseblue]

I moved to here from a different country and had to take the USMLEs. That automatically sets you back by couple of years. There was nothing anyone could have done in this situation.

I'm kind of in your boat but a little worse off.
I agree--take step 3. Do on and off clinical work if you can, so you can keep updating your LOR's--they don't like old ones much.
If you can get a publication, great but it's probably not going to help too much, although it can give some weight. I worked in research for a year at a prestigious hospital plus a publication and 2 on the way, and it didn't help me one bit in getting a position. So there's an example not to follow.
I asked a few PDs and they said that we need to be doing clinical work, because residency is largely clinical. So maybe medical assisting will do you some good if you want to get paid. You can also just do on and off clinical observerships to keep up--that could help. You were only out 3 years, not 5 so don't worry so much right now. You have a chance. Apply to a lot of FP that you qualify for all over the country--no matter where. Try programs from residencymatching.com, where they can get you the programs you qualify for. You'll get it sooner or later im sure. Just make sure your LORs have good things about you particularly about english, knowledge, that you are a hard worker, that you are impressive and that the recommend you without hesitation to residency etc. to make you more credible.

Also, don't forget to include your reasons for graduating late in your personal statement, like "still in my country during that time, had to take time off to study for USMLE's, etc. whatever it was, explain the gaps.

Hope it helps a little at least!

 

[Winged Scapula]

I moved to here from a different country and had to take the USMLEs. That automatically sets you back by couple of years. There was nothing anyone could have done in this situation.

The USMLEs (at least Step 1, Step 2 CK and Step 3) are offered all over the world. With the exception of Step 2 CS you do not have to come to the US to take the exams.

In addition, most students do not take two years to take them. Not that I am not sympathetic to your plight but living outside of the US is not a reason to not be able to take the USMLEs before graduation and to take 2 years to complete them.

 

[medicienne]

The USMLEs (at least Step 1, Step 2 CK and Step 3) are offered all over the world. With the exception of Step 2 CS you do not have to come to the US to take the exams.

In addition, most students do not take two years to take them. Not that I am not sympathetic to your plight but living outside of the US is not a reason to not be able to take the USMLEs before graduation and to take 2 years to complete them.

I'm sorry you misunderstood. I only made the decision to take the USMLEs after graduating from medical school and following my relocation. I hope I am clear by now? I bet you also don't know that it takes 1-2 years ( in my case 2 years) to get legal work-permit in the US ( that also for the lucky few who have a direct relative like a spouse or sibling who is a US Citizen).
And most people have some gaps in the resume whether they like it or not because its very hard to get somebody to give you that opportunity due to "liability issues". It takes months of volunteer work and establishing contacts to get a decent work experience that you can put on your CV for residency.

I am not saying this as a matter of defense but I think its high time I address some of the ignorance building up here and elsewhere. Its easy to do residency in your own country but it gets some guts to get out of your comfort level and pursue that in another.

On the other hand, your response gave me an insight of what some PDs may have been thinking when they saw my application so I will use this as a lesson and make my application better.

 

[medicienne]

Also, don't forget to include your reasons for graduating late in your personal statement, like "still in my country during that time, had to take time off to study for USMLE's, etc. whatever it was, explain the gaps.

Hope it helps a little at least!

Thanks! I think I made the mistake of not explaining all these in my CV. judging from a response I got here I think some PDs may have had misunderstandings. This time I will make sure I address this clearly.

 

[Winged Scapula]

I'm sorry you misunderstood. I only made the decision to take the USMLEs after graduating from medical school and following my relocation. I hope I am clear by now?

Thank you for the clarification, that does help.

I bet you also don't know that it takes 1-2 years ( in my case 2) to get legal work-permit in the US ( that also for the lucky few who have a direct relative like a spouse or sibling who is a US Citizen).

I actually did know that, although I am not sure why you needed the work permit unless you had to come to the US and needed to work.

On the other hand, your response gave me an insight of what some PDs may have been thinking when they saw my application so I will use this as a lesson and make my application better.

I wish you the best of luck with your application.

 

[medicienne]

Thanks. Well, I am under no illusions. I want to continue practising medicine but its easy to fall through the cracks given my situation. Physician or not everybody needs to move on and work. I am no exception and who knows my second act may turn out better 😉

 

[buckley]

I agree with Winged and I would not say "taking time off to study for the USMLEs." I know it is a monster, and the pressure is intense to score high, but studying for it is not really an explanation for lag time. One PD told me he was impressed I took the USMLEs in a short time. I said, I decided late to come over to the US and I wanted to make up for lost time. And then he went to this litany about how he couldn't fathom why some IMGs spend years on it. Technically, in the eyes of the world, you should not be taking time off to study for them--we all know you do, just depends how long, right? But if you say that, I think you're basically shooting yourself in the foot. If you get a high score, well--hello you studied a year for it?! If you get a low score--it's the same, hello you studied a year for it?! If you get average--it's the same.

If you can't really help it, then turn the conversation around by saying stuff like when you commit to something, you really commit to something...

Apply early, charm the interviewers, and hope for the best!
good luck!