Monday, April 17, 2017

Road To Residency--10 Helpful Tips for IMG's

Just like the journey to and through Medical School is long, settle in a while because this post is long also.  
For the non Med Student/Potential Med Student readers: I apologize in advance...this post will totally bore you! You should come back when there's more fun things to read & more pics to look at. 

For the Med Students: It's definitely a lot to absorb all at once but hopefully you pick up a couple points that you find useful in your quest for Residency. 

By no means am I an expert when it comes to being successful in the Residency Match process however here are a few tips/suggestions to help with the process as an IMG (International Medical Graduate).

1. What Kind of Doctor do you want to be? Have you always wanted to go into a particular field? Which rotations did you like best/least as 3rd Year Student? Determine which specialty you want to pursue additional training in and learn more about it. Ideally you have been thinking about this and have some clue by now. Schedule Sub-I's early in 4th year because those are often rotations students get LOR's from.  More on those later. 

2. Be Realistic. Realistically assess your scores and see how that aligns with the averages in the specialty you wish to pursue. I'm all for people chasing their dreams. If you have always wanted to specialize in a field where your scores aren't as high as the specialty average, apply VERY broadly and consider applying to a backup specialty as well. 

3. Look at your school's Match history. Most schools publish lists of the Specialties and Programs their graduates have matched in. Use this list as a guide for where to apply. If graduates from your school have matched there, you have a good shot at matching there as well. While you're at it, check the websites of other International Medical Schools as well to see the programs where their graduates have matched, those programs are likely IMG friendly as well!

4. Check the list for unmatched programs. The NRMP publishes a list of every single program and specialty in order by State. It shows how many slots were available and how many were filled for the last 5 years.  Programs that went unfilled are great programs to consider applying to because they may be more willing to give you a chance as an IMG. Here's a link to the 2012-2016 list: NRMP Program Results 2012-2016 Main Residency Match

5. Get your coins ready NOW!!! If you're still on campus, start saving. If you're doing clinical rotations, save whatever you can for the time you have left.  I suggest you save your money for Residency searching in a separate account. I was able to save a little every semester and used that to finance the application season. I spent about $7,000 on Residency search associated fees: ERAS and NRMP fees; travel-plane tickets, hotels, rental cars, tolls, gas, Lyft, Uber; food; clothes & dry cleaning and whatever other misc interview associated expenses came up. Without that savings I would have been in trouble! After The Match is over, if there's any money remaining in that account, put it to good moving expenses to wherever your residency placement is! Or use SOME for a post Med School Vacation like I did!!!!!  The rest will help with those aforementioned moving expenses.

6. Apply as broadly as possible. I can't stress this enough!!!! Apply to as many programs you are eligible for and your budget can handle--within reason! US students apply to about 30 programs or less. Even if you have the exact scores/grades as a US student, IMG's don't have that luxury. We're forced to apply to many more programs in order to have a shot at Residency. Most IMGs work just as hard, if not harder, to have a seat at the table. It's not right, nor fair but it's the reality we're faced with until things change. I think as more IMGs continue to match at these great programs, the attitudes of many Program Directors will shift. But until then, this is what we have to deal with. You don't wanna be cheap at this point bc the prospect of having to pay ERAS & NRMP registration costs & fees and interview related expenses again is not an easy pill to swallow. The IMG's I know have applied for anywhere between 50-200 programs.  If your scores are lower or you had to re-take any of your STEP Exams, you may end up closer to the higher end of that range.  

Oh! And be sure and apply to your dream program even if they don't usually accept IMG's!!! You will kick yourself if you don't give it a shot. You never know what can happen. 

7. Write a great personal statement. One that's original and talks about you, your motivation for why you want to pursue a career in medicine, why your chosen field, and where do you see yourself practicing in the future. Write this yourself! I don't know why anyone would pay someone else to write their statement but there are services available. Don't do it! Who can convey your passions better than you? This is where you can show the selection committees who you are. If you have blemishes on your academic record, explain them & mention what you learned and/or how you overcame difficult situations. Be honest & concise and then move on. Experts have suggested staying away from controversial topics (think religion and politics), super abstract pieces, and long drawn out stories. 

Make your statement succinct, about 1 page in length, and be sure it contains no errors. Have multiple people review it and ask for critical feedback. You may have to write your statement multiple times, I sure did. I had 3 different statements with totally different approaches before settling on what I wanted to write. Once I was sure, I re-wrote, and fine tuned it about 10 times! Seriously, maybe more than that. But I was satisfied when I was finished. Once you have a statement you're satisfied with, accept that you may still need to tweak it for different programs.  Be sure to check each programs website because some require specific things to be included in your statement.  Don't count yourself out for something silly like not following directions.  You can upload as many Personal Statements as you want into the ERAS Portal and then assign them to the various programs as you see fit.  I ended up with about 6 different versions of my personal statement.

Most medical students are smart. Grades and test scores may be similar. Your personal statement is one of the only things you have complete control over and the best tool to set you apart from everyone else. The statement is important, period. 

8. The early bird gets the worm. Prepare your application so that it will be submitted on the first day that application season open: Sept 15th (this date may change when it falls on a weekend, so check the dates on the ERAS website).
What does prepare mean?? It means have a COMPLETED application ready--STEP 1, STEP 2 CK, STEP 2CS, Personal Statement, LOR's, & EGFMG Certification. The MSPE (aka Dean's Letter) won't be released by the schools until Oct 1st so don't worry about this. Just be sure everything else is uploaded and submitted well in advance so a complete package can be transmitted on Sept 15th. 
Here's the thing--can you submit without all of the exam scores? Sure. 
Should you? No! 
As an IMG/FMG, you will give yourself the best shot at getting the maximum number of interviews if you have a complete package when the programs start their reviews. If you can't submit your app on the first day, get it in as soon as possible after Sept 15th.

About those LOR's: You usually only need 3 and 1 of those must be in the Specialty you are applying for.  Some specialties (like EM) have more specific requirements, so verify what you need early! You may need to restructure your rotation schedule to make sure you can get the letters you need. 
Start asking for them earlier than you think you should because some letter writers take a while to get them back to you. Ask while you are almost finished the rotation/still at the hospital if possible.  If it's in your 3rd year, ask the Student Coordinator if they can hold the letter on file for you until it's time to be submitted to ERAS. 
When you request a letter, do it in person if you can and then follow up with an email.  In your email consider including the following info:
-remind them who you are, thank them for agreeing to write you a strong letter of support, let them know which specialty you're applying to, your AAMC ID
-if you received positive feedback from the Residents or other Attendings during the rotation mention it
-provide a brief CV for them and be sure it includes the dates of your rotation
-a copy of a rough draft of your personal statement if you have it available (see, starting early helps)
-a picture of you in your email signature/attached, especially if it's been a while since your rotation or if they have many students
-in the email body tell them what attachments you are including
-the date you would like them to have the letter ready. I would suggest July 15th! Maybe it will actually be ready by Aug 15th. Seriously.  
-ERAS Letter upload info (pdf). You will be able to generate this once you open an ERAS account (registration opens in early June)
-Include your contact info and ask if they need anything else 
-include the contact info of the Student Coordinator if they will be uploading the letter for you
Follow up 1-2 weeks before the due date you mentioned and ask if they have questions.  Let them know that you will forward the ERAS Recommendation Letter upload information to them once your account is set up and they can upload the letter directly.  

9. Prepare for your interviews. Interview invites are sent out as early as Sept 16th!! When you're invited for an interview, respond immediately! Set email alerts on your cell phone so you get the invites and can reply right away.  Put all of your interviews on your calendar and be sure to note if there's a candidate dinner the night before and if the program will cover any lodging expenses. I was fortunate and quite a few programs helped with this cost!  Keep this info handy when making travel plans. 

Try to schedule interviews as early as possible in the season--your clothes will fit, you will be fresh, and you won't seem disinterested. As additional invitations come in you can add them later. Schedule interviews at less preferred programs early so you can get some practice and get over any nervousness.  Contact programs that are in the same area and see if you can interview around the same time to save on travel expenses. By strategic scheduling, I was able to interview with 3 Michigan programs in the same week saving on hotel and plane ticket costs. 

Get a few interview outfits ready & don't be afraid to show a little bit of your own personal style.  
Review common interview questions in advance. 
Review the program websites a few times before going on your interview and make a list of questions to ask the Program Directors, Residents & other interviewers. Jot down notes immediately after each interview so you can look back on them later. Send thank you notes/emails to programs post interview.  If you have additional questions for the programs, reach out to them with the contact info provided on interview day. 

10. Get ready for the Match! Don't forget to register for NRMP, which is separate from ERAS, before the early deadline, the fee was $75 this year. You don't want to waste money on late registration fees. Determine how you want to rank the programs you've interviewed at and rank them accordingly. Rank your favorites at the top. You have nothing to lose by ranking a top tier program high on your list. Be sure to submit your Rank List and certify it by the due date! Don't be like that well known Cardiothoracic Program in NY that didn't submit their Rank List by the deadline this year. 
Once you certify your list, pat yourself on the back for getting through a crazy few months and enjoy the last rotations you may have as a Medical Student. 

Also, try your best not to stress too much while waiting for Match Day. Hahahahaha, that's a joke right!?! I know...It's much easier said than done but for your sanity you have to at least try.  

One last thing...if you don't Match and need to SOAP, be prepared. The NRMP will send you an email letting you know your eligibility to participate in SOAP a few days before Match Day. SOAP is the supplemental offer and acceptance program for unmatched applicants. This is where unmatched applicants apply to programs that didn't fill all of their spots. This is another way for students to secure a spot. Sometimes it's in a field other than their original choice but it's still a Residency spot! 

Whew, I know that was A LOT of info!  This process is no joke but being organized & prepared will serve you well! GOOD LUCK!!!

Students: What other questions do you have?  
Newly Minted Residents: What other tips do you have for students??
Leave them in the comments. 

 Until next time...