PLANNING RESIDENCY VIA GRE: Some Pointers

The GRE route to a Residency is (I love calling it the Great Residency Excuse ..he he) is rapidly emerging as a hot route for visa-needing IMGs for several pressing reasons:

a. Student visas are easier to get
b. Gives you the geographic and visa advantage for US Clinical Experiences and Research (Probably the most important reason)
c. These US Experience fetch you vital US LORs
d. You don't have to worry about US entry for Step 2 CS, Step 3 and Residency Interviews.
e. Some residency programs do appreciate the advanced Masters-PhD degrees - like University of Missouri-Columbia specifically mentions on its IMG requirements webpage: "advanced degree program (M.P.H., PhD) with a record of multiple publications in peer-reviewed medical journals" - see it for yourself
f. And of course, the OPT Visa Advantage !


In the spirit of the motto of this blog - i.e. 'Pre-informed is to be in form" - let's attempt to look at how one can maximize Returns on the GRE Investment, considering a Residency as your final target! So, If the GRE (Graduate Record Examination) route has been playing on your mind, then put on your planning caps, keep aside that chic or hunk you were just thinking about for a minute & read on ;-)

1. First of all - Choose the right Field !! You want to be in a Major that will augment and supplement your residency application. So think for yourself - What will impress a Neurology Residency Program director - an MPH degree or a Masters in Neurological sciences ? An MPH may be best for Family Medicine programs with a public health component like the residency program at Baylor Medical College. There are tons of options for selecting a branch - check out the list of possibilities here at Gradschools.com

2. Next, consider getting into a University that can catch the attention of Residency PDs running through hundreds of applications - i.e. Try to get in places that are well respected University in the residency circuits. For example the biggies like Johns Hopkins , Harvard, Stanford, Case Western, Tufts, Washington University, etc. have plenty of Masters / PhD programs. Shall be putting up a list of such desirable colleges / Universities. Names do matter for University Residency Programs

3. This kinda offshoots from the Point 2 - Try to pick graduate programs that have an affiliated residency program i.e. which is easily accessible geographically (Same campus) - For example, a Master's Program in Immunology at the University of Missouri-Columbia grants you walkable access to the School of Medicine at University Missouri-Columbia with all its residencies and faculties. Now why do you want that ? So that you can participate in voluntary research in your free time after classes (if lucky even get paid for it), and work your way to know the clinical faculty to allow them to know you and grant you Observerships , externships , etc. in the future.

4. On the same lines, why not try your best to get into places that are known to offer observerships. Compiling them gradually at http://USCE.blogspot.com


5. And the Height of Planning ! Lol - You might wanna consider doing your Masters/PhD in a city which has a Step 2 CS Center ! He he...Most of these cities do have major medical institutions. Emory University at Atlanta, Baylor, UTMB, etc. at Houston, and so on. This saves the $$$ and time spent on travelling and booking hotels. Well, you don't really have to get too serious about this point , it's just an added bonus ;-)

6. Finally, it's a sincere recommendation to ya'll : Be done with Step 1 and Step 2 CK BEFORE you enter the States for your Masters/PhD : Generally Speaking, it's easier for IMGs to score high on Step 1 and Step 2 CK when these exams are taking back in the comfort of their home countries. Life as a student is too busy with attending classes, working to pay your rent besides cooking, all which play either delay your USMLE prep OR take a toll on your performance.


Having said all that, for people who are currently still in Medical Schools and have time to set up Clinical Electives in the USA, that's some excellent US Clinical Experience too and you won't even need to consider the GRE Route !


Q. Can I do Observerships / Externships on a Student Visa ?
A. Yeah - as long your classes are not intefered with. The Winter or Summer Vacations are probably the best times to do these.



Watch put for updates on this topic

SERIES: TO GRE OR NOT TO GRE: THE VISA ISSUES

The previous post on the GRE Route to Residency dealt with how a visa-needing IMG could strategize and pre-plan for using the GRE option to leverage Residency Dreams, which brings the next natural question to the fore - is that option right for you ?

This article is a start of a series of discussions and analysis about the pros and cons of this GRE to Residency Route to help give IMGs a decision-support on whether the GRE route is sensible for them. I am not attempting to bias anyone for or against this decision, but merely shall be placing facts that can affect a decision. Priorities will differ from IMG to IMG and so shall the decision.

In Medicine, when the exact reasons behind a disease are not known, it is shoved off in the category of 'multifactorial'. Likewise, the answer to the questions - "Is the GRE route to a residency necessary" or "is the GRE route right for me" must begin with..."It Depends..." ;-)



Visa Issue I: Since CS Visas (Visitor's visa for CS) are now easier (though not always a guarantee), some people may find themselves more inclined to instinctively scrap the GRE route as unnecessary and an overkill. But lets analyze this further - before getting a residency, an IMG candidate based outside the US will need to be in the US for at least three reasons - Step 2 CS, Step 3 CCS (If H1 needed) and then again the Interviews. I said 'at least' because in addition some folks may secure observerships / externships and may need to step on the American soil again. Other reason could be being around the post-match scramble. Unless you lucky to get a multiple-entry visitors or a long term CS Visa and you are able to coordinate all of aforementioned activties in a single visit, I perceive the constant visa hassle and the repeated flights to the US as a headache and a financial strain. The F1 visa gives you that long term presence in the US to complete all of those at your own pace and convinience. Well, that was the first issue.

Visa Issue II: The second issue that has begun to gain prominence as a bother to program directors, atleast for the H1b visas, is the visa approval delays due to first-time-rejected-second-time-accepted scenario, unavailable dates, etc. in home countries. I know of atleast 3 incidences where an IMG joined a residency late because the visa stamping got delayed. People on F1 visas don't need to go back to their home countries before starting residencies. They they are allowed to stay on in the USA during the summer (May to mid-August) without taking any classes. They can then begin work on H1-status after getting the paper work done. The eventual visa stamping can then be done after 6 months either in their home countries or Canada/Mexico/Bahamas. etc. This way has a lesser chance of rejection since the IMG can show his 6-months of residency-pay stubs as solid proof of work. An IMG on a visitor's visa must always head back to his country and have the appropriate visa stamped before flying back to begin residency.
(Though technically it is possible to 'change status' from B1 / B2 to a J1 or H1b within in the US itself, it is not considered a good thing to do. Coz', eventually you will need to get out of the USA and will need to have the new visa type stamped to get back - and visa officers around the globe seem to have a particular distaste for people who came to the US on a visitors visa, i.e. with no intention of staying on and yet got their status changed. )

Visa Issue III: The final Visa issue I shall touch on is that of the F1-Student Visa itself. As I mentioned earlier, USMLE Step 1 and Step 2 CK Studies will be most effective in the comfort of your home countries - For a Masters/PhD student who needs to work and cook besides study/research, availability of sustained prep times for USMLE Steps are often a luxury [it's too expensive to eat out each day on a student budget and yeah - maids are not cheap either ;-)]
The visa issue is - it safe to take USMLE Steps and then apply for the Student Visa ?

Again, let me begin with "it depends" - The trend of visa-rejects and approvals are often cyclical and can be gauged from other people's experiences on forums and friends. Use that information. Second, an admission to a well-known University is less likely to be rejected. Third, Scholarships / assistantships from the University granting you an admit makes visa approval more likely, besides strong homeland finances. If you still must feel pressed to not risk a student visa and rather take USMLE Steps after a visa approval, then to make the best of your situation, you should aim to finish studying and revising for the first step before you land here .....sort of attempting a damage control :-) A medical school junior of mine was either lucky or smart enough to have the Step 1 taken days before flying to US AFTER the student visa was approved :-)

FOR IMGs PLANNING GRE!

Often, due to a visa scare, IMGs think of GRE as a loophole to enter the USA. Ofcourse there are many who are genuinely interested in pursuing something different like Masters and PhDs in Genetics, Medical Informatics, Immunolgy, etc.
There are some distinct advantages and disadvantages of this route towards a residency:

Advantages:

1. You get to be in the USA, free to do observerships / externships in US hospitals, as time permits
2. You get to make contact with physicians that could be possible sources of your US LORs
3. Opportunities for paid / voluntary research and publications
4. DOnt have to worry about visas for CS and Step 3 and Interviews.
5. After you graduate, you get the one-year OPT work visa which you can use for a residency / internship / preliminary year - coz this one year wont need any sponsorhip.

Disadvantages:

1. Scholarships, On-Campus Jobs and Assistantships are not easy anymore - so one needs to be prepared to shell out to pay the hefty fees and living expenses.
2. Living in the USA has its own distractions ! and studying for USMLE may not be as dedicated as you want them to be.

Lessons to take home:

1. MPH does not seem to add any value to the Residency application anymore - almost everyone knows that its a loophole entry system in the USA
2. Other fields that could add value for a Residency : Medical Informatics, Clinical Nutrition, Immunology, Genetics, Pharmacology, Cardiac Rehabilitation, etc. (which have some clinical bearing and good clinically-related research opporunities
3. Try to get into a graduate program that has a good university hospital attached to it - this way opportunities for clinical research and observerships / externships become easier and you dont have to take a break and travel to other cities for clinical exposure.
4. IF possible, complete step 1 and / or step 2 in your home country before you arrive in the US via GRE ! That gives your free time for Observerships and Research