Which is a better plan?

[somosa]

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I'm an IMG who joined MBBS in 2004 July and completed internship in 2010 September. I have been working continuously since then and my contract is for two years till 2012 September. However, the work load is miniscule and I can study 10-12 hours a day.

I now want to write USMLE and apply for a moderately competitive residency. Since I have not read anything in the past year or so, I might need to study pretty hard. So, with that in mind, would it be a better idea for me to aim for 2013 match or 2014 match?

Advantages of 2013 match:

1. I would be only 3 years out of medical school.
2. I would be only 31 years old when I complete residency.
3. No gap in the resume. That is, I would not have any break in service.

NEGATIVES:

1. I will have to study really hard and rush all the exams, risking a low score.
2. In all likelihood, I will only have Step 1 marks by September 1st, 2012 and finish CK and CS before Dec 31st, 2012.

Advantages of 2014 match:

1. I can finish step 3 and may be able to get a US Observership.
2. I can take about 6 months prep time for step 1, 5 months for CK, 4 months for step 3 and 1 month for CS, and may be able to do CS after a US Observership.

NEGATIVES:

1. I would be without any work for a year- showing a big gap in my resume.
2. I would be 4 years out of medical school.
3. I would be 32 years old when I complete residency.

 

[Law2Doc]

I'm an IMG who joined MBBS in 2004 July and completed internship in 2010 September. I have been working continuously since then and my contract is for two years till 2012 September. However, the work load is miniscule and I can study 10-12 hours a day.

I now want to write USMLE and apply for a moderately competitive residency. Since I have not read anything in the past year or so, I might need to study pretty hard. So, with that in mind, would it be a better idea for me to aim for 2013 match or 2014 match?

Advantages of 2013 match:

1. I would be only 3 years out of medical school.
2. I would be only 31 years old when I complete residency.
3. No gap in the resume. That is, I would not have any break in service.

NEGATIVES:

1. I will have to study really hard and rush all the exams, risking a low score.
2. In all likelihood, I will only have Step 1 marks by September 1st, 2012 and finish CK and CS before Dec 31st, 2012.

Advantages of 2014 match:

1. I can finish step 3 and may be able to get a US Observership.
2. I can take about 6 months prep time for step 1, 5 months for CK, 4 months for step 3 and 1 month for CS, and may be able to do CS after a US Observership.

NEGATIVES:

1. I would be without any work for a year- showing a big gap in my resume.
2. I would be 4 years out of medical school.
3. I would be 32 years old when I complete residency.

No program is going to see any real difference between someone who is 31 vs 32, so just take that negative off the table. As for whether the bigger negative would be a bigger gap in years or a lower Step 1 score, I suspect a poor Step 1 will hurt you more. Your best bet as an IMG is going to be to have very high Step scores, to complete all if them, and to have as much US work experience on your resume as possible.

 

[adagio]

A residency completed outside of the US is still a gap in the CV as far as IM programs are concerned. They do not consider this training to have any value, on the contrary, it may actually hurt your chances as they prefer people who are (fresh graduates without prior training in their countries).

However, the work load is miniscule and I can study 10-12 hours a day.

this comes in contrary to US graduates who take the USMLEs in a week or two. Residency programs tend to view very high scores as being unrealistically inflated by this practice. if you study USMLE step 1 for a year, how can you equate it to the AMG who takes it in 10 days?

Your best bet is to apply for residency as soon as possible. its getting very competitive for IMGs in the US; people who applied for 150+ programs are getting less than 10 interviews. It is dismal, it is grim, but its the truth.

You need to get through the door ASAP.

Best of luck

 

[Old Style Nanny]

A residency completed outside of the US is still a gap in the CV as far as IM programs are concerned. They do not consider this training to have any value, on the contrary, it may actually hurt your chances as they prefer people who are (fresh graduates without prior training in their countries).

this comes in contrary to US graduates who take the USMLEs in a week or two. Residency programs tend to view very high scores as being unrealistically inflated by this practice. if you study USMLE step 1 for a year, how can you equate it to the AMG who takes it in 10 days?

Are you suggesting that the exam be taken in a hurry?

You make a good point but the difference is not as much as you make it out to be. The students in US come from a teaching environment focused completely on USMLE. The curriculum properly reflects that. So all one needs, apart from attending the classes, is a good revision. Unfortunately, 99% of the IMGs don't have this luxury. They have to depend upon self-learning and also learn in a completely different manner from how they learn in school (factual and theoretical without much application). So, while I agree it is not very much comparable, I don't agree the IMGs have an advantage of prep time. If any, they are at a disadvantage. And most programs would still prefer an AMG over an IMG wouldn't they?

Your best bet is to apply for residency as soon as possible. its getting very competitive for IMGs in the US; people who applied for 150+ programs are getting less than 10 interviews. It is dismal, it is grim, but its the truth.

Really?

 

[adagio]

This may very well be true (or it may not be, its valid both ways actually), but PDs in the US will look with a skeptic eye at any stellar scores for people with gaps. IMGs are not smarter than AMGs. period. when a large proportion of IMGs are getting very high scores, its likely that the lengthy duration of preparation influenced this outcome. If you are doing your PhD or postdoc, however, and manage to get stellar scores, this wont be an issue.

I am not suggesting that exams be taken in a hurry, I am saying that delaying OPs application till 2014 is not a very good strategy. The doors are closing. FMGs with good applications are applying to 150+ programs and getting 10> IVs (good in terms of 240-250+ in both USMLEs, some USCE, good command of english), and some applicants with stellar applications are getting 20> IVs (which is still low if you consider that the total number of applications was well beyond 150.

Bottom line:
Residency in the US has always been cyclic for IMGs. In some eras, demand is high, more IMGs get in. In others, demand is low, and doors begin to close.

I feel that in a couple of years it will be very difficult for IMGs to get into the system (I think it already became difficult)

 

[adagio]

And most programs would still prefer an AMG over an IMG wouldn't they?

Sure they would. And they should. It makes sense that (betting) on an AMG, whose school has a tradition in graduating good people who do well in residency (generally speaking) is way better than betting on an IMG, who graduated from an unknown place. I would bet on a winning horse, although I know that some of the new horses might have potential as well. Again, its life.

MSPEs and LORs issued by US faculty are way more reliable than those from across the seas. They know how there system works, and they would not want to reinvent the wheel.

Its only the shortage in some specialties that are making programs enter this gamble. And still, you have IMGs coming from Germany, France, Italy, japan etc some of these european countries have some of the oldest universities in the world, and they contribute in bulk to research.

Those IMGs will have more interviews than other developing countries, simply because of the fact that (generally, and i emphasize generally) graduates of those places are reliable.

 

[Winged Scapula]

In regards to USMLE scores, I think the relevant perception amongst US faculty is that FMGs are *expected* to have stellar scores because of the fact that these applicants usually have much more time to study than the typical AMG.

Therefore, an FMG applying who has not scored in the 99% percentile on the examination will be less interesting as a candidate because most of his FMG peers will have such a score.

After FMG/IMG status, I'd venture that USMLE Step 1 score is the most frequent measure used to filter applicants out and thus, applying without the expected stellar score (perhaps because one did not spend enough time studying) would be a mistake.

I agree with L2D - the age difference and the single year difference since matriculation are not worth bothering about; a poor Step 1 score is.

 

[adagio]

I agree with L2D - the age difference and the single year difference since matriculation are not worth bothering about; a poor Step 1 score is.

Agree with winged scapula with my aforementioned caveat: delaying the application will most likely diminish the prospective number of interviews.

 

[Winged Scapula]

Agree with winged scapula with my aforementioned caveat: delaying the application will most likely diminish the prospective number of interviews.

In general, the longer one waits after medical school graduation, the harder it will be to match, however, this will not trump a poor USMLE score.

 

[adagio]

In general, the longer one waits after medical school graduation, the harder it will be to match, however, this will not trump a poor USMLE score.

Oh, I am not talking about the year of graduation here!! I am talking about how increasingly difficult the match is becoming with the current trend.