UQ-Ochsner 2016

[deleted158872]

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I am able to pay zero dollars to my loan and have it count towards my PSLF. Meaning that since I am looking at a long training duration (3 fellowships... told you I'm insane) I will end up paying only about $175k of my ~$400k loan.

oh this is great! i didn't know that we could do PSLF while in training O_O

 

[bebijoon]

Question: does MedEdPath even look at your application before giving out interviews? Or is it simply whoever has the minimum requirements gets one? I literally sent in my application this morning and got an interview email several hours later. Is that normal?

 

[Rhandhali]

how about: my plan is to practice in the UK (and hence i don't have to worry about the USMLE)?

@Maruko
Honestly I would see what @nybgrus said earlier. If you want to go to the UK I would look at applying to schools in the United Kingdom. If that isn't an option I would apply to UQ as a "traditional" four year student, or to other schools in Australia & the Commonwealth.

There's really no reason for you to sign on to the UQ-Ochsner program if you don't intend on pursuing residency training in the United States. I don't see where there are any real advantages to you for doing so and it may well be counterproductive. You're going to have two years of US training under your belt and you will have letters of recommendation from American physicians.

You are going to look for all the world like someone that stands a good chance of taking off partway through your contract when they match a position in the US. Australian internships start in July for example. There have been students who took an internship knowing that they still stood for the match and resigned after they knew they had a spot Stateside. Several Canadians from my class entered into internship agreements in bad faith and will be returning to start US residency positions this July after doing half or less of their one year contract.

I would imagine the powers that be would be leery of someone who has the faintest whiff of possibly taking off. Why should they take a chance on someone who might break contract, leaving them short staffed and essentially robbing an applicant who would have stayed of their position? Everything on your CV and in your applications is going to scream that you are going to take off back to the States.

Google the Ochsner program and see what comes up. This is something any internship anywhere in the world is going to do when they see that you were in this new program they probably haven't heard of.


The Official UQ Page Says

They have joined to create a distinctive program for outstanding students that will lead to the practice of medicine in the United States.

Ochsner's Fact Sheet Says

With visions and missions that are highly complementary, two world-class academic medical institutions joined to create a unique program for outstanding U.S. students that would lead to their practice of medicine in Louisiana and other U.S. regions.

MedEdPath's About the Program Page says

They will then spend two years in New Orleans and/or Baton Rouge, Louisiana at Ochsner Health System, completing their core and elective clinical rotations. Upon satisfactory completion of the four years, students will be eligible for ECFMG certification, to take the USMLEs, for the NRMP match, and to practice medicine in the U.S.

This is on top of all the US-specific stuff like match statistics, USMLE, comparisons to US medical programs and so on so forth. Everything you find about the program screams that you're in it because you want to practice in the US. I am also fairly certain that the MSPE/Dean's Letter reflects the goals of the program to train US medical students for practice in the US as part of the introduction.

oh this is great! i didn't know that we could do PSLF while in training O_O

Residency is legally a form of employment and most teaching hospitals are nonprofits. However, it would really only apply if you're working in the US. Which, in order to do as a physician, you must at some point in your career take all four parts of the USMLE and stick with a nonprofit job for 10 years. I seriously doubt that the UK's NHS has the 501 (c) (3) US nonprofit status that is required for you to be PSLF eligible.

I don't want to sound mean, or be unpleasant, but this program is not likely to serve you well given your stated career goals.

 

[deleted158872]

I literally sent in my application this morning and got an interview email several hours later. Is that normal?

did you mail your app? it couldn't be that fast O_O

 

[bebijoon]

did you mail your app? it couldn't be that fast O_O

Woops I just realized I wrote that wrong. I meant to say they received it this morning lol

 

[PacificNWDreamer]

Thank you to everyone that has been providing good advice so far! I just have two additional questions
1. I notice that it says you need at least a B average for your undergraduate degree. Are there any specific courses that are required? Do we need to have taken physics, for example?
2. It seems that the consensus is that this place may not be as good for USMLE prep, but I'm sure it still has many pros over Carib schools (SGU etc). I would love to hear some of the pros/great things about this school over Carib.

Thank you!

 

[smectutor]

Thank you to everyone that has been providing good advice so far! I just have two additional questions
1. I notice that it says you need at least a B average for your undergraduate degree. Are there any specific courses that are required? Do we need to have taken physics, for example?

Thank you!

1) There is no set course list that you need to take but in order to well on the MCAT it would be advised to take the suggest courses by AAMC ( physics, organic, bio, chem solutions,stats ...) In preparation for med school it would be good to take human physiology,histology, and anatomy. In med school there are people that have non-science backgrounds and they do just as well as people from science backgrounds. It all depends on your study habits and how well you grasp the material. For USMLE prep - is just like the MCAT you get what you put in so to speak. hence studying efficiently and smart is the key for getting a high score.

 

[Rhandhali]

Thank you to everyone that has been providing good advice so far! I just have two additional questions
1. I notice that it says you need at least a B average for your undergraduate degree. Are there any specific courses that are required? Do we need to have taken physics, for example?
2. It seems that the consensus is that this place may not be as good for USMLE prep, but I'm sure it still has many pros over Carib schools (SGU etc). I would love to hear some of the pros/great things about this school over Carib.

Thank you!

You are always going to be expected to carry your own weight with regards to the USMLE. No, UQ doesn't teach to the test and grade you based on simulated USMLE style multiple choice questions. UQ does covers the subject matter of the USMLE as part of the same basic science training found medical schools across the world.

Some schools might force you to do practice questions and hold your hand while they spoon feed you what you need to know for the test but that doesn't matter much if you aren't willing to put the work in. UQ-Ochsner will provide you with study materials, question banks and tutorials. The tutorials are run by students for students and the ones I went to I thought were very good. That didn't mean I could do nothing but tutorials and the dozen or so questions we'd talk about once a week. I got question banks and books beyond what the school provided for me because that's was what any medical student, anywhere, would have to do.

Some schools in the US give you chunks of time off, from what I understand, to allow you to study. UQ doesn't do that; you'll get plenty of break time that you can use as you see fit, but you don't get to cut out of your scheduled training because of a test. There are no study blocks for exams because those study blocks are meant for classes, PBLs, clinical training and so forth.

You are simply going to have to take the time to do some studying on your own. Some schools will force some of this studying on you. I wouldn't expect anyone from any medical school, anywhere, to vaporize the exam just by showing up and staying awake through lecture and the minimum practice they might or might not be required to do. Nobody's going to crack your skull open and surgically implant knowledge into you.

Your score is going to be up to you and how you make use of the tools that are provided you. UQ-Ochsner gives you more than some, less than some. You've got two years to get ready for the exam. That's two years to go through Goljan, Pathoma, Kaplan, USMLERx, USMLEWorld, First Aid or countless other resources, some of which are provided by the program and some of which are not. You've got two years of weekly tutorials with other students. You've got two years of PBL learning which is a chance to do in depth study and discussion on USMLE subjects with fellow classmates and faculty.

You will get the score that you deserve no matter what school you go to. It really is up to you to do well on the exam. The people at this program want our students to do well on this test. You will get support. You will be taught, but nobody else can carry your weight.

 

[nybgrus]

Thank you to everyone that has been providing good advice so far! I just have two additional questions
1. I notice that it says you need at least a B average for your undergraduate degree. Are there any specific courses that are required? Do we need to have taken physics, for example?
2. It seems that the consensus is that this place may not be as good for USMLE prep, but I'm sure it still has many pros over Carib schools (SGU etc). I would love to hear some of the pros/great things about this school over Carib.

Thank you!

Things may have changed since I have been there but I do not believe there are any specific pre-reqs.

No matter where you go your USMLE score will depend very heavily on you and your personal effort. Certainly more so at UQ, but you also get access to resources you don't in the US. But if you are not a self motivated individual this is likely not the program for you. And depending on how much motivation you lack, you may want to consider a different career path. I still have to study and read and take board exams and I also have clinical duties and medical students to teach.

As for advantages - UQ is a world class research university. Some of the lecturing professors are Nobel laureates. Ochsner is also quite respectable in terms of research (including bench, if that's your thing) and is actively trying to become more of a research powerhouse. It is pouring money in so that you get great perks for doing your research like free poster printing, graphic design, professionally done and HIPAA compliant photography and micrography, and a team that will submit the article for you, creating the account, formatting the manuscript, and so on.

I'm sure there are others, but many are necessarily subjective.

 

[PacificNWDreamer]

Thank you everyone for your responses!

 

[sean80439]

Since they changed to the MD program, it is no longer 2 pass. It is 1 pass. (This means that they used to teach all physiology the first year, and then all pathology the second year. Now they teach physio/path simultaneously so you only see it once.) The program coordinators recommend that people take UG level anatomy, physiology, biology/micro, and biochem. Yes, they say they aren't pre-reqs, but they also expect you to know it... yeah we don't get it either.

 

[JPL8]

Since they changed to the MD program, it is no longer 2 pass. It is 1 pass. (This means that they used to teach all physiology the first year, and then all pathology the second year. Now they teach physio/path simultaneously so you only see it once.) The program coordinators recommend that people take UG level anatomy, physiology, biology/micro, and biochem. Yes, they say they aren't pre-reqs, but they also expect you to know it... yeah we don't get it either.

So now the curriculum is structured like the block system at US med schools? Do you think it's more effective to learn it this way?

 

[sean80439]

I don't know. I didn't learn it the other way. Based on feedback from tutors and hospital visits, our year 1 knowledge is actually pretty solid though, compared to year 2's.

 

[mcat_taker]

Not an unfair commentary.

As I and many others have mentioned, yes you do need to be a lot more focused and work harder than your Aussie counterparts. That said if you go Carib you won't be working harder than your classmates but you will need to work harder than a US student, so I don't see that the comparison actually adds any useful information. If you recognize that you are the person who needs more structure and essentially being forced to study for the USMLE then I wholeheartedly agree - UQ-O is probably not the best option for you. For me, the freedom was exactly what I needed and I thrived in it. As Pitman said, you have to be honest with yourself in these matters.

As for the match list... what's to be impressed about? The tough specialties and places are going to be tough and our sample size is small and the program is still fresh and making inroads. I would have been quite surprised if it was somehow significantly more impressive than any other IMG match list. That said, the Caribs are well known for a business model based on attrition. They take a huge number of students and the cream rises to the top and does OK and the chaff gets cut. There is also little to no opportunity for research, particularly serious research, which is a huge feather in the cap of UQ over any Carib program. I've had to turn down many good research projects for lack of time. I think what will really be telling is the match list in 3-4 years, after a few classes at max capacity have tried to match. Bear in mind that the first fully capitated class (at 125) is still in their 3rd year. We need more numbers and a better data set to say anything truly meaningful. Right now all that can be honestly said is that if you are a frack-up you won't match but if you work hard and do reasonably well you are well likely to get some spot somewhere.

Thanks for the reply. But as to your point for who you have to work harder than (Australians vs Americans, isn't that a moot point because aren't you competing against all IMGs and those same U.S. students wherever you go when it comes to the match?

I only mention the match list because people assume that automatically going to UQ-O is leaps and bounds better for matching purposes than going to SGU for example or the other big 3 caribbean schools. I just want to caution that if you look at the match lists side by side a lot of them are similar because at the end of the day you are an IMG from all of them (Although I have heard that Ross and SGU had a very good match this year). I'm sure there are still people that choose UQ-O over american programs (this is probably non existent at the caribbean which is viewed as a last resort for everyone). And I understand that UQ-O is still a young program and therefore isn't that well known yet (Other programs are trying to use the same model now like the even newer INTO-SGUL program that does 2 years basic sciences in the UK and 2 years in the US to train U.S. students). That being said, I have no idea how program directors view UQ-O when compared to the caribbean. My message was more a caution to people to not just look at it through rose colored glasses is all. It seems great and exotic, but based on what my friend studying there has told me there are very real concerns.

 

[deleted158872]

So now the curriculum is structured like the block system at US med schools? Do you think it's more effective to learn it this way?

i think the SPIRAL curriculum is more effective than Block... because it helps you recall old stuff as you go.

 

[deleted158872]

Residency is legally a form of employment and most teaching hospitals are nonprofits.

so... to qualify for PSLF, do you have to work at one place for 10 years? after residency, can you work at another nonprofit hospital to qualify for PSLF, or do you have to stay at one place?

 

[sean80439]

i think the SPIRAL curriculum is more effective than Block... because it helps you recall old stuff as you go.

I think that depends on how it is taught. We still use CBL, which is literally like a House episode. We have to think about every cause even when we are in a certain block and back it up with reasoning. It forces you to use previous knowledge. Also if you are studying concurrently for the step1 you are always reviewing information.

 

[nybgrus]

Thanks for the reply. But as to your point for who you have to work harder than (Australians vs Americans, isn't that a moot point because aren't you competing against all IMGs and those same U.S. students wherever you go when it comes to the match?

I only mention the match list because people assume that automatically going to UQ-O is leaps and bounds better for matching purposes than going to SGU for example or the other big 3 caribbean schools. I just want to caution that if you look at the match lists side by side a lot of them are similar because at the end of the day you are an IMG from all of them (Although I have heard that Ross and SGU had a very good match this year). I'm sure there are still people that choose UQ-O over american programs (this is probably non existent at the caribbean which is viewed as a last resort for everyone). And I understand that UQ-O is still a young program and therefore isn't that well known yet (Other programs are trying to use the same model now like the even newer INTO-SGUL program that does 2 years basic sciences in the UK and 2 years in the US to train U.S. students). That being said, I have no idea how program directors view UQ-O when compared to the caribbean. My message was more a caution to people to not just look at it through rose colored glasses is all. It seems great and exotic, but based on what my friend studying there has told me there are very real concerns.

I am not entirely sure what you mean in your opening sentence. My intention was to point out that no matter where you go (US, Carib, UQ, whatever) that the overwhelming majority of your score on the Step 1 will come from your own personal effort on your own time. Meaning that the contribution towards your study (which I think is reasonable to say correlates well with your score) provided by US or Carib programs that have a core curriculum specifically geared towards prepping you for the Step is a small factor. So if you go to a program like UQ, where the curriculum is not geared for that, you will indeed have to spend more of your own free time and be more self motivated to cover the same amount in preparation. What I am saying is that this "more" time is a rather small fraction of the total and, IMHO, people spend too much time worrying and place too much value on the core curriculum being Step 1 geared. If you are already going to be spending easily around 1,000 hours of your own time studying for the Step over the first 2 years (with the requisite month of dedicated study at 10ish hours per day right before the exam that every student takes, whether US or UQ-O), then chucking in an extra 100-200 hours spread out over 2 years because you are at UQ seems to me rather insignificant*.

Interestingly the Step 2 is a different story. As that is more clinically and management based, it has a heavier reliance on Year 3 clerkships to boost your score. And one thing that UQ-O students have demonstrated thus far is that we completely outclass our US counterparts in the Step 2. We have consistently scored just shy of the average for Step 1 (in aggregate, and improving year on year) but have been over a standard deviation above the mean when it comes to Step 2. Part of that is that there is clinical training and management built into M1&2 (though this may have changed since the new curriculum is in place, so I would listen to others in the program more on this one and I myself am curious as to how the Step 2 scores will turn out) but also because of the truly excellent clinical education we get at Ochsner. One thing I can say having discussed it numerous times with many friends at different US schools, Ochsner really is a stand out in terms of the opportunity for clinical education. I myself was primary surgeon as a 4th year (even though I didn't go into surgery ultimately), I was managing patients myself, able to act and present on my own, and always had excellent support, teaching, and feedback. That is carrying through to my residency at Ochsner right now. Of course you can game the system and find convenient ways out of getting a good education, but it is harder to do at Ochsner and once again goes back to what kind of person you are and even if you should be in medicine to begin with. That said, the point is that the opportunities are there and the education and training is, in my estimation, top tier.

As for the idea that UQ-O is "leaps and bound better for matching purposes"... I agree with you about the admonition. Once again, if you look back at my comments you will see that I have consistently advised a measured approach and recognition of the very preliminary state of the relevant data on the matter. There are indeed reasons to believe that UQ-O has the potential to be leaps and bounds better, but I think it is entirely premature to say it is currently. I do think that it is probably slightly better currently since PD's "know" what it means to be coming from a Carib but UQ-O is novel to them. In my experience as well as everyone I have talked to there is seemingly universal positive interest and curiosity when UQ-O is mentioned. Of course this is a biased sample and doing a more rigorous analysis could easily demonstrate exactly the opposite to be true, but there seems to me to be enough prior plausibility along with the robustness of the anecdotal data to tentatively conclude there is likely a more favorable view taken upon UQ-O than Caribs. Of course there are programs that are uniformly anti-IMG for which this is not true, but then it is a complete wash and a moot point anyways.

Furthermore, comparing match lists has the potential to be extremely misleading. I am forced to read a bit into your language, so correct me if I am wrong, but it seems to me you (your friend) was merely looking at the sorts of places and specialties that were matched into. That is sort of an "upper bound" that will be similar across IMG programs because of the anti-IMG bias that we all know is inane but absolutely present and should be accounted for in making life decisions like this. But what it doesn't tell you is what proportion of the classes actually make it to that point in the first place. And from my research on the topic there is a vastly higher attrition rate at Carib schools than at US schools or UQ. Meaning that while the general composition of matches at the end are indeed similar, that is only after the bottom third of the Carib school student population has been removed from the equation. The honest truth is that even the Ochsner match stats you see are similarly skewed - the students that withdrew from the match or never participated are not counted amongst the stats. Some of this is indeed misleading, some of it is entirely legitimate. The point is to recognize the limitations of whatever metric one is using to gauge and compare the programs. I obviously can't speak directly to the Carib programs but what I can say is that so far of the 3 years of UQ-O that have gone through the match absolutely none save for 1 or 2 that didn't match were entirely unsurprising; the sort of student that would be much more likely to not even make it into the Carib stats.

So I absolutely agree with you that UQ-O should not be looked at through rosy colored glasses. The fact that I and others have positive things to say should be taken in context and I have taken pains to make that clear in all the comments I have made. Obviously for most people a top or middle tier US school would still be a better option from just about every angle of consideration. It would be silly and foolish to argue otherwise. But that is also unlikely to be the audience to whom we are speaking. It may become that way, who knows (I'd certainly like to think it would and have reasons to believe it might), but that is quite a ways off. As for there being "very real concerns"... not sure what concerns there would be that are so different to concerns common amongst going to a foreign medical school. Sure there are unique concerns to being in Australia or so far from home and so on, but they are similarly unique to living on a small Caribbean Island or going to the UK or eastern Europe or wherever else one may be going. In other words, I fail to see big salient concerns that are unique to UQ over other foreign programs. Though I do see unique salient benefits to UQ over other foreign programs (though I would probably feel that UK schools would over similar benefits and concerns but also be much more difficult to get into).

By anecdote, I was also extremely concerned as an M1 in the program and even further along. That was a big part of why I became a founding member of OMSA and created the entire USMLE adjunct study curriculum and successfully lobbied the SoM to provide a significant amount of free USMLE study materials. I spent quite a lot of time speaking with my friends back in US schools going over my own "serious concerns" as I was mired in it all. And at the end of it all I realized that it was nothing more than a manifestation of the fact that there are always problems and "serious concerns" no matter where one goes. My US friends were telling me to not worry about my "serious concerns" and saying how much they wished their program was more like mine in certain ways. I was telling them the same. In other words, the grass is always greener on the other side. Obviously there will be a few more legitimate "serious concerns" that I had than they did, but once you quasi "controlled" for the fact that there is an indisputable and unmodifiable difference between a US and foreign program, I really felt like it was overall a wash. Many others agree with with me, some don't. But I honestly feel that the bulk of that difference is merely the difference between programs regardless of where they are located. Someone may absolutely love John's Hopkins and think it is the best thing since sliced bread. I have a good friend who hated it there so much he left after 1 year (this was many years ago, but the point stands).

So sure, don't be rosy colored. That's a silly way to approach anything in life. But to anyone else interested, read through my comment history. Nearly every comment I have ever made on SDN is about the UQ-O program since that was basically the only reason I created the account. I have tried to be as dispassionate as possible, but of course no one is entirely free from bias. Read the thoughts and opinions of many different people and weight them appropriately. Use as many objective markers as you can (which are admittedly limited at this time) and ultimately make a decision that you have thought over carefully and will be comfortable with. Because no matter what you will always find a way to be dissatisfied with any program you go into. But if you went into it having made the best decision possible at the time, having taken into careful consideration as much information as possible, with the intent of succeeding regardless I think you'll find that you'll do well and be happy at the end of the day regardless.

*Obviously these numbers are estimates to give a sense of scale, so this may vary quite a lot from person to person but is a reasonable ballpark estimate. For the person who is desperately non-self motivating this may skew in a completely different way and/or that extra 200 hours may indeed prove to be a huge difference, something that you will find I have consistently commented on and advised people to consider.

 

[nybgrus]

so... to qualify for PSLF, do you have to work at one place for 10 years? after residency, can you work at another nonprofit hospital to qualify for PSLF, or do you have to stay at one place?

No, the way PSLF works is that you have to make 120 qualifying payments. A qualifying payment is one that is on time and in concordance with whatever repayment scheme you have signed up for (whether it be IBR or standard 10 year or 25 year payments) so long as you were employed at any qualifying institution at that time.

So if you do 3 years of residency at a qualifying place you will rack up 36 payments. If you go do your fellowship at a different but qualifying place, then your rack up however many payments that is. After that if you go into private practice or work as an attending at a place that doesn't qualify, you'll be stuck paying off whatever is left of the loan. In other words it doesn't matter if it is 10 years or 30 years that you take to do it or whether it is one place or 30 places. Whatever money you have left on your loans after the 120 qualifying payments are made will be forgiven. So if you can do it all in the first 10 years you'll save the most money. The longer it takes the more you will end up paying.

Also, it has to be done in the US. You can't qualify for PSLF by practicing or training elsewhere in the world.

 

[Rhandhali]

As for the idea that UQ-O is "leaps and bound better for matching purposes"... I agree with you about the admonition. Once again, if you look back at my comments you will see that I have consistently advised a measured approach and recognition of the very preliminary state of the relevant data on the matter. There are indeed reasons to believe that UQ-O has the potential to be leaps and bounds better, but I think it is entirely premature to say it is currently. I do think that it is probably slightly better currently since PD's "know" what it means to be coming from a Carib but UQ-O is novel to them. In my experience as well as everyone I have talked to there is seemingly universal positive interest and curiosity when UQ-O is mentioned. Of course this is a biased sample and doing a more rigorous analysis could easily demonstrate exactly the opposite to be true, but there seems to me to be enough prior plausibility along with the robustness of the anecdotal data to tentatively conclude there is likely a more favorable view taken upon UQ-O than Caribs. Of course there are programs that are uniformly anti-IMG for which this is not true, but then it is a complete wash and a moot point anyways.

I will point out that I had the opportunity to meet with multiple program directors at a residency fair that was part of a American Society for Anesthesiology l meeting in New Orleans. More than one of them essentially told me that since I trained in a "first world" or "developed" (their words, not mine) country my application would be considered in a more favorable light. One of those programs told me I would be treated like a domestic applicant and I did get an interview with them. Your mileage may (will) vary as the program becomes better known as the program gets better known, based on how the students in the years behind me present themselves, but I believe that at least on the surface that training in Australia definitely made me stand out among IMGs.

However, I don't know what programs see when they look at ERAS applications, but you will still have the IMG flag on your application just like anyone from not-America.

 

[mcat_taker]

I am not entirely sure what you mean in your opening sentence. My intention was to point out that no matter where you go (US, Carib, UQ, whatever) that the overwhelming majority of your score on the Step 1 will come from your own personal effort on your own time. Meaning that the contribution towards your study (which I think is reasonable to say correlates well with your score) provided by US or Carib programs that have a core curriculum specifically geared towards prepping you for the Step is a small factor. So if you go to a program like UQ, where the curriculum is not geared for that, you will indeed have to spend more of your own free time and be more self motivated to cover the same amount in preparation. What I am saying is that this "more" time is a rather small fraction of the total and, IMHO, people spend too much time worrying and place too much value on the core curriculum being Step 1 geared. If you are already going to be spending easily around 1,000 hours of your own time studying for the Step over the first 2 years (with the requisite month of dedicated study at 10ish hours per day right before the exam that every student takes, whether US or UQ-O), then chucking in an extra 100-200 hours spread out over 2 years because you are at UQ seems to me rather insignificant*.

Interestingly the Step 2 is a different story. As that is more clinically and management based, it has a heavier reliance on Year 3 clerkships to boost your score. And one thing that UQ-O students have demonstrated thus far is that we completely outclass our US counterparts in the Step 2. We have consistently scored just shy of the average for Step 1 (in aggregate, and improving year on year) but have been over a standard deviation above the mean when it comes to Step 2. Part of that is that there is clinical training and management built into M1&2 (though this may have changed since the new curriculum is in place, so I would listen to others in the program more on this one and I myself am curious as to how the Step 2 scores will turn out) but also because of the truly excellent clinical education we get at Ochsner. One thing I can say having discussed it numerous times with many friends at different US schools, Ochsner really is a stand out in terms of the opportunity for clinical education. I myself was primary surgeon as a 4th year (even though I didn't go into surgery ultimately), I was managing patients myself, able to act and present on my own, and always had excellent support, teaching, and feedback. That is carrying through to my residency at Ochsner right now. Of course you can game the system and find convenient ways out of getting a good education, but it is harder to do at Ochsner and once again goes back to what kind of person you are and even if you should be in medicine to begin with. That said, the point is that the opportunities are there and the education and training is, in my estimation, top tier.

As for the idea that UQ-O is "leaps and bound better for matching purposes"... I agree with you about the admonition. Once again, if you look back at my comments you will see that I have consistently advised a measured approach and recognition of the very preliminary state of the relevant data on the matter. There are indeed reasons to believe that UQ-O has the potential to be leaps and bounds better, but I think it is entirely premature to say it is currently. I do think that it is probably slightly better currently since PD's "know" what it means to be coming from a Carib but UQ-O is novel to them. In my experience as well as everyone I have talked to there is seemingly universal positive interest and curiosity when UQ-O is mentioned. Of course this is a biased sample and doing a more rigorous analysis could easily demonstrate exactly the opposite to be true, but there seems to me to be enough prior plausibility along with the robustness of the anecdotal data to tentatively conclude there is likely a more favorable view taken upon UQ-O than Caribs. Of course there are programs that are uniformly anti-IMG for which this is not true, but then it is a complete wash and a moot point anyways.

Furthermore, comparing match lists has the potential to be extremely misleading. I am forced to read a bit into your language, so correct me if I am wrong, but it seems to me you (your friend) was merely looking at the sorts of places and specialties that were matched into. That is sort of an "upper bound" that will be similar across IMG programs because of the anti-IMG bias that we all know is inane but absolutely present and should be accounted for in making life decisions like this. But what it doesn't tell you is what proportion of the classes actually make it to that point in the first place. And from my research on the topic there is a vastly higher attrition rate at Carib schools than at US schools or UQ. Meaning that while the general composition of matches at the end are indeed similar, that is only after the bottom third of the Carib school student population has been removed from the equation. The honest truth is that even the Ochsner match stats you see are similarly skewed - the students that withdrew from the match or never participated are not counted amongst the stats. Some of this is indeed misleading, some of it is entirely legitimate. The point is to recognize the limitations of whatever metric one is using to gauge and compare the programs. I obviously can't speak directly to the Carib programs but what I can say is that so far of the 3 years of UQ-O that have gone through the match absolutely none save for 1 or 2 that didn't match were entirely unsurprising; the sort of student that would be much more likely to not even make it into the Carib stats.

So I absolutely agree with you that UQ-O should not be looked at through rosy colored glasses. The fact that I and others have positive things to say should be taken in context and I have taken pains to make that clear in all the comments I have made. Obviously for most people a top or middle tier US school would still be a better option from just about every angle of consideration. It would be silly and foolish to argue otherwise. But that is also unlikely to be the audience to whom we are speaking. It may become that way, who knows (I'd certainly like to think it would and have reasons to believe it might), but that is quite a ways off. As for there being "very real concerns"... not sure what concerns there would be that are so different to concerns common amongst going to a foreign medical school. Sure there are unique concerns to being in Australia or so far from home and so on, but they are similarly unique to living on a small Caribbean Island or going to the UK or eastern Europe or wherever else one may be going. In other words, I fail to see big salient concerns that are unique to UQ over other foreign programs. Though I do see unique salient benefits to UQ over other foreign programs (though I would probably feel that UK schools would over similar benefits and concerns but also be much more difficult to get into).

By anecdote, I was also extremely concerned as an M1 in the program and even further along. That was a big part of why I became a founding member of OMSA and created the entire USMLE adjunct study curriculum and successfully lobbied the SoM to provide a significant amount of free USMLE study materials. I spent quite a lot of time speaking with my friends back in US schools going over my own "serious concerns" as I was mired in it all. And at the end of it all I realized that it was nothing more than a manifestation of the fact that there are always problems and "serious concerns" no matter where one goes. My US friends were telling me to not worry about my "serious concerns" and saying how much they wished their program was more like mine in certain ways. I was telling them the same. In other words, the grass is always greener on the other side. Obviously there will be a few more legitimate "serious concerns" that I had than they did, but once you quasi "controlled" for the fact that there is an indisputable and unmodifiable difference between a US and foreign program, I really felt like it was overall a wash. Many others agree with with me, some don't. But I honestly feel that the bulk of that difference is merely the difference between programs regardless of where they are located. Someone may absolutely love John's Hopkins and think it is the best thing since sliced bread. I have a good friend who hated it there so much he left after 1 year (this was many years ago, but the point stands).

So sure, don't be rosy colored. That's a silly way to approach anything in life. But to anyone else interested, read through my comment history. Nearly every comment I have ever made on SDN is about the UQ-O program since that was basically the only reason I created the account. I have tried to be as dispassionate as possible, but of course no one is entirely free from bias. Read the thoughts and opinions of many different people and weight them appropriately. Use as many objective markers as you can (which are admittedly limited at this time) and ultimately make a decision that you have thought over carefully and will be comfortable with. Because no matter what you will always find a way to be dissatisfied with any program you go into. But if you went into it having made the best decision possible at the time, having taken into careful consideration as much information as possible, with the intent of succeeding regardless I think you'll find that you'll do well and be happy at the end of the day regardless.

*Obviously these numbers are estimates to give a sense of scale, so this may vary quite a lot from person to person but is a reasonable ballpark estimate. For the person who is desperately non-self motivating this may skew in a completely different way and/or that extra 200 hours may indeed prove to be a huge difference, something that you will find I have consistently commented on and advised people to consider.

@nybgrus thank you for taking the time to respond and for the well thought out analysis. I agree and understand your reasoning (and as a recent student your opinions obviously carry weight). I think my friend's concerns are probably in line with what you said about feeling that the grass is always greener on the other side, and the general concerns that anyone would have at any foreign school.

No matter where you go there is going to be a lot of independent study and review required for step 1.

As for UQ-O vs. UQ do you think that one is significantly better than the other for matching back to the U.S.? Could you still do 4th year elective rotations as a regular UQ student at ochsner for example? Could you still go to USMLE tutorials and get those resources and support as a UQ student even if you aren't part of the UQ-O cohort?

 

[Rhandhali]

so... to qualify for PSLF, do you have to work at one place for 10 years? after residency, can you work at another nonprofit hospital to qualify for PSLF, or do you have to stay at one place?

Like Nybgrus said, you aren't tied to one place. You have to meet two criteria - work for a 501 (c) (3) nonprofit organization. Many, many hospitals are 501 (c) (3) organizations. You must also be an employee. You can't be an independent contractor or anything like that, you must actually be part of the organization as a full time employee. As long as you can maintain employment for a qualification organization and make minimum payments you get them wiped after 120 payments. I'm not sure if the counter resets if you leave residency, do private practice, and then go back to 501 (c) (3) nonprofit work. Probably.

 

[Rhandhali]

@nybgrus thank you for taking the time to respond and for the well thought out analysis. I agree and understand your reasoning (and as a recent student your opinions obviously carry weight). I think my friend's concerns are probably in line with what you said about feeling that the grass is always greener on the other side, and the general concerns that anyone would have at any foreign school.

No matter where you go there is going to be a lot of independent study and review required for step 1.

As for UQ-O vs. UQ do you think that one is significantly better than the other for matching back to the U.S.? Could you still do 4th year elective rotations as a regular UQ student at ochsner for example? Could you still go to USMLE tutorials and get those resources and support as a UQ student even if you aren't part of the UQ-O cohort?

I don't believe you get the same support as a traditional student. No first aid, NBME or qbanks, for example. You do have tutorials but they're not the same ones as are set up for (exclusive) UQ-O use.

There's going to be a huge difference between doing 9 or 10 rotations in at Ochsner and doing just one. You are going to want letters from American physicians and be able to go to American conferences, whether or not you are presenting research. This is going to be hard when you are in Australia. Traditional students have rotated at Ochsner, but the increasing size of the UQ-O cohort is making that difficult. I'm still at the hospital every day and I'm seeing nowhere near as many "University of Queensland" short coats as I used to. That's not a formal assessment, mind you, but logistics dictates a limit to the number of students that can be at Ochsner at a given time and it makes sense that there would be fewer traditional students able to rotate as the number of UQ-O students increases. That means instead of having 9 or 10 guaranteed rotations at Ochsner you're now competing with everyone else for what might amount to a 3 or 4 of slots per rotation.

Add to that the logistic difficulties of switching continents for a single rotation. You need a furnished place, you need access to a car. You just simply can't do New Orleans without some kind of vehicular access. You might or might not get the rotation you want, if you get OB for example it is a long walk to Baptist, West Bank or Baton Rouge. There are a lot more medical students at Ochsner and they're getting sent out to all of the Ochsner facilities, if you're on GP you can go to North Shore for example and I believe some students might be going to Raceland, but I'm not 100% on that.

If you are at all interested in applying to the US then I would strongly recommend the UQ-O program over the traditional program. If you are going to practice anywhere else then you'll want to go the traditional student route, but for returning to the States UQ-O is absolutely the way to go.

 

[nybgrus]

I will point out that I had the opportunity to meet with multiple program directors at a residency fair that was part of a American Society for Anesthesiology l meeting in New Orleans. More than one of them essentially told me that since I trained in a "first world" or "developed" (their words, not mine) country my application would be considered in a more favorable light. One of those programs told me I would be treated like a domestic applicant and I did get an interview with them. Your mileage may (will) vary as the program becomes better known as the program gets better known, based on how the students in the years behind me present themselves, but I believe that at least on the surface that training in Australia definitely made me stand out among IMGs.

However, I don't know what programs see when they look at ERAS applications, but you will still have the IMG flag on your application just like anyone from not-America.

This has been similar to my experience and many others I have heard. Heartening, but obviously still anecdotal and should be taken as such.

And Rhandali is spot on: ERAS apps have the ability to filter any app by any metric. A program could check a box that says to exclude all applicants with a Step 1 < 230. Or all IMG's. Or anything. The only way to overcome that is to do an away rotation at the place of interest, bust ass, look amazing, make really good contacts, and even then it is not a guarantee. I know a friend (AMG) who got burned that way.

 

[nybgrus]

@nybgrus thank you for taking the time to respond and for the well thought out analysis. I agree and understand your reasoning (and as a recent student your opinions obviously carry weight). I think my friend's concerns are probably in line with what you said about feeling that the grass is always greener on the other side, and the general concerns that anyone would have at any foreign school.

No matter where you go there is going to be a lot of independent study and review required for step 1.

As for UQ-O vs. UQ do you think that one is significantly better than the other for matching back to the U.S.? Could you still do 4th year elective rotations as a regular UQ student at ochsner for example? Could you still go to USMLE tutorials and get those resources and support as a UQ student even if you aren't part of the UQ-O cohort?

My pleasure.

As for your friend there is also likely a component of knowing that the Carib path is well established. I alluded to that earlier when I said PD's "know" what it means to come from the Carib. They tend to get pigeonholed but the comfort in that is you have a very good idea of where you stand. Something entirely new and different necessarily has more unknown variables and the unknown is always concerning. That is a fundamental human trait.

As for UQ-O vs UQ: yes, I think that UQ-O will give you a significantly greater chance of matching in the US. Yes, you can go back as a UQ "traddie" (that's what we tend to call them, non-pejoratively of course) and kill the Step and all that. But the reality is that letters of rec are really big deals for residency apps. And US programs will prefer letters from US physicians. And the networking opportunities alone are valuable. There are a lot of us, but overall physicians make up a very small fraction of the population. So it is very likely someone knows someone and can offer you an opportunity to capitalize on. Plus research opportunities here with US researchers will offer you the same benefits. And of course Ochsner itself will inherently be biased towards people that it knows well over 2 years rather than a single rotation (where you will never perform up to your best because the system and expectations are so different, plus New Orleans). And so on.

As for resources: no. UQ-O gets more resources. There are some shared resources but a lot of the resources are rather costly and the SoM was unable to roll it out to the entire student body. I was able to convince them to roll it out for us, thereby giving us special preference, because we have special requirements of us that the rest of the student body is required to do. For example we have an additional 8 weeks of schooling that is required and nobody else does. Our electives in M1&2 must be in Australia, whereas everyone else can go anywhere in the world. We aren't formally required but nominally so to take the USMLE. And a few other things. But they point being, yes, there is indeed additional curriculum and resources for UQ-O that does not exist for UQ. That also includes Step 2.

 

[nybgrus]

Like Nybgrus said, you aren't tied to one place. You have to meet two criteria - work for a 501 (c) (3) nonprofit organization. Many, many hospitals are 501 (c) (3) organizations. You must also be an employee. You can't be an independent contractor or anything like that, you must actually be part of the organization as a full time employee. As long as you can maintain employment for a qualification organization and make minimum payments you get them wiped after 120 payments. I'm not sure if the counter resets if you leave residency, do private practice, and then go back to 501 (c) (3) nonprofit work. Probably.

I have asked my financial planner that exact same question as I am planning on doing that. He specializes in working with residents and physicians in general. He said that it is not a problem. If you do 5 years at a qualifying institution, go 1 year as a locum, then you just need 5 more years at a qualifying place. The rub is that you will end up paying more for your loans both because you will have 1 extra year of repayments and because your payments will be significantly higher. The added rub is that you will be paying your loans at the higher rate after going back to fellowship (or other qualifying place) and so you will have whatever that salary is to pay the higher monthly bills with. That is because they use your previous year's W2 to calculate your 10% in IBR for the current year. Which has the added bonus of making your first year's payments zero. Most people don't actually make money in their M4 year. So you pay 10% of zero income, divided by 12 = zilch. And those payments count towards your 120. Yes, I am sure.

 

[nybgrus]

I don't believe you get the same support as a traditional student. No first aid, NBME or qbanks, for example. You do have tutorials but they're not the same ones as are set up for (exclusive) UQ-O use.

There's going to be a huge difference between doing 9 or 10 rotations in at Ochsner and doing just one. You are going to want letters from American physicians and be able to go to American conferences, whether or not you are presenting research. This is going to be hard when you are in Australia. Traditional students have rotated at Ochsner, but the increasing size of the UQ-O cohort is making that difficult. I'm still at the hospital every day and I'm seeing nowhere near as many "University of Queensland" short coats as I used to. That's not a formal assessment, mind you, but logistics dictates a limit to the number of students that can be at Ochsner at a given time and it makes sense that there would be fewer traditional students able to rotate as the number of UQ-O students increases. That means instead of having 9 or 10 guaranteed rotations at Ochsner you're now competing with everyone else for what might amount to a 3 or 4 of slots per rotation.

Add to that the logistic difficulties of switching continents for a single rotation. You need a furnished place, you need access to a car. You just simply can't do New Orleans without some kind of vehicular access. You might or might not get the rotation you want, if you get OB for example it is a long walk to Baptist, West Bank or Baton Rouge. There are a lot more medical students at Ochsner and they're getting sent out to all of the Ochsner facilities, if you're on GP you can go to North Shore for example and I believe some students might be going to Raceland, but I'm not 100% on that.

If you are at all interested in applying to the US then I would strongly recommend the UQ-O program over the traditional program. If you are going to practice anywhere else then you'll want to go the traditional student route, but for returning to the States UQ-O is absolutely the way to go.

Spot on.

There most certainly are fewer traddies at Ochsner and those that do get here have to actually apply for the rotation. It isn't merely picking it and going. Not all rotations will be available at all times and some will be more in demand than others. If your intent is to train/practice in the US then UQ-O is unquestionably the way to go. If it is not, then I think you shouldn't even be looking at UQ-O at all but that the UQ traditional program is still a good option. You really don't gain much being UQ-O if your intent is not to go back to the US and you actively detriment yourself by becoming the absolute lowest preference for Australian intern selection.

 

[hcry63uc]

Spot on.

There most certainly are fewer traddies at Ochsner and those that do get here have to actually apply for the rotation. It isn't merely picking it and going. Not all rotations will be available at all times and some will be more in demand than others. If your intent is to train/practice in the US then UQ-O is unquestionably the way to go. If it is not, then I think you shouldn't even be looking at UQ-O at all but that the UQ traditional program is still a good option. You really don't gain much being UQ-O if your intent is not to go back to the US and you actively detriment yourself by becoming the absolute lowest preference for Australian intern selection.

What did you think of the advising you got in years 3 and 4 nybgrus? Also, I noticed one guy matched into Ortho at Ochsner....do you know much about him? As in step 1 score? etc. I was very interested in ortho, but had pretty much cast it off because I figured it would be a pipe dream as an IMG. Sorry if its prying and you dont feel comfortable giving a response, thats completely understandable. And thanks for your contributions to the thread.

 

[deleted158872]

@nybgrus: why do you choose PSLF over IBR or PAYE?

 

[nybgrus]

What did you think of the advising you got in years 3 and 4 nybgrus? Also, I noticed one guy matched into Ortho at Ochsner....do you know much about him? As in step 1 score? etc. I was very interested in ortho, but had pretty much cast it off because I figured it would be a pipe dream as an IMG. Sorry if its prying and you dont feel comfortable giving a response, thats completely understandable. And thanks for your contributions to the thread.

I thought the advising was superb. I think that my experience, however, will be a little unrepresentative because I was the 2nd class and with only 35 people. Obviously resources will be a little diluted when the class is 125. However, Ochsner has been steadily adding more and more staff dedicated to UQ-O students and I know all of the current staff and their skill, dedication, and professionalism are impeccable.

As for Ortho... it is not my place to speak in specifics because it does not involve me, so I will be a bit diplomatic. The person who matched worked very hard and very, very closely with one of the ortho attendings (who is no longer at Ochsner). Via those connections he was able to take his application all the way to a match. This past year someone who, on paper, was much more qualified did not match. So I would still consider orthopedics quite a stretch as an IMG. I believe I have mentioned before that I have a friend who is US grad who has now failed to match into ortho 3 years running. He has stats are similar to the person who matched into ortho at Ochsner. So I would not count on the combination of luck, connections, and work to pan out for you.

One thing I can say in general about ortho though is that if you have less than a 230 on the Step 1, you have essentially made your chances so close to zero that they may as well be. If you do plan to apply to ortho I would recommend applying not only to every single program in the US but simultaneously apply to a backup specialty, regardless of your stats. It is a stupidly competitive field no matter who you are.

 

[nybgrus]

@nybgrus: why do you choose PSLF over IBR or PAYE?

You don't pick PSLF or IBR or PAYE. PSLF is just the program that allows you to be done with your loans after 120 payments. You must pick between IBR and PAYE because that sets how much you pay for each qualifying payment.

You essentially have 4 options with your loans after graduation:

1) Declare financial hardship and go into forbearance. This is the least best way to go because what you've done is let the interest get recapitalized into the principle, then started the interest over again, and then when you exit forbearance and begin to pay your loans that interest gets recapitalized on the principle again. So all you've done is ballooned your loan out and delayed when you start paying for it.

2) Consolidate loans into a single private provider. The advantage here is that you will have a much lower interest rate. The disadvantage is that you will never again qualify for PSLF or IBR or any other federal program. You will have less interest but you will end up paying the full amount of the loan no matter what. And your repayment plan may be unaffordable during residency. This option is probably only best suited for people who either have a smaller amount of loans or will be doing a short residency (like IM or EM) and have zero plans to go on to fellowship. You then very aggressively pay down your your loans with your attending salary and lower interest.

3) Pay at the standard rate which is intended to pay back the full loans in either 10 years or 25 years. Obviously the shorter term means higher monthly payments. In either case, you will not make enough money as a resident or fellow to pay those monthly rates, even at the 25 year rate. For my loans the 10 year plan was something like $3,500 per month.

4) Enter IBR or PAYE. These are nearly equivalent payment options with the only difference really being the percent of your income that gets payed towards your loan. I honestly can't recall exactly why I picked IBR over PAYE but I do remember sitting and reading carefully about them and for whatever reason picked IBR.

At any point that you are paying loans you can be in the PSLF program which is basically just a check box and the stipulations for that were discussed above by both myself and Rhandali.

 

[deleted158872]

You don't pick PSLF or IBR or PAYE. PSLF is just the program that allows you to be done with your loans after 120 payments. You must pick between IBR and PAYE because that sets how much you pay for each qualifying payment.

Wait... i think PSLF is different from IBR and PAYE: PSLF is 120 payments at standard rate, then the rest is forgiven. You are required to work for a nonprofit.

With IBR and PAYE: You aren't required to work for a nonprofit. You make 20 or 30-year repayment plan based on your income, then you'll have a "tax bomb" at the end (something you don't have with PSLF).

I honestly can't recall exactly why I picked IBR over PAYE but I do remember sitting and reading carefully about them and for whatever reason picked IBR

So you're using PSLF and IBR at the same time?? I didn't know that's possible O_O What are the terms and conditions for that?

 

[hcry63uc]

I thought the advising was superb. I think that my experience, however, will be a little unrepresentative because I was the 2nd class and with only 35 people. Obviously resources will be a little diluted when the class is 125. However, Ochsner has been steadily adding more and more staff dedicated to UQ-O students and I know all of the current staff and their skill, dedication, and professionalism are impeccable.

As for Ortho... it is not my place to speak in specifics because it does not involve me, so I will be a bit diplomatic. The person who matched worked very hard and very, very closely with one of the ortho attendings (who is no longer at Ochsner). Via those connections he was able to take his application all the way to a match. This past year someone who, on paper, was much more qualified did not match. So I would still consider orthopedics quite a stretch as an IMG. I believe I have mentioned before that I have a friend who is US grad who has now failed to match into ortho 3 years running. He has stats are similar to the person who matched into ortho at Ochsner. So I would not count on the combination of luck, connections, and work to pan out for you.

One thing I can say in general about ortho though is that if you have less than a 230 on the Step 1, you have essentially made your chances so close to zero that they may as well be. If you do plan to apply to ortho I would recommend applying not only to every single program in the US but simultaneously apply to a backup specialty, regardless of your stats. It is a stupidly competitive field no matter who you are.

That is what I expected. I have a friend who managed to get an Ortho residency, he was a AMG and scored somewhere in the 240s on the Step. His advisor had said his chances were slim....so I can only imagine what kind of step scores an IMG would have to score. As much as I like the idea of Australia, I really hope I can get off the waitlist of ONE of the schools I am waitlisted at in the states.

 

[nybgrus]

Wait... i think PSLF is different from IBR and PAYE: PSLF is 120 payments at standard rate, then the rest is forgiven. You are required to work for a nonprofit.

With IBR and PAYE: You aren't required to work for a nonprofit. You make 20 or 30-year repayment plan based on your income, then you'll have a "tax bomb" at the end (something you don't have with PSLF).


So you're using PSLF and IBR at the same time?? I didn't know that's possible O_O What are the terms and conditions for that?

Yes, IBR/PAYE is different from PSLF. Where you are not quite right is that PSLF requires 120 qualifying payments, not standard rate payments. Qualifying payment means that it was made both at a time when you are employed at a qualifying place of employment and you have paid whatever payment is required of you by the repayment plan option you are currently under. In other words, anything except forbearance. If that is the standard 10 year rate, then that's it. If it is the 25 year rate or IBR or PSLF rate or whatever, it doesn't matter as long as it is made on time and during said employment. Which is why the first year of payments will be $0 and still count towards your 120 PSLF payments: I am employed at a qualifying institution and my IBR dictates my monthly payment is zero. Therefore I have payed the required amount due on time while employed at a qualifying institution.

As for doing just the IBR or PAYE, I forget the exact differences between the two but you are pretty close. The exact terms set the amount you pay back monthly based on your income. You continue to pay this until one of two things happens: 1) You pay off the loan with all interest and your balance is zero 2) 25 years have gone by, whatever amount of money is left on your loan at that time is forgiven. It does not matter where you worked or what you did.

The "tax bomb" is actually not something that is currently an issue. This one I am less certain on than the other topics but pretty darned certain. Because I know that there is proposed new legislation to screw us even more by actually implementing a "tax bomb" where there currently is none. Essentially the proposed law states that the money that is forgiven from the loans acts as income earned that year. So if you had say, $200k forgiven then suddenly your income goes up by that amount, possibly putting you in a new tax bracket but at least certainly making you pay the tax on $200k. There was also proposed legislation to remove the origination fee refund on federal loans* but that did not pass. However new legislation is being drafted based on the failed bill and now the tax bomb as well.

Anyways, as for terms and conditions for PSLF and IBR... none. That's just the way it works. After your 6 month grace period is over after graduation you must pick a repayment plan. That can be IBR, PAYE, 10 year, 25 year, forbearance, consolidation, etc. Once you have selected that, if you are employed at a qualifying institution you just fill out the little form for PSLF and that's it.

*Without editorializing too much the student loan system in the US is completely corrupt, inefficient, unwieldy, and designed to make a small number of rich people vastly more rich and not to actually benefit the students in question. For the privilege of loaning its own citizens money in order to (at least hypothetically) become more valuable and productive members of society, our government charges an origination fee with every single loan disbursement. So you borrow, say, $80k and you only ever even see $76k of it because that money never really existed, the government (and actually Freddie and Fannie, for all practical purposes) just wrote a bigger number on an electronic form. If you made the first 6 (or 12?) months of payments on time some portion of that fee gets refunded (can't recall if all or just most). The law would have rescinded that.

 

[nybgrus]

That is what I expected. I have a friend who managed to get an Ortho residency, he was a AMG and scored somewhere in the 240s on the Step. His advisor had said his chances were slim....so I can only imagine what kind of step scores an IMG would have to score. As much as I like the idea of Australia, I really hope I can get off the waitlist of ONE of the schools I am waitlisted at in the states.

Yes, 230 is merely to get your foot in the door. The rest of you app better be pretty stellar to make it to interview. 240's is really where one needs to be. And yes, that is for AMG's. Interestingly enough the playing field is actually rather heterogeneous in terms of AMG vs IMG Step scores. Most places don't explicitly say that IMG's need a higher score but it is generally assumed to be the case. Some places very clearly state that they do not differentiate between IMG vs AMG so long as the applicant is ECFMG certified. Some very explicitly state that they have much higher Step 1 requirements for IMG's. UCSD's internal medicine program, for example, said it looked for 220's for AMG's and 250's for IMGs. My 242 and a few connections to ask for support were not enough to net me an interview there.

If you really are dead set on ortho then I would honestly advise you to do an SMP and work hard to get into a US school even if that means taking an extra year or two. And that is not to disparage Ochsner - it is merely reflective of any IMG. My best friend went that route because he knew he wanted to get into academics, research, and specifically regenerative medicine type stuff. He researched things exhaustively and came to the conclusion that Rosalind Franklin in Chicago was the best option for an SMP. Obviously this info is dated, so you should still do your own research, but he noted that it was the only program that guaranteed you an interview (but not a spot) if you were in the top [x]% and had a record for taking a lot of the top performers and the courses you took during that both counted towards your M1 year (so he worked half time during M1 year and was able to live in the city and basically party and relax more) and towards a master's degree that he was able to complete in a few months of spare time work during his clinical years. He got a 28 on his MCAT and then a 26 the second time he took it. Really smart guy. Bad at standardized tests. Now he is matched at a top 5 opthalmology program.

There are two morals to this story. The first is that there are avenues to pursue to get to those lofty dreams if it is what you really want. But you will have to bust your ass with no guarantee. I can assure you that my friend was like an absolute machine that first year for his SMP. He treated it like war. And he absolutely crushed it. You may not.

Second is that what you think you know you want to do now can (and probably should) change. I bounced around a bunch of things before settling on critical care and pulmonary medicine. Things I was certain I would absolutely never even consider suddenly became interesting. What I was pretty confident was going to be my field turned out to really not interest me much at all. And I discovered that I like palliative and hospice medicine as well. Never would have dreamed that one up in a million years.

So I would say stick to what you want to do and relentlessly pursue the best means by which to achieve those goals, being brutally honest with yourself along the way. If you give it enough time and effort (whatever that means to you, hence brutally honest) then you should at some point recognize it may not be worth the effort (believe me, we all feel really bad for my buddy trying to get into ortho, but he is upbeat and determined so who am I to judge?) and go for a solid backup plan with the comfort of knowing that it is indeed very likely you will change your mind anyways and that there is so much great stuff to do in medicine that even if you truly should have been an orthopod in a perfect universe you may be nearly as happy being a general surgeon or anesthesiologist or (and believe me I've seen it and so has everyone I know) a family practice doctor. Seriously, everyone has the story about that one person in their class (or the one above or below) that was a complete gunner on her way to oculopastics and then totally fell in love with and went into family practice.

 

[deleted158872]

The "tax bomb" is actually not something that is currently an issue. This one I am less certain on than the other topics but pretty darned certain. Because I know that there is proposed new legislation to screw us even more by actually implementing a "tax bomb" where there currently is none. Essentially the proposed law states that the money that is forgiven from the loans acts as income earned that year. So if you had say, $200k forgiven then suddenly your income goes up by that amount, possibly putting you in a new tax bracket but at least certainly making you pay the tax on $200k. There was also proposed legislation to remove the origination fee refund on federal loans* but that did not pass. However new legislation is being drafted based on the failed bill and now the tax bomb as well.

the "tax bomb" is not a proposed law; it's already in effect.
it's something everyone should educate himself on: the tax bomb at the end can be quite detrimental, given that it's the cumulative remaining balance & interests accrued over 20-30 year period.

so I'd like to ask: since you do both PSLF and IBR, do you have a "tax bomb" at the end?

*Without editorializing too much the student loan system in the US is completely corrupt, inefficient, unwieldy, and designed to make a small number of rich people vastly more rich and not to actually benefit the students in question. For the privilege of loaning its own citizens money in order to (at least hypothetically) become more valuable and productive members of society, our government charges an origination fee with every single loan disbursement. So you borrow, say, $80k and you only ever even see $76k of it because that money never really existed, the government (and actually Freddie and Fannie, for all practical purposes) just wrote a bigger number on an electronic form. If you made the first 6 (or 12?) months of payments on time some portion of that fee gets refunded (can't recall if all or just most). The law would have rescinded that.

completely agree.
the US is the only country where gov. lends to students at 7.6% interest rate, with no way of discharging it in bankruptcy!
at least in the UK, everybody pays 10% of their income and if they don't pay it off in 25 years, the remaining is forgiven (no "tax bomb").

 

[nybgrus]

I'll be the first to admit I could be very wrong as finance is far from my expertise. The way I recall reading it is that the tax bomb is not yet a law in effect. Perhaps I am completely mistaken and recalling incorrectly.

So to the best of my knowledge at the moment, I am not expecting a tax bomb.

 

[deleted158872]

i believe the "tax bomb" is already in effect.... https://studentaid.ed.gov/sa/repay-loans/understand/plans/income-driven#pros-cons

What are the pros and cons of repaying my loans under an income-driven repayment plan?
Income-driven repayment plans may lower your federal student loan payments. However, whenever you make lower payments or extend your repayment period, you will likely pay more in interest over time—sometimes significantly more. In addition, under current Internal Revenue Service (IRS) rules, you may be required to pay income tax on any amount that is forgiven if you still have a remaining balance at the end of your repayment period for an income-driven repayment plan.

 

[nybgrus]

i believe the "tax bomb" is already in effect.... https://studentaid.ed.gov/sa/repay-loans/understand/plans/income-driven#pros-cons

I believe you are misapplying that section. That is, as I am understanding it, general federal loan FAQ. Which is why it says:

In addition, under current Internal Revenue Service (IRS) rules, you may be required to pay income tax on any amount that is forgiven if you still have a remaining balance at the end of your repayment period for an income-driven repayment plan​

That "may" is because it depends on exactly the particular loan forgiveness repayment scheme. Regarding specifically the sort of loans and repayment plan and circumstance relevant to us:

Public service loan forgiveness, teacher loan forgiveness, law school loan repayment assistance programs and the National Health Service Corps Loan Repayment Program are not taxable.​

Whereas if you didn't do PSLF and just did IBR and the 25 year time limit on it was up, thus forgiving the remainder:

The forgiveness of the remaining balance under income-contingent repayment and income-based repayment after 25 years in repayment is considered taxable income.
​

You can read the original source document from the IRS directly here.

Student loan repayments made to you are tax free if you received them for any of the following.... Any other state loan repayment or loan forgiveness program that is intended to provide for the increased availability of health services in under served or health professional shortage areas (as determined by such state).
​

So you are actually more technically correct than I am. But I am more correct in the relevant sense. ;-)

 

[deleted158872]

I believe you are misapplying that section. That is, as I am understanding it, general federal loan FAQ. Which is why it says:

In addition, under current Internal Revenue Service (IRS) rules, you may be required to pay income tax on any amount that is forgiven if you still have a remaining balance at the end of your repayment period for an income-driven repayment plan​

That "may" is because it depends on exactly the particular loan forgiveness repayment scheme. Regarding specifically the sort of loans and repayment plan and circumstance relevant to us:

Public service loan forgiveness, teacher loan forgiveness, law school loan repayment assistance programs and the National Health Service Corps Loan Repayment Program are not taxable.​

Whereas if you didn't do PSLF and just did IBR and the 25 year time limit on it was up, thus forgiving the remainder:

The forgiveness of the remaining balance under income-contingent repayment and income-based repayment after 25 years in repayment is considered taxable income.
​

You can read the original source document from the IRS directly here.

Student loan repayments made to you are tax free if you received them for any of the following.... Any other state loan repayment or loan forgiveness program that is intended to provide for the increased availability of health services in under served or health professional shortage areas (as determined by such state).
​

So you are actually more technically correct than I am. But I am more correct in the relevant sense. ;-)

it's fantastic now that I know this is an option! definitely take advantage of this in the future 🙂 😀

 

[californiaMD19]

How are you guys paying for this deposit?? I didn't think it'd be 5K+

 

[akinetopsia]

Webcamming. Just kidding. I've got some savings and I work full-time.

 

[Ragamufn11]

I am just curious if anyone has had an interview and has NOT been accepted. I just had my interview May 8, but I'm curious the acceptance rate of those interviewed.

 

[UncomfortablyNumb]

Can I get some insight into the interview questions? Is it a normal job style interview or are they trying to swing towards the MMI.

Also, has anyone seen an applicant get in with a 7 in one section of the MCAT? I know it's allowed (contrary to what the website states) but MededPath won't give me any numbers.

 

[sean80439]

Can I get some insight into the interview questions? Is it a normal job style interview or are they trying to swing towards the MMI.

Also, has anyone seen an applicant get in with a 7 in one section of the MCAT? I know it's allowed (contrary to what the website states) but MededPath won't give me any numbers.

10/10/7B.

 

[nybgrus]

it's fantastic now that I know this is an option! definitely take advantage of this in the future 🙂 😀

Bear in mind this is only valid if you get US Federal loans and work in a qualifying institution inside the US. Doing training or work anywhere else will not count.

 

[nybgrus]

How are you guys paying for this deposit?? I didn't think it'd be 5K+

That has indeed proven to be somewhat difficult for some students. I know of one who sold his car and found ways to use public transport to get around in order to do it.

One option is to take out a private loan for the amount at a bank, just like you would any other loan. Alternately getting a credit card specifically for that reason at least was an option (assuming you can still pay via CC). In either case, since your tuition for first semester will be less the deposit amount (except the OSHS fee) then you take that extra money and use it to pay off the loan/CC immediately so as not to incur further interest. Obviously you will need to research what loan/CC option is best for you. This is one where having a parent co-sign would be a very good option.

 

[UncomfortablyNumb]

10/10/7B.

Thank you!

 

[pitman]

10/10/7B.

Did they change the range for the writing sample? I thought it was J through T (which never made any sense at all)..

 

[sean80439]

No idea. Took the 2013 mcat. No writing.