Yes USMLE scores are important - but not everything for a Medical Residency in USA!
To be Pre-Informed is to be In Form :-)
Sharing Wisdom learned through application experience and mistakes - especially for IMGs / FMGs!
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Wednesday, December 12, 2007
APPLICATION STRATEGIES: LESSONS FROM THE PAST...
Let's begin with a quote by Arie De Gues to give ourselves a good context why this post is important:
“The ability to learn faster than your competitors may be the only sustainable competitive advantage.”
Which is pretty reflective on what Aristotle had once said,
''The secret of business is to know something that nobody else knows''.
Having said that, back to our topic : 1. Apply on time: For God's sake ! and that means September to very early-October 2007 if you are aiming for the 2008 Residency match! Start your deadline clocks today ! And gather all required stuff on time - Time goes fast while we are busy, and Sept. 2007 will be here faster than you think ! (Yes - you can apply only with Step 1 Scores too and mention the Step2CK date on your application). And of course, read about the technical reason to apply on day one - if you are not ready to.
2. USMLE Steps Planning: Plan Steps such that you have Step 1 and Step 2 CK IN HAND at the time of applying. Grant about 4-weeks to the ECFMG slow-pokes for your scores - schedule accordingly ! This assures the maximum number of interviews. If you are applying on a single score like ONLY step 1 or ONLY Step 2 CK - interviews are much lesser ! 3. USCE - US Clinical Experience / Research Experience ! Try hard to get this, coz it now seems to be the most important application booster after your scores ! A lower score with US clinical experience may get ranked high by program directors than someone with high 90s but no clinical experience. Match 2006 certainly has proved that USCE is very important to program directors ! As an additional proof of its rising importance, check out this IMG requirements page put up by the Pediatric Residency Program at University California at San Francisco.
Be advised that in terms of importance / preference for Residency Applications:
Clerkships, Electives, Externships > Observerships > Short-Term Clinical Research
More dedicated to explanation of the various types of USCE in a separate post. Externships or Sub-Internships, Mini-Residencies, and Clerkships / Electives are considered true USCE since they give you hands-on clinical experience, whereas Observerships ( a.k.a 'Shadowing') only give you a chance to be a passive observer without being allowed to touch the patient. Start contacting hospitals where you can go and try to fix them early - so that you can specify that on your ERAS application that its arranged. Even you arrange it later, you can always call up the programs that you have interviews with or interviewed with later, so that they rank you high in mid-February. Click herefor an ongoing compilation of places that offer Observerships in the USA. Again , USCE has proved important in the 2006 match , with many 95-plus scorers going unmatched while 80-scores with USCE matching ! So take note ...
4. US Letters of Recommendations (LORs): Try to get atleast 2 LORs from US doctors / Clinical Researchers - your application will get considered way high ! Read more about them at LOR basics for Residency.
5.ECFMG Document Verification: If you medical school is slow about verifying your documents from ECFMG - get on their asses and get it done before applying too - trust me, it helps to be ECFMG certified atleast before you interview. Don't forget to have your Dean's letter or the MSPE ready by July-August.
6.Take the Step 2 CS (CSA) Early: If you have not already, my personal recommendation is book the earliest day for Step 2 CS Today ! It takes only 15 days to study well for it and now you can take it even before Step 1 (Preferrable, given the crazy delays in score reporting in the later half of the year). Last year, many Step 2 CS results were delayed and people could not participate in the match ! To see the earliest date available at this very moment at the 5 CSA centers in USA - Click Here! . Some programs like the Internal Medicine Residency Program at the Penn State's Milton S. Hershey Medical Center would like to see Step 2 CS results even before you apply to their program, hence, its in your best interests to have as many Step Scores ready before you apply so that you can be eligible for as many programs as you can be. Even ECFMG issued a notice urging candidates to book a date before the end of July to ensure a date for the year. My USMLE Step 2 CS Tips-N-Tricks-N-Notes have been compiled at [especially for IMGs] at CSprotocol.blogspot.com
7. Start early on your Personal Statement : Don't make a sloppy last-minute job out of it. For every specialty you apply for, it is advisable to have two formats for your Personal Statements - one for Community Programs and the other for University-based programs. More on Personal Statements at http://www.usmletomd.com/ps
8. About Step 3 and H1B Visa: If you wish to be considered for an H1B sponsorship, Step 3 must be completed ideally before you even go for the interview - but thats painting a very very ideal picture. The second best would be to have your results before the programs submit their candidate ranking to NRMP. Will be writing more on Step 3 on a separate dedicated post.
9. Targetted Applying approach: When the time to apply arrives, you will be busy calling up programs to know visa policies and other policies such as minimum scores, USCE requirements, Reco requirements and so on. Many of you will call up those hundreds of programs and decide where to apply. Thats cool - and I advocate that approach - But, in addition, it helps to make it targetted basing whom you call depending on which programs actually gave out H1 Visas in the past ! I have begun compiling a list of IMG-friendly residency Programs at http://www.USMLEtoMD.com/imgfriendly based on collected information from pals and will be completed soon.
10. Speeden up your USMLE prep: Agreed that these studies get pretty boring - so get your a study partner - Enlist yourself for free at www.USMLEbuddies.com. Besides study partner listings - more new innovative resources will keep getting added - that are otherwise hard to find - such as Interview Experience Submissions Database , which has about 270 First Hand Interview Experiences by residency applicants and gives a lot of info about Individual programs like Fellowship chances, Visas offered, Prematches given or not, etc. Other resources will are scattered here and there - so grab the diamonds ;-)
11. Interview Performance: Again , the year 2005-06 has proven how much this matters ! In year 2005, A well-known IMG-Friendly university program called about 200 candidates for interviews, but only ranked about 50-60 candidates based on interview performances and assurances from candidates! So - it's not just your personality that matters on an interview, but also how much you can assure the program director that you are genuinely interested in the program. When your time arrives, you could use Residency Interview Tips-N-Tricks are being compiled at USMLEtoMD.com/mdinterviews, besides real interview experience submissions by 2005-'06 interviewees Here.
12. No Gaps on the Resume ! This is particularly more important for the IMGs taking the USMLEs is not viewed as an excuse for a 'time-off' and sitting home. So try your best to keep something going on like some nominal research or a part-time clinical experience. Of course, this won't be a concern for those involved in some academic program or medical school.
13. Professional Help: A little bit of that does not matter - of course as long as you are not paying too much ! That's why quiet a few friends of mine and other people on the forum have been using these neat books which are not too expensive either:
- "California H-1b residency usmle" - "when to apply for residency 2008" - "usmle residency application tips" - "how to improve chances for residency medicine and surgery" - "usmle forum, fellow match"
Number of Residency Positions v/s Number of Residency programs
After boiling down your list of residency programs to the ones that you are eligible, some of you may find that you are eligible to many programs but the amount of money you can spend is strictly limited. In such not-so-uncommon scenarios, thinking of the number of positions one applies to instead of focusing on the number programs has two advantages -
a. higher chance of interview b. You get a more economical deal ;-)
Of course a lot of you may already know this...but its amusing to note some of us boast about the number of programs applied to without also focusing on the number of total positions in the game...
This is because, there can be a pretty big difference in the number of positions - for example, the Internal Medicine residency program at Creighton University, Nebraska had 25 positions while the University of Buffalo program at Buffalo, NY has 56 first year positions as per 2007 FREIDA data.
So if Rohit applied for 30 programs with a total of 200 positions and Arif applied for 30 programs with a total of 300 positions - who got a better chance for an interview - (credentials considered similar) ? - Yeah...Even though both paid exactly the same amount of Dollars.
The same logic can play its part while applying to programs as 'backups' from other specialties...why not get more 'bang for your buck' ;-)
How does the Residency Program Director Side of ERAS Applications Look ?
Ever wondered how do the ERAS screens and your applications look on the computer monitors of Program Directors and Program Coordinator side ?
The AAMC website does host a Powerpoint presentation meant for the Program directors and coordinators that shows us a lot of useful screen shots of how the application looks on their end, how they can sort applications and more..
The screen shots look cool and give a lot of information- Here's an example:
1. The candidate's Picture is visible to the Programs ONLY after they have invited your for an interview.
2. So here are the various possible "application Statuses" that your residency application may have:
a. Application Received b. Application Reviewed c. Application on Hold d. Selected to Interview e. Invited to Interview f. Wait-listed for Interview g. Scheduled for Interview h. Interviewed i. Selected for ranking j. Inactive k. Ranked l. Withdrawn m. Withdrawn by applicant n. Will start o. Scramble Application
Where do you mention USCE (Observerships / Externships ) etc. on the CAF ?
Been thinking on that question lately ? Well, here's some help !
My apologies for a small digression = One of the problems that the Medical informaticians face is trying to 'structure' all medical information so that it becomes computable - of course the objective is noble, but trying to fit something as fuzzy as medicine into binary predefined templates is a very long shot, in fact almost impossible. For example, you can never have just have a "Yes" and "No" dropdown for a question as simple as "Does the patient have clubbing of the nails?", coz' even for the same patient, different physicians will answers like "yes", "no", "not sure", "maybe", "need second opinion". etc. , depending on their experience, expertise and perceptions. Almost nothing in medicine operates on rigid single-values, is mostly a range.
Likewise, while the CAF on the MyERAS application tries its best to 'structure' all candidate responses, there will always be information that does not have a well defined space to fill in !
A common question is where should the candidates mention those various types of non-curricular clinico-medical experiences (Both US and Non-US) like Observerships, Externships, Electives, Externships, etc.
This is what the CAF clearly mentions below the Experiences section title bar"
"Include Clinical and Teaching experience as work experiences, include all unpaid extra-curricular activities and committees you have served on as volunteer experiences "
That should include all types of clinical experiences - including Observerships. Though some say it would go as voluntary experience - but my principle is, do not undersell yourself and besides, as an observer, you are really gaining work experience and not volunteering your services to the hospital. If it is of any help - I have put up a sample filled out section for an Observership experience on the Page 5 of ERAS - Check it out by clicking on the accompanying image on the left.
********
There will also be additional points on your resume that you may not find a predefined 'structured' place on the CAF for - for example, some candidates might take some Continued Medical Education (CME) credits or short courses like BLS (Basic Life Support), ACLS (Advanced Cardiac Life Support) . etc - Where Do you mention All those ?
Use the "Other Awards/Accomplishments" sub-section located on Page 12 (Miscellaneous section) of the CAF for all such information
Search keywords to this blog post:
- "Where should we mention about observerships and externships on the Common Application Form" - "Where do I write about CME credits on CAF on myERAS Residency Application " - "observership - work experience or voluntary ?"
Are you really ready to pay for transmitting ERAS residency applications ?
They say a chain is only as strong as its weakest link....a relay team of runners is only as fast as its slowest runner...so, if you planned for months getting the things right for the Electronic Residency Application circus - like taking the USMLE Steps on time, getting those LORs on time and submitting documents on time, it will suck really bad to realize at the last moment, that after all that meticulous planning you are not equipped to pay for the programs !
So read on and take note fellas ..
1. MyERAS accepts only Mastercard and Visa for credit-card payments - Sorry No American Express
[During my first year in the United states, I was once buying a book at a small book store within this small town. When I fetched my brand new 'American Express Blue for Students' credit card out of my wallet, before I could even forward the card to the cashier, he kindly said, "Sorry pal, but we do not accept American Express - other cards are welcome". He told me why - American Express charges the merchants upto 4% of what the customers pay, while Mastercard, Visa and Discover card charged upto 1.5 to 2%. So, lets not be surprised if small shops and ERAS do not like American Express :-)]
Other tips on credit cards:
a. Make sure there is enough balance on these cards. Paying off those balances often takes 3-5 business (more or less) depending on the bank that issued the card, so have those pending balances paid off early.
b. For those in the USA, August is also a apartment-moving month, make sure you update your billing addresses well in advance and correctly, so that the credit cards work in September !
c. Applying and getting a approved credit card is a slow process and often the first credit card may not have enough credit limit to pay off the ERAS fees. A quicker is to buy a pre-paid visa credit card from a local store. that you use online too. I saw them being sold at Walmart the other day and thought they would be a quick and excellent thing for those IMGs without credit cards and credit histories. Read more about Prepaid Visa Credit cards Here. The site also lets you find the nearest store near your US location, where you can buy one.
d. If you have a Bank-issued Visa or Mastercard Debit card, confirm with your bank in advance if can be used online. If not, they might be able to enable that option on the debit card.
2.Not having a credit card is not the end of the story - well, at least for the match - since MyERAS also accepts Checks and Money Orders drawn on US banks - By this method, you need to print out the invoice in the payment module, and send in your fees via check in U.S.Dollars to the address mentioned on the invoice. Now this form of payment will take time to reach the ERAS guys, but they will still forward those applications immediately for you, like they would if you would pay by a credit card - but if the money does not reach them on time, your applications will be taken back from all the programs and you lose valuable time.
3. In point two above, I said 'at least for the match' , since during the scramble, ERAS will accept only credit cards for payment - since there are only two days for the scramble anyways. So, if you don't have a credit card yet - getting started on getting one is in your best interests :-) Of course you can always a friends or a relatives card - but building your own credit history in America has distinct advantages for fresh-in-USA IMGs who land a residency - like getting a lower interest rate when you buy that first car...or if you decided to buy a house during your residency/fellowship :-) - Lets save tips on those for another bright day !
Q. Will my ERAS applications be transmitted slower if I pay by Checks instead of Credit Cards ?
A.No ! As the NRMP Sites says: "In good faith, ERAS transmits applications to the ERAS PostOffice for processing immediately and regardless of payment method." But remember, if the payment does not reach them on time, applications will be taken back.
INTERVIEW OFFER EMAILS : KEEP TABS ON YOUR 'JUNK EMAILS' FOLDER !
Call it the bad side of technology or simply call it the non-human side of a computer - unfortunately, at times, the Interview Offer email may land up in your "Junk Emails" Folder on your email. Many of us, including myself, blindly go ahead and click on that "Clear Junk" tab without even going through what is being deleted. Kindly refrain from that during the period from September 1st until the Match Day - You don't want to miss out any program emails!
Hotmail is known to do that a lot, yahoo at times - I personally love Gmail ..yet trust none of them to do your Junk email categorization for you .
Ofcourse, you should also receive the same email on your MyERAS messages section - but at times programs send regular emails, whereas some programs send out paper mail via post !! - e.g. FP program at University of Oklahoma at Tulsa did paper mails during the 2005-2006 season.
You can always change your email address preference on your MyERAS application, if you want to switch.
So , stay alert and ready for some picking-from-the-trashcan activity ;-).
Some of you may say this is aint something to make a big deal about, but I really would not want to miss out that one interview that would have mattered ... hmmm, just a matter of taking-no-chances
Update: Whoa ! Looks like ERAS folks have been reading this blog ;-) Coz recently this notice did show up within ERAS online system :
"Programs have two options of sending emails. They could send an email using the ERAS software or they could send an email using their own email software. If they use the ERAS software you will receive a copy of the email in your Message Center.
Depending on the email service you use, the possibility exists that the emails from programs may be interpreted as either Spam or Junk Mail and therefore they will not appear in your inbox.
Since ERAS has no control over this - we recommend that you check the Message Center regularly for your messages."
THINKING 2008 RESIDENCY MATCH ? BOY U GOTTA START NOW !
Lately I have been power-cycling a lot on my 21 Speed Mongoose Bike into the dense Oak forest trails to take advantage of the lovely American fall season. The Fall happens so regularly, each year...just like the phases of moon keep repeating...or the way you keep coming back to same "Do Re Mi' notes octave after octave...Cyclical events, just like our residency applications, year after year. Yet, each residency-match year has its own distinct flavor and dynamics. Early planning has remained a vital credential for highly competitive programs and I would like this post to make hopeful IMGs aware of deadlines - both Technical and Logical. This year the Internal Medicine Program at Abington Memorial Hospital received 700 IMG applications with scores above 90 on both steps WITHIN the first week of September ! Competition is intense ...So read on...and plan while you still have time ...
Sometimes, while planning, it's best to work our way backwards from our ultimate target, so that you not only know what and when to do stuff, but also WHY to do it. So know the deadlines and act on them, otherwise its all futile, as Soren Kierkegaard puts it :
"It is perfectly true, as philosophers say, that life must be understood backward, but they forget the other proposition, that it must be lived forward."
Lol...I see that I have built up enough drama for this post ;-) Hmmm, So lets suppose you were planning on starting a Residency in 2008 ( All Residencies begin on the 1st of July of the year)
1. The 'Match' is a computer algorithm owned by the National Resident Matching Program (NRMP) that will occur around Mid-March 2008. The algorithm will 'match' program preferences on the list submitted by candidates with interviewed candidate preferences submitted by the residency programs. These lists are called "Rank Order Lists" (ROL).
2. When are these ROLS Submitted to NRMP ? That will be around the Middle of February 2008
3. Now, in order to have your name added on that ROL of the residency programs that you interviewed at, before the middle of February 2008, this is what program directors want to see from you :
a. Be 'ECFMG Certified' by then (i.e. Cleared Step 1, Step 2 CK, CS and have Medical documents/credentials verified with medical school)
b. Have passed Step 3 (if you need an H1b Visa) - please note that you can apply for a Step 3 Permit only after you have RECEIVED your ECFMG Certificate - which takes two weeks to arrive after passing all the previous 3 steps - Step 1, 2 CK and 2 CS.
4. Technically, applying to residencies and then participating the match is handled by different organizations - ERAS does Residency applications while NRMP does the matching part , so by December 2007, do not forget to Register yourself for the match - costs 40$
Hmmm, so far so good, Lets continue backwards further...
5. The peak Interview season will be Oct-Nov-Dec 2007 , while some programs (especially the ones that offer Pre-Matches) will send out Interview offers to applicants as early as September 2007, often on a first-come-first-serve basis. In order to be called for Interviews, obviously you should finish applying to programs through the ERAS (Electronic Residency Application Service) before the Interview season. To maximize your chances for interviews and get an edge over the competition, it is highly recommended that you apply EARLY (ideally 1st of September 2007) and your application should be complete (with Step 1 , Step 2 CK scores reported and Step 2 CS Passed by then)
6. Now, let's give a thought to what credentials you should have completed BEFORE applying on September 1st 2007 ?
a. Step 1 , Step 2 CK and Step 2 Passed and scores reported (Step 1 and Step 2 scores take 4 weeks for reporting and CS scores take about 8-10 weeks)
b.US-clinical Experience (US Clinical Electives, Observerships or Externships) - either completed or ongoing or secured [ so that you can mention on your application while applying itself]
c. All documents scanned by ECFMG and uploaded to the ERAS virtual mail-box so that they are ready for programs to download by the time you apply - as explained in point 7
( At this I point I would to state again that this timeline is an IDEAL scenario so stay ahead of competition - it does NOT mean that you cannot technically apply without all scores in hand - you can apply even on a single score... but people with all the above ready will always have that advantage..so do aim for this! Also read about ECFMG Certification)
7. Next, in order to be able to apply on 1st September 2007 deadline these are the things that must be taken of BEFORE 1st Sept. 2007:
a. you should have finished sending required documents [MSPE , LORs ,Copy of Medical school Transcript] to ECFMG-ERAS for scanning, by the middle of August - ECFMG says it will take about 10 business days for finishing scanning everything and making them ready to be attached to your ERAS applications - but this year, the time taken was more ! So the earlier you are , the better. Let me say something more ....actually, all your documents should REACH ECFMG by the middle of August. Hence, based on which part of the world you are applying from, you will need to have ready and mail them even earlier that middle of August 2007.
b. Completed filling up all the details the online Common Application Form (CAF) on the ERAS website and completed writing Personal Statements for all specialties. Note here that Personal Statements are often underestimated on the time that they will take to prepare and finalize. I would say, to a get a completely satisfactory Personal Statements, it takes 7-10 days of drafting, editing, tweaking, polishing and feedback from friends :-)
c. Completed compiling a list of programs to apply - i.e. your own 'IMG-Friendly List' of Programs - again it's best to prepare this by individually calling/emailing programs from the various IMG-friendly Programs listed Here. This takes a lot of time too. Thus, all this pre-application prep is easily gonna make August 2007 your busiest month - so dont plan a vacation then ;-) !
8. Next, in order to have ECFMG accept your documents and to be granted access to the ERAS website, you first need to have an AAMC ID - and that is obtained ONLY after you purchase the electronic 'ERAS token' online through your OASIS account on the ECFMG.org. And when will ERAS tokens for the 2008 Match be available ? First week of July 2007 ! So grab it as soon it is available (for 75$) and get the ball rolling - coz even the ERAS Token takes anywhere between 5-10 days to be granted after you have made the purchase :-)
So if you wish to have an ideal situation as described below....the time to act is now !
:-)
NOTE: This post was to help understand the timeline that 2008 residency aspirants should aim for - to learn Tips and Tricks about making your application more competitive. Remember that only USMLE scores are no longer important - to undertand what else matters for getting interview calls - please read : 'Application Strategies: Lessons from the Past'
Accepting a prematch (out-of-match) offer is probably the biggest reason for withdrawing from the NRMP match. Guess we don't need to delve into other reasons.
First of all, prematched candidates must note that it is imperative to withdraw from the Match before the Rank Order List Submission deadline - The deadline for 2007 Match is Wednesday 21, at 9:00 PM Eastern Time. Otherwise you might end up with a second marriage - LOL. Entering the NRMP Matching program is a contractual agreement to abide to the Match results. In case you do forget to withdraw and end up matching - you land in troubled waters. Even if you decide to go with the Matched position, the prematch offering program is gonna be up in arms - unless of course you only signed the Letter of intent and Not the binding prematch contract letter (Lets reserve that for another post, but it's a safe idea to wait till you actually sign and send back the prematch contract letter before you withdraw from the match)
Here are the steps to withdraw from the NRMP Matching Program:
1. Open up to the NRMP Match WebSite. 2. Login ( *Duh*) 3. After you login, Click on "Update My Profile" Link on the Menu Seen on the Left 4. Next, you should see a "Withdraw" Link adjacent to your name along with other Links 5. Choose Withdraw and Confirm
This will automatically send a notification to all programs who rank you on their ROLs.
If it helps, Click here to look at the images / screenshots of the process.
Now, In Addition, candidates can and should notify individual programs about your withdrawal. This is not compulsory, but as I wrote on an earlier post about notifying programs about Interview cancellations, I consider it ethical to let the programs know about your withdrawal, so that they can extend invitation to other candidates on the waiting list. Of course, if the Interview season is already over (Jan end), then notifying individual programs is more of a matter of courtesy - they will get to know anyways if they rank you. [ If they did not want to rank you, they don't need to know anyways ;-) ]
Here's the Steps to notify programs individually. Instead of me overusing my ATP molecules into typing, lemme copy-paste what AAMC.org site says on this ..he he " You may withdraw from programs one of two ways; - by contacting them directly (e-mail, phone, etc.) - or by using the new withdraw feature in MyERAS.
1. Withdrawing by Contacting Programs:
* If you no longer wish to be considered by a program you can contact the program directly and notify them of your decision. Contact information for the programs can be obtained from within your MyERAS account. Once contacted programs will have the ability to mark you as "withdrawn" from application and will no longer consider you for the position(s).
2. Withdrawing using MyERAS:
* You may now use MyERAS to withdraw your application from consideration by a program. To withdraw using MyERAS you will need to login to your MyERAS account, click on the "Programs" tab, click on the "Programs Applied to" tab, click on the the program you wish to withdraw from, mark the field "I would like to notify this program that I am withdrawing myself, click on "Save."
Here's a screenshot of where to find that withdrawal field they are talking about. Personally I don't like the way they have designed this functionality, coz' you gotta do it individually do it for each program ! And there are plenty of IMGs who applied to 100-plus program - didn't you guys ? ;-)
Specifying Desired Visa on ERAS Application: H1b ? J1 ? Or Both ?
It's been an awfully long time since my last post on Tips4Match Blog and it's time to rekindle the flame here.
Well...like I probably have written elsewhere on one of my too-many blogs [seriously, am losing count! ] - having excessive choices make our life miserable, coz' each choice has it's own 'opportunity cost' - that is, the price you pay for missing out on the benefits of other choices when you finally make a choice. Unless, you could simply select all and still be right ;-)
When you be fill out the Common Application Form(CAF) while applying for residencies through ERAS, visa-needing IMGs are required to specify their visa preferences: H1b or J1 or Both
Here are some thoughts on why I feel you should select both:
1. Given the increasing competition, wisdom suggests that its best to keep your application less restrictive so that it flows through the initial screening sieves that residency program directors use for incoming applications. An old medical school friend visited me as she was interviewing for fellowships - she mentioned that the biggest regret she had was restricting her visa choices to 'H1b visa only' when she had applied, coz' that seriously brought down the number of programs that called her for interviews.
2. Being open to both visa types is especially advisable for IMGs applying for the primary care specialties where J1-waiver job opportunities are good: Family Practice, Internal Medicine, Pediatrics, Psychiatry Obstetrics-Gynecology and General Surgery. This does not mean other specialties will not have J1-waiver jobs, only lesser and may need early searching, but then the number of IMGs getting in those specialties are fewer too.
Recently on a AMA News article concerning J1-Waiver physician supply, Texas Dept. of Health Primary Care Office reported that a total of about 896 physicians received J1-waiver jobs in 2005 and considering that the Conrad 30 program alone allows 30 J1-waiver jobs in each of the 50 US states, we got a lot of unused potential J1-waiver positions. Of course, it's not that mathematically easy to land a waiver job, but not impossible if you use the right strategies (shall put that up later).
3. There is a palpable positive change in the outlook of IMGs towards taking up J1-visa Residencies :
a. Some very good residency programs offer J1 visas only b. Fellowship options are certainly more and better on J1 than H1b c. And yeah - its better to have a residency than to go down trying exclusively for that H1b - he he..a retarded way of putting the same is : A J1 residency in Hand is worth 2 H1bs residencies in the bush ;-)
4. At times, programs that say they prefer J1 visas may in fact grant you an H1b visa on non-invasive, patient persuasion. In fact, I know a guy who convinced his program to change their J1 offer to a H1b visa offer AFTER the match. [Read about how to negotiate for the H1b visa with Residency Programs]
So for what candidates is it worth it to mention only H1b as the desired visa type ? For those who plan to take up non-clinical H1b jobs in the US after residency - in areas like management, informatics, pharma companies. etc. And why would such IMGs do a residency in the first place ? Coz' having an MD in some non-clinical fields gives a great edge.
Residency Application Tips for Candidates with failed USMLE Attempts
People with multiple attempts do get into residency programs, albeit with more difficulty than the first-time passers and may not always be the best programs. Here are some thoughts and pointers for candidates with more than one attempt on USMLE Steps
1. Unfortunately, it does bring down the number of programs you are even eligible for applying - if you look up the individual programs requirements on my IMG friendly Residency Programs list Blog, you will notice quiet a few programs mentioning 'first attempt' or 'not more than 3 attempts' on their criteria list. Thus, a sound advice to IMGs, [especially the rich IMGs ;-)] is - do not rush through the steps, take your time, a better score is anyday better than a failed attempt
2. An excellent score can and often will offset the effect of previous failed attempts. Now, if you will be taking a step AFTER you apply in September, and you are not too sure you will do good, it makes sense to keep your ERAS transcript settings on 'manual transmission' rather than 'automatic transmission'. Why ? the reason is more psychological than technical and I shall update that soon here (am revising a previous entry which I found errors on)
I shall anyways be covering the basics and benefits of both Automatic versus mechanical transcript transmission in a later post.
3. It is important for candidates with failed USMLE attempts to consider buffing up their application resumes with other avenues - US Clinical Experience, Research with publications and US LORS [and yeah - contacts ;-)]
4.Lastly, candidates with failed USMLE attempts must make good use of their personal statements in justifying the attempts and highlighting the strong points.
Q. Can you retake the USMLE Steps if you passed with a dismally low score ?
A. No - you may only retake it if you failed the USMLE Step, if you passed it - you may retake it only after 7 years.
So, remember :
"Failures are stepping stones to success - but Failures on USMLE Steps Stone your Success" - So take ur steps only after performing good on self-tests"
Search keywords to this blog article:
- "residency chances after failed USMLE" - "how many attempts USMLE for match"
Applying to Multiple Residency Specialties : Tips and Basics
As I write this post, it is that magical American summer time again and I can hardly contain my excitement about my upcoming trip to the rich green forests of Great Smoky Mountains in Tennessee, with all those wooden forest cabins, rafting and chopper-rides. When you guys get your residencies and happen to take a break there, make sure you think of me ;-) Maybe I will post a few pictures of my mini-vacation, if those are worth it...
Keeping the Smokys aside for now, let's go over a few quick questions on the matter at hand:
Q. Dude...First of all, can we even apply to multiple specialties using ERAS ?
A. Yes you can ! There are three main reasons why candidates would apply to different speciaties:
a. They are not decided at the time of application b. Applying to other specialties as a 'backup'. (e.g.: Internal Medicine candidates often apply to Family medicine as a backup) c. Because specialties that need pre-requisite prelim years, which not all programs will have, will necessitate the candidate to apply to not only the specific specialty but also prelim medicine or Surgery programs that are a pre-requisite.
Q. Will the Residency Program Directors know that we applied to other specialties ?
A. No, the ERAS program does not allow program directors to find out that you applied to other specialties - forget that - they wouldn't even know how many programs and which programs you apply even for the same specialty ! Having said that, of course there is that slight chance that program directors of different specialties at the same hospital / university discuss your excellent application and realize they are talking of the same guy/gal..lol
Q. Will I be allowed to send different Personal statements and Different Letters of Recommendation to different specialties I apply to ?
A. Yes - In fact you are allowed to have a separate customized Personal Statement for each program (highly recommended) and a different set of LORs for each program too. Unfortunately, though, you can only have one common application form - Read below.
Now, here are some points to note:
1. While ERAS is magnanimous enough to allow you apply to as many specialties as you like, there's a catch - the SAME Common Application Form (CAF) application will be sent to each of those specialties - of course you can send different Letters of Recommendation and different Personal Statement, your 'resume' that the programs will receive in the form of CAF, will remain the same. So let's say, you concentrated on applying to Pathology and made your resume look perfect for Pathology with pathology observerships, pathology research, etc. it may look wierd for Internal medicine and you cannot hide it from them!
[Personally I feel it is unfair that candidates are not allowed to restructure their resumes as per the specialties - I mean even when we apply for regular jobs, we customize the resume to highlight the job-specific strengths, don't we ? Hmmmm]
2.The Common Application Form, once submitted, cannot be changed ! Which means, after applying to a specialty, if you decide on applying to additional specialty, you CANNOT alter the CAF to customize it for the second specialty :-(
3. This does not mean that you are totally disadvantaged. Use the Personal Statement to explain the experience in the 'other specialty' and how it helped you for the specialty you are applying for. For example, guys with Internal medicine observerships applying to psychiatry as a backup could write on their personal statements how the personal connection with the patients you encountered and the impact of the illness on their perceived happiness and quality of life has drawn you psychiatry..something like that - gotta use your imagination here ;-)
4. Speaking of applying for backups - I often note how IMGs await interview calls from their main specialty of interest...and when calls don't seem to come, they hit the panic button and apply to their backup specialty in late November - which is not strategic ! Coz' the same Applying on September principle applies to the backup specialty too...
Moral of this post:
1. Applying to multiple specialties is allowed 2. It would probably would be to your advantage to apply to related specialties. 3. Use the personal statement to explain the connection of those disconnected thingies on your resume 4. Apply for backup specialties the same time you apply for your main specialty and do so very early in September :-) 5. Smoky Mountains is a great vacation place..LOL
ERAS Now Accepts Digital Photographs of Candidates
Yeah - ERAS gets more digital for the 2008 Match and thank god for that for 2 main reasons:
1. Getting a passport sized photograph in the US is unusually expensive
2. Pre-scanned will hopefully save time and probably even result in documents transmitted earlier for that candidate as opposed to those who send in paper shots
Here are the official requirements for a Digital passport-sized picture (as published by ECFMG):
- It must be in the Joint Photographic Experts Group (JPEG) format. - It must have a resolution of 300 pixels wide by 300 pixels high OR 240 pixels wide by 320 pixels high, and a color depth of 24-bit color. - The source of the digital photograph should be either a digital camera or a print photograph scanned into a digital format. - If a print photograph is scanned, it must be scanned at a resolution of 150 dots per inch (dpi) and with a color depth of 24-bit color. - The maximum image size accepted will be 300,000 bytes (300 Kb)
Most Digital cameras will already have the required color depth and we don't have to worry on that one, however the candidates who will be scanning their paper pics will need to make sure the scanner is set to capture that color depth or more.
ECFMG Warns against Fradulent Letters of Recommendation (LORs)
It might just be too tempting to write tons and tons of self-praise on the Letters of Recommendation think
Quoting an email warning from ECFMG:
"In recent years, the ECFMG Medical Education Credentials Committee has made a determination of irregular behavior in 12 cases based upon the submission of either altered or wholly fabricated letters of recommendation. In 11 of these cases, the applicant's Standard ECFMG Certificate was revoked. Since these individuals are no longer certified by ECFMG, they are not eligible to participate in an accredited residency program in the United States and are not eligible to take USMLE Step 3."
So who does a confirmation check on your LORs ? IProgram directors do not routinely do a check on LORs for all applying candidates, but the chances could be higher for the following:
1. Candidates called for Interviews , especially candidates that the program like or are considering a prematch offer for
2. Candidates with extremely flowery and praising Letters of recommendation
3. LORs that clearly look fabricated by the candidate (not much specific substance, but general praise)
4. Letters without an official letterhead and an official seal of the insititution OR department OR the faculty
5. Unsigned letters - *Duh*
6. Letters signed in Black ink - yeah, coz' photocopied signatures look black
So avoid all these factors mentioned :-)
Hmmm...having said that - while its true that some professors would like the candidate to write the letter himself/herself and then sign it after approving the letter, residency applicants should be sure the faculty remembers them and the letter LOL! [Maybe a reminder phone call or email that they might receive a call from the US about the letter he/she signed for u ;-) ]
You definitely do not want to write and sign your own letters ! he he
What if you get that LOR AFTER Applying to Residency Programs ?
Sometimes good things in life come after the time you wanted them the most, which somehow takes the fizz out of them when they come to you, nevertheless they still might have some might remaining ;-)
Likewise, it is always possible that you finally get a new Letter (or letters) of Recommendation (LOR) AFTER you already applied - for example, if your observership term got over or the recommender was out of town. etc.
Oh a question first : Does ERAS accept new LORs after you already applied ? = Yes, they do ! But that will take time for the letter to reach them by post, to get scanned and available for download the programs and finally time for the programs to see the new document and download it. Lets say at least 7 to 10 days or more
1. In case your experience was ONGOING while you applied but got the LOR later, it may worth your time to send an email (or even better to call) all programs about the availability of the new letter of recommendation. Tell them that it will be available on ERAS shortly and also mention that if they wanted, you could fax it to them (since ERAS thingie takes time as I mentioned above). Now, to be able to fax the letter, two things are automatically implied:
a. Send the original LOR to ERAS as soon as you get it - BUT make a copy of that letter before you do so for faxing
b. Obviously this can happen if you DO NOT "waive" your right to look at the LOR (an analysis of waive or not to waive LORs will be posted soon)
Now, I understand that some recommenders might insist (especially US LORs) that they will send the LOR to ERAS directly - in that case you may not be able to fax it to the programs but you can always write an email to programs to applied along with providing them with the email address or phone number of your recommender
2. In case you land an a clinical experience or a research project AFTER you applied, you might wanna still send an email to all the programs you applied along with providing them with the email address or phone number of your potential recommender.
[ Note: At this point, I would also like to point out that getting an experience would make you eligible for some more programs that you have not applied to before - so consider applying to those programs after emailing them to find out if they would consider your application.]
Psst....You might begin to understand why its a good tip to have all email addresses of programs that you applied to, to be stored in a separate file on your computer with commas separating them. So when the time comes to update programs, you merely have to copy paste that list and put them onto the BCC section when you compose that email. Other way to do so is to store them on your online email address as a group and then all you have to do is compose an email to that group!
Also, do not forget that some physicians would not mind calling up some programs personally for recommending you (depends on how your rapport builds up during your experience). This can be pretty powerful interview-fetcher if you can manage it ;-)
Each year, many IMGs are faced with the scenario of taking a shot at Residency Applications without having all USMLE scores in hand - like, maybe just Step 1 , or just Step 2 CS, or any two scores ...
If we considered having Step 1 + Step 2 CK + Step 2 CS scores as 'complete', then the most 'incomplete scores' combination happens to be Step 1 + Step 2 CK - but this combination is still much better than other possible combinations. Been hearing of Step 1 + Step 2 CS very very often these days, thanks to lack of CS dates which makes people take the CS as soon as possible.
Supposing you decided to go ahead and apply with incomplete scores, lets address some poignant issues in this context :
a. Yes, Interviews are still possible applying with Step 1 scores alone, though over the years the probability has been getting lesser. Yet, to maximize chances, you gotta send in your applications early AND the Step 1 Score should be impressive enough to garner enough confidence in the program director about your subsequent performance. It's should be tacitly understood that the number of residency interview calls you will get will be much less than if you had applied with both USMLE Step 1 and Step 2 CK scores.
b. Remember that on your ERAS application, you are allowed to specify the expected month of remaining USMLE Steps, in case you have not taken them all by application time. Don't let that be too late - remember the 'ECGMG certified' status must be completed before early February. So if the program believes that you will not be certified until then, it will put your application on the backburner.
c. The next natural question : "Should I apply early in September with my Step 1 score or should I wait till I get my step 2 CK result later ? "
Now, this was a question someone shot at me over email and I am copy-pasting the reply below :
" While there is no sure-shot answer to this question, lets consider some alternatives =
a. Write to/call all programs u wanna to apply to and see if they will consider ur application with a Step 1 score alone and that you will be taking other exams soon. Definitely go ahead and apply to the ones who reply positively - the ones that say 'No' or Don't reply, apply after u take ur step 2 CK - and keep providing updates to those programs about ur exams, scores, observerships, etc.
OR
2. Another strategy is to apply to low-traffic, moderately-ranked or low-ranked programs with whatever scores you have - and the others after all scores come in
OR
3. Go ahead and apply to all programs and then keep on sending updates as when u take ur exams, get ur scores, etc - the only problem i see in this approach is over-spending. In any case, you will benefit most by personally calling / emailing programs :-) I know it ain't a perfect solution but I do hope this gives you some direction"
Choosing your alternative is a personal choice incumbent on factors like how much $$ you willing to risk, or if you simply have to match this year instead of adding more years to your "Old IMG" status, or considering whether you are rather better off for the next year's match and use the extra time to complete even Step 3, get some US Clinical experience & better LORs or whether you got contacts that can pull you an Interview at a program, etc. So ...choose your 'trade-off's guys and decide.
And I shall now go back to a hot cup of tea waiting for me .... LOL
From the year 2010, ECFMG will be charging everyone 50$ to even THINK of taking the USMLE - Well, I was obviously kidding, trying to do a Jay Leno - but seriously, you got to pay even to START your ERAS residency application....Jeeez ! Then they make you pay for each program you apply. In the end of the year, by December, you have to pay AGAIN to NRMP, to participate in the Match.
Lets go over ERAS Residency Match application process step-by-step :
STEP 1:Getting the ERAS token ! Costs 75$ and that's just the beginning of cash efflux. [ Am glad you can't see the sarcastic smirk on my face right now].
When Do I Get the ERAS Token ?
They begin to give them out from June itself for the coming match. Go get it !!!
How do I get the ERAS token ? Log on to your OASIS account --> check out the "ERAS Token Request" Link at the bottom of the Left-Side Menu --> Click on it --> Follow Instructions & pay
I am not ECFMG Certified yet, Not finished all my USMLE steps - Can I apply for a Token ? Yes you may !
How does the ERAS token look ? Now, this "token" is NOT like a gold or silver token-coins you get at Ameristar Casino - it will be updated on your OASIS system itself. You WILL NOT get any email about the token. Keep checking back , i.e. login to OASIS now and then and go the ERAS token section - the moment it is updated you should see your token as a long number.
I am participating in the next Match - should I get the token too, just to be really early ? No ! The tokes are given out each year, specifically for the upcoming match and WILL NOT be valid until the next match - so hang on till your time arrives ;-) - which will be the next July !
STEP 2:Registering at MyERAS using the ERAS token ! By the way, AAMC = American Association of Medical Colleges and ERAS (Electronic Residency Application System) was built by AAMC to make it easier to apply and transmit documents to the participating residency programs over the Internet. Back to getting your AAMC ID. Copy-paste the ERAS Token that you see after you Login to OASIS and go to the ERAS Token section - and then go the MyERAS Registration page to begin filling in the details. Click here to register onto MyERAS with ERAS Token
After you fill up the details (Leave the AAMC ID Blank since you don't have one yet, unless you had appeared for the previous match )
[More coming soon...this is an ongoing compilation..completed slowly as an when time is available - meanwhile do look up the Match Application Process Synopsis]
Why Stress so much on applying on Day 1 ? There are more Reasons that you think there were. Besides the logical reason that most programs look at applications on a first-come-first-serve basis, there is another often overlooked technical reason to do so: ERAS ! Yeah - ERAS too treats applicants on a first-come-first-serve basis. You will begin to understand what I am blabbering about after you consider this fact:
ERAS begins to scan your documents and upload them to your virtual online "mailbox" on MyERAS ONLY AFTER you have applied to atleast one program and paid for it.
That's right ! To repeat with great emphasis: However early you send your documents to ERAS before September, though your documents may get scanned before, your documents get loaded to the 'mail box' for programs to download scanned ONLY when you pay (i.e. Apply) for atlteast one program - and that takes a few days, depending on the waiting list of candidates - and that can be pretty big, especially in September.
This is especially important for those people who plan to apply AFTER September 1st for various reasons - like awaiting ALL scores before applying, not completed a list of places to apply or waiting for accumulating $ to apply and stuff.
Let us labor to explain this with a sample scenario:
Suppose Melissa decides to apply on, say, September 20th - since she only completes compiling her list of residency programs by then. She hits the pay button on MyERAS and 'sends' her application. We assume that Melissa has already posted her paper documents to ERAS way back in August - Yet, on that day, only her Common-Application-Format (CAF) and Personal Statements will reach the programs - her other important documents like LORs and Dean's Letter/MSPE will be relayed to the programs AFTER ERAS digs out her documents from their scanned images pile and then loads it to the 'mail box' - which will take another 3-4 days or more depending on which part of the week you apply! (fridays are the worst - he he)
On the other hand, on the Residency Program's side, the Program Coordinator (PC) gets an alert that Melissa has applied to their program but then she notes that her application is yet incomplete since some documents cant be downloaded yet - so the PC puts the application on hold awaiting the documents. Until Melissa's documents arrive on day 3, the PC receives another 35-50 complete applications and is busy with those...while Melissa's application stays on the backburner for sometime..
While this may be especially true for highly competitive programs like Internal Medicine ..he he..for the other specialties, maybe I took the situation too far - but I hope you get the point ! Why let competition ever get the better of you ?
Do Note that once loaded, any subsequent programs that Melissa applies to will have NO such delay in receiving everything, since everything is already scanned and ready by then.
Now, What does this teach us ?
It tells us that you shoud Apply & pay for ATLEAST ONE Residency program on the first application day of September , so that ERAS starts your document scanning process and keeps them ready for your subsequent applications. I hope I drove home the point why you should be doing this even if your not ready to apply for whatever reasons - like application scores are not complete, your program list is not complete or whatever !!
For those who are ready to apply , do ahead and apply to ALL programs on day one...g/l
:-)
So, Remember Remember , the first day of September.......LOL - did anyone watch "V For Vendetta ? " ;-)
We can categorize application strategies for the NRMP match into two - you can either do "wide" or go "deep" !
"Wide" Strategy
This is very much like carpet bombing - a technique that the Air-force uses to take out possible targets in a single fly-over sweep over suspicious areas. This application strategy , (some also call it the Shot-Gun Method), implies applying to AS MANY PROGRAMS as your wallet can allow - with some basic targeting. Like targeting ALL Programs in Family Medicine that are known to be IMG friendly - without consideration of what their specific application criteria are and hoping to secure a hit at least somewhere... No wonder this approach is used by those candidates who "don't wanna take a risk" and have some $ to spend. I have known people who applied to 5 specialties with 80-100 programs in EACH specialty !
Given the fuzziness of information on program criteria and the fact that even with program with published criteria might ease down on some criteria on candidates with other proven achievements like lotsa publications or awards or contacts - this approach seems to be on the rise. This is why I really wish ERAS came up with making it compulsory for programs to give out their requirements and visa information for the year on MyERAS itself...wouldn't that make things much much easier ????
"Deep" Strategy
In contrast to the above, this strategy is kinda like a bunker bomb - in which the exact location is known, the missle burrows deep within and Boom - a hit ! Here, we apply to 30-40 programs that we know are eligible to apply based on their application criteria. This researching obviously takes more time, research and patience.
Just, for fun, Here's a Video of how a Bunker Bomb Operates !
Well, both strategies can get a hit - with differences in efficiency of course.
American Medical Graduates typically apply to 30-40 programs per specialty are more territorial in their approach, while IMGs apply (and should apply) to at least 40-50 in each specialty. I dare say that if it is Internal Medicine that you are keen on, with the ever increasing competition, 70 to 100 programs is the current norm in the 'wide-strategy' or lesser than that if you go with fact-finding, targeted strategy . Generally speaking, the Northeast, East and Mid-west Regions of USA are considered "IMG Friendly". Read more about determining IMG-Friendliness of a program Here
Be informed that while interviewing, programs typically choose about 10 times their intake capacity and little more as per their budget, on a set date from the pool of applications that have been received through ERAS by then. So if there are 12 positions expect about 140-150 interviewees. This 'set date' is unofficial and is highly variable. Interview invites are then sent out to selected candidates. Once all dates are confirmed by candidates, programs do not look at any more applications until someone cancels interviews ! So ....is it clear now why your application must reach on time ! If not , lets look at a sample here : The Family Practice Residency program at William Beaumont Hospital, Michigan clearly mentions on its site that applicants are considered on a "First-come, First Served" Basis - Check that out Here.
Normally Community Programs choose Interviewees earlier than University Hospitals i.e. the 'set-date' is usually before the end of September - whereas University hospitals may send out invitations by October. But since the year 2005 has been crazy for both with applications received - I anticipate earlier choose times by University Hospitals next year ! Hmmm..lets see
Search Keywords to this blog article:
- "getting residency after failing STEP 2" - "chances of getting residency with failed usmle attempt"
only with Step 1 Scores too and mention the Step2CK date on your application). And of course, read about the technical reason to apply on day one - if you are not ready to.
only with Step 1 Scores too and mention the Step2CK date on your application). And of course, read about the technical reason to apply on day one - if you are not ready to.: For about 36-38$ has been around for a long time and covers all aspects
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into the dense Oak forest trails to take advantage of the lovely American fall season. The Fall happens so regularly, each year...just like the phases of moon keep repeating...or the way you keep coming back to same "Do Re Mi' notes octave after octave...Cyclical events, just like our residency applications, year after year. Yet, each residency-match year has its own distinct flavor and dynamics. Early planning has remained a vital credential for highly competitive programs and I would like this post to make hopeful IMGs aware of deadlines - both Technical and Logical. This year the Internal Medicine Program at Abington Memorial Hospital received 700 IMG applications with scores above 90 on both steps WITHIN the first week of September ! Competition is intense ...So read on...and plan while you still have time ...
" is right on target :-)
