Year: 2019

Certify Your Perfect Rank Order List by Feb. 26

If you are currently in the Match, you’re probably finished or about finished with your interviews with potential residency program directors, and it’s time to finish your rank order list (ROL).

What is a Rank Order List?

A ROL is a list created in the National Resident Matching Program (NRMP)’s registration system. The list is intended to allow you to rank the programs in which you’d like to attend. It also gives residency program directors a chance to rank their applicants in the order of preference of whom they’d like to train. The idea is that residency programs and applicants are matched based on who will be a best fit.

Tips on Ranking

There are varying opinions on whether or not you should flood your ROL with as many residency choices as possible. You can rank 100 programs without any additional fees and up to 300 with additional fees (up to $30 per program). As an International Medical Graduate (IMG), it is true that you are at a disadvantage statistically speaking, so it may be worth it to include more choices on your list. However, you also want to be thoughtful in your choices. Your residency is a huge step in your career path, and you want it to be the right step. Here are some tips:

  • First, make a list of all residency programs you are willing to attend. Don’t exclude programs you aren’t sure about. Put them all on there. You’ll prioritize later.
  • Don’t choose programs simply because you feel the program director will choose you based on interactions or letters received. In addition, if you are pretty sure you will place in the residency of your dreams, DON’T SHORTEN YOUR RANK LIST. You don’t want to miss out on an opportunity if your “promised” residency doesn’t pan out.
  • Consider competitiveness. It is great to get into a highly competitive program, but consider your chances, and make sure you rank a combination of competitive and less-competitive programs to increase your chances of a Match.
  • Don’t wait until the last minute, as you risk servers shutting down due to too many users. Instead, add your rankings early, and know that you won’t run into technical difficulty.
  • Other things to consider when ranking:
    • Program quality: Who are the attendings? How successful are the graduates? How does the hospital rank? What is the philosophy of the residency/program director? Make sure you understand the program for which you are applying.
    • Research opportunities: The availability of research opportunities is very important if you are expecting to enter a medical profession where you engage in your own research projects. Entering a residency with research opportunities gives you a head start.
    • Success of residents: Find out if graduates from this residency program are successful in their futures. Whether the measurement of success is fellowship placement or overall happiness, finding out about graduates can be a huge indicator of your future should you Match with that program.
    • Relocation: You may have to move to enter a residency program, but are you okay with the location? Could you see yourself moving there for an extended period of time beyond residency? This is something worth considering.

Considering multiple factors regarding residency programs will help you to appropriately rank them. You should rank them in order of preference based on these factors but also rank them based on a good mix of competitive and less-competitive programs along with programs that tend to be IMG-friendly.

Certification of Your ROL by Feb. 26

By February 26th, you must have your Rank Order List certified in NRMP’s system. Once it is certified, you can still make changes until 9 p.m. EST on that date.

What if You Didn’t Match?

If you didn’t get any interviews, then you didn’t have a chance to submit a ROL. If you didn’t Match, then you may also be wondering what to do. There is a Supplemental Offer and Acceptance Program (SOAP) that allows candidates to apply for programs that have unfilled positions.

Overall Message in Regard to Rank Order Lists

Ultimately, you should not rank a residency that you do not want to be a part of. At a certain point, it defeats the purpose of your entire medical journey. Instead, be open to opportunities, and rank according to your preference. There are some tactics that may help to get you placed (i.e. IMG-friendly, competitive mix), but you don’t want to simply take an option because you can or limit your options because you think one program is a sure thing. Instead, a well-thought approach to ranking programs should be used.

Have your advisor look at your list if you have any concerns, and make sure you aren’t forgetting about any opportunities. Your rank order list is confidential (except for NRMP staff), and residency program directors will not see it, but it doesn’t hurt to get a little extra input.

Practicing Confidence in Preparation for an Interview

When you are interviewing for a residency slot, confidence is the key to success. This can be a huge challenge when stress and a perceived need to please get in the way of holding on to any self-confidence. Forcing confidence can turn the tables from positive to negative, and it is important to make confidence authentic. This puts candidates in a conundrum when trying to exhibit confidence. It can’t be forced, it may not be natural, but it has to be authentic. No wonder interviews are stressful! It is not impossible to learn how to be confident during an interview. In fact, practicing confidence in preparation for an interview can ensure that it is genuine and effective.

Eye Contact

One of the biggest ways to appear confident is to maintain eye contact during conversation. Depending on your home country’s culture, this may be difficult. That is why practicing making eye contact during conversation is essential to the success of an interview. You don’t want your eye contact to appear awkward or forced. Most residency program interviews will have multiple people involved in the interview. It is okay to favor eye contact with the program director over other participants, but make sure you give everyone some of your attention. Shifting your gaze will also prevent you from staring, which can look odd and uncomfortable. Practice interviewing with friends and family, but make sure they are native to the U.S. and willing to give you any tips on correctly using eye contact to exhibit confidence.

Posture

Standing and sitting with good posture also reflects confidence. Cowering in the face of judgement in front of interviewers shows that you are not confident in your skills, and you must exude confidence in your posture both in front of your interviewers in your patients. Practice holding your head up high, and make it a habit to hold your shoulders back. It will become natural, and you won’t feel odd doing it during your interview.

Smile

A smile is essential to greeting new people, but a smile can be done incorrectly. This can be especially difficult if your own culture does not commonly use “toothy grins.” The key to a good smile is to do what you can. Not everybody looks genuine with a wide-mouthed tooth-revealing smile. It is okay to make it small, but make sure it makes you relatable.

Handshake

In America, everyone appreciates a firm handshake. This doesn’t mean it is a power struggle between you and the recipient. Rather, a limp handshake feels wrong and weird. Too strong of a handshake feels like you are insecure. Firmness should be warm and indicative of your earnestness.

Slow Down

It is very common to speed up your speech patterns when you are nervous. It is okay to show some nervousness during your interview, but ramping up the speed of your speech can make it difficult for interviewers to understand you and will leave more room for errors in your speech. Take a breath. Slow it down. Make sure you are saying what you meant to say and not rambling.

Listen

One of the biggest mistakes you can make in an interview is not listening. This may sound obvious, but it is very typical for an interviewee to talk too much and even interrupt because of nervousness. Don’t let this be you. Take the time to think about your interactions with your interviewers. Are you listening? Are you responding when appropriate? You must stay engaged during an interview in order to show confidence, and this can be lost if you let your nervousness take over.

Ask Questions

Don’t just respond to questions. Make sure you have some questions to ask. This shows that you are truly interested in finding a good fit in your residency choice. It shows interviews that you’ve thought about what you want out of your residency, and you are confident enough to ensure you get it. This works almost like reverse psychology. If you ask questions, it makes interviewers feel like they are being interviewed, which makes them feel like they want you. This may not always work, but it definitely shows that you are looking for the right spot, and that shows confidence and self-worth.

Practice Makes Perfect

All of the tips to appear confident in an interview might seem elementary, but they work. The trick is to perfect these methods to make them seem authentic and effortless. That means practice, practice practice. Make sure to practice your interviewing techniques and include these tips. It’s not all about having the right answer. It is also about having the right demeanor and personality to make program directors know that you have the confidence to make crucial medical decisions. Confidence is necessary in any medical profession, so you have to show confidence to rank highly with your prospective residency programs.

Thank You Notes Following Interview? Why Not?

If you make a stellar impression during your residency interview, a thank you not is probably not the thing that is going to get a residency program director to rank you highly. You’ve already made it to the top of their list. However, there are only one or two people that will perform this well, and other interviewees may be less memorable. A thank you card is not going to single-handedly get you into a residency program, but it doesn’t hurt. When residents ask whether or not to send thank you notes following an interview, the simple answer is, why not?

When NOT to Send a Note

Some residency programs specifically state that they do not want thank you notes sent following interviews. Abide by their wishes. Even if you are absolutely smitten with the program, an overzealous thank you note will not impress. It may even eliminate your chances at a residency slot because it shows you don’t like to follow instructions.

When to Send a Note

In cases where it is not stipulated, it is best to send a thank you note immediately following the interview and not more than one week afterward. You may want to wait one day to digest the information, but get it sent out early, especially if you know the program will be making a decision soon. If you wait too long, the people who interviewed you won’t remember your interview well enough to link it to your note.

Handwritten or Email

The jury is out on whether a handwritten or email thank you is preferable. Handwritten notes show that you went the extra mile, but they take time to get through the postal service and may never reach the program director’s desk. When they do get there, they are memorable because of their rarity. Email is generally accepted but requires less effort. Do what you feel is right, and stick to email when you know that directors are making their decisions soon.

Who to Send a Note

Send a thank you note to everyone who was at the interview. Each notes should be individually addressed with a unique note to that person, as they may be compared among the interviewers. Check with the program’s administrative assistant to make sure you have all the names correct, and ask the best way to make sure you reach them.

Reflection and Notes

One of the first things you should do when returning home from an interview is jot down some notes about things that went well with the interview or things that really stood out. It is the details that matter in the notes, and you don’t want to forget anything substantial. This will also help you reflect over the evening and have a well-constructed thought process to write about the program the next morning.

Content

Generally speaking, you want your note to be pretty simple. If it is too long-winded, busy program directors won’t have time to read all of it. Keep it to a three-part letter. The first part should be a thank you for the interview. The second should be some key reflections, and the third part should be your continued interest in the residency program.

Don’t Include These Thoughts

What should not be in your thank you note is anything negative under any circumstance. Even if it is gnawing at your consciousness, leave it out of the letter. Keep it positive, and don’t talk about the monetary benefits of the residency. This isn’t about anything other than your thanks and enthusiasm for the residency, so keep it short and sweet.

Worst-Case Scenario

In the worst-case scenario, your letter won’t reach its destination. This would most likely be because it was filtered by administration, or it was forgotten somewhere by the recipient. There is no guarantee that a thank you note will do anything, but even then, it does no harm. This is why it is good to write or email thank you notes. It can only help and is guaranteed not to do any harm.

Best-Case Scenario

In a best-case scenario, a thank you card opens an extended line of communication between you and the program director or other interviewers. In some cases, this has led to further discussion and near-guarantees of ranked positions. In other cases, it has made candidates memorable. A remembered face with an application generally outperforms a forgotten one. The best-case scenario is the whole point of sending a thank you note, and it is virtually risk-free.

A well-written thank you note can only be a positive aspectto your chances of being ranked for the residency program desired. Do make sure it is well-written. If this means having a friend or colleague edit it for you, make sure you enlist in their help. You want to make a good impression during your interview, but that impression can be confirmed through the follow up thank you note.

With a J-1Visa Waiver, You Don’t Have to Return Home

Foreign Medical Graduates (FMGs) typically enter the U.S. for medical training with a J-1 visa. This visa is intended to allow people from all over the world access to U.S. medical training, but they aren’t allowed to stay. Following the end of a program, the person must leave the country within 30 days. In order to come back to the U.S. permanently, the person must live in their home country for 2 years, then apply for another visa.

 

The Conrad 30 Waiver Program

There are multiple ways to waive the two-year home country requirement. The government of the home country can release a no objection statement (NOS). The requirement can also be waived if it would cause exceptional hardship to a U.S. citizen or legal resident. If the person would be persecuted in his or her home country, it may be waived. The U.S. government can also waive the visa requirement if it would harm the intent of the person’s project or agency’s interest. Lastly, the Conrad 30 waiver program allows physicians to stay if they will fulfill the needs of the American healthcare system in rural or underserved areas.

Under the Conrad 30 waiver program, the department of health in each state can request waivers for 30 International Medical Graduates who would otherwise have to return home for two years before coming back. In return, the graduate must agree to practice medicine in an underserved area for three years.

The underserved area must be specifically listed as a:

  • Health Professional Shortage Area (HPSA)
  • Medically Underserved Area (MUA), or
  • Medically Underserved Population (MUP)

The person must also obtain a NOS from their home country if that country’s government funded the initial exchange. Understandably, the Conrad 30 waiver program aims to fill gaps in the number of U.S. healthcare providers while maintaining the interests of the home country.

How to Get a Conrad 30 Waiver

A physician who wishes to obtain a waiver must get the sponsorship of the state health department where they plan to practice. There is an online application, and it must be filled out before getting a recommendation. The Department of State Waiver Review Division electronically communicates the application status to the U.S. Citizenship and Immigration Services (USCIS). If there are no concerns, the USCIS will typically allow the waiver to proceed.

What About After the Waiver?

After a successful waiver, the physician must submit their waiver letter along with a Petition for a Nonimmigrant Worker, so his or her visa status can be changed to H-1B. Children or a spouse must submit an application to extend or change nonimmigrant status, so their visa can be changed to H-1B status as well. After this, the physician can begin working in an area where they are very much needed for 3 years. Following this, the physician and family may be eligible for permanent residence, an immigrant visa, or certain types of non-immigrant visas. If they don’t work for 3 years, then the physician has to go back to his or her own country for the original 2-year requirement before returning.

The U.S. Healthcare Provider Shortage

The American Academy of Medical Colleges predicts a shortage of 122,000 doctors by 2032. Demand for medical care is exceeding supply, which could result in catastrophic delays in care and negative health outcomes. Because the population is living longer, the number of patients needing care is growing. By 2032, the number of people living over age 65 is expected to increase by 48 percent. Additionally, elderly populations often have co-morbidities that require multi-disciplinary teams. On the one hand, people living longer is a great thing. However, they still need medical care. The doctors are also aging. According to the AAMC, 1/3 of doctors practicing today will be over 65 within the next 10 years. If these doctors retire early, this could drastically negate active provider numbers.

Problems with Conrad 30

Conrad 30 is one solution to the physician shortage, but it isn’t enough. Only 30 physicians per state are allowed to get waivers regardless of the state’s need. Legislators are seeing the impact that the physician shortage is already starting to have, and they are responding with solutions that involve expanding the Conrad 30 program to more satisfy the needs of America’s underserved populations.

In April, legislators submitted the Conrad State 30 and Physician Access Reauthorization Act. If passed, it would create additional waivers for each state based on need, allow spouses of doctors to work, and streamline the green card process. It is unclear if this Act will pass, but in its current state, the Conrad 30 waiver program is very limited. It responds to the need for more physicians, but it does not satisfy that need. Hopefully, the future will bring an expansion of the program, so more FMGs can stay in America to practice medicine.

Learning Common English for USMLE Step 2 CS

Step 2 of the USMLE exam has two components, clinical knowledge (CK) and clinical skills (CS), and language is an important part of CS. That is because you will have 15-minute “encounters” with patients and be expected to communicate with those patients while being observed. The fluency used will have to be much more than a functional grasp of English in order to fully understand, diagnose, and establish a relationship with the patient. Encounters may be face-to-face or over the telephone, in which case pronunciation and fluency are even more critical.

The scoring of USMLE Step 2 CS is further broken up into Communication and Interpersonal Skills (CIS), Spoken English Proficiency (SEP) and Integrated Clinical Encounter (ICE). This means that not only must a physician be able to speak clearly and professionally, he or she must also be emotionally supportive and speak at a level that is understandable to the patient.

True English fluency is difficult for those who haven’t spent enough time conversing with those for whom English is their native tongue. Like most languages, there are nuances to learn that can only be appreciated when immersed in the language. The most-dedicated medical student can memorize all the medical terms in the text books, but he or she won’t be able to communicate with a patient without understanding common vernacular.

There are many methods to learning English, and often, living in an English-speaking country for a while is the best one. However, there are other ways to speed up the process that are valid and make learning American lingo an easier quest.

10 Non-traditional Ways to Learn Common American English

  1. Watch television

The TV is an excellent way to listen to common English, and if your language skills are very rough, subtitles can help with comprehension and pronunciation. Stick to entertainment television, not the news, or you won’t get the lower-level diction required for fluency.

  1. Watch YouTube

If you watch television, you’ll definitely get some exposure to slang, but YouTube allows you to see real people doing ordinary things. Watch children’s videos, how-to videos, and viral videos to get a variety of voices and dialects.

  1. Read magazines

Don’t restrict yourself to books when you are reading, as magazines offer fun language opportunities and a different format that enhances the variety of your language knowledge. It’s all about variety, and the more variety you get in your language use, the more complete your language fluency will be.

  1. Listen to music

Music is a fun way to learn any language, and it is a great way to work on pronunciation. This makes any drive time more productive because you can sing to the music in the car.

  1. Go out for coffee

Many foreigners have a tendency to hang out with people from their home country or other foreigners because of the shared situation. As a result, they diminish their exposure to native speakers. Going to a coffee shop, even with fellow foreigners, will expose you to ambient native language.

  1. Sit in lobbies

Like going to a coffee shop, sitting in lobbies is an excellent way to eavesdrop and hear normal conversations. This will help with your listening skills and also teach social norms. One-on-one conversation is difficult to observe unless you are in a public place like this.

  1. Ask questions

If you don’t understand, make sure to ask. It may seem cumbersome at first, but asking questions will catapult your learning. It also helps people to understand that you are trying to speak fluently.

  1. Socialize with Americans

Foreigners sometimes socially isolate themselves from Americans because they don’t speak well enough to engage in casual discussion. This isolation only furthers the problem, so get out there!

  1. Don’t be shy

Plenty of people who speak English perfectly are shy, and changing that is nearly impossible. However, that doesn’t mean you cannot force yourself to communicate more. Chit chat with the person at the cash register, and say hello to people passing by. You may make some mistakes, but surviving those mistakes will make you more confident.

  1. Practice

Practice all of the time. Give up your own native language for a day. Immerse yourself in everything that will give you more practice. If language is your hurdle for USMLE Step 2, conquer it.

Learning proper English is difficult, but learning common English with all of its idiosyncrasies and colloquialisms can take some time. The only way you can ensure that you have enough fluency to effectively communicate with patients is to use it often. As you can see from these tips, it is all about exposure and usage, and the more you surround yourself with the English language, the more natural it will feel to hear and speak it. When you get to the clinical skills portion of your USMLE exam, language will no longer be a problem.

Time Management Strategies for PGY1

There are two main reasons to focus on time management when you transition into your residency program. The first is to decrease your chance of burnout, and the second is to deliver higher-quality patient care. Time management can improve both of these challenges.

Medical students are often ill-equipped in time management skills to successfully negotiate their busy environment during postgraduate year one (PGY1). Up until now, you’ve been focusing on knowledge and skill acquisition over individual time or work-life balance. You may be thinking you can pull through and think about time management after residency, but lack of time management skills will decrease your productivity and your continued education. If you don’t start working on it now, time management problems can be a contributor to professional failure.

How to Get Started with Time Management

The first thing you must do when starting to practice better time management is to change your attitude. You must be willing to take the steps necessary to manage time, which means investing some time in yourself. There are steps, like making lists and writing goals, that take time in order to make time, and you have to see these actions as having worth. Prioritizing time management is the solution to professional and personal limitations.

Secondly, stop thinking about your limitations as too many things to do and too little time. It is about your activities and your results, not about how many hours there are in a day. Focusing on getting things done and prioritizing those things increases productivity.

Steps to Time Management

  1. Identify and prioritize current tasks: This means writing down a to-do list and identifying what needs to be accomplished, what should be accomplished, and what could be delayed. The more detail you put into this list, the more effective your time management will be.
  2. Set goals: Before you go about analyzing your current tasks, identify or set goals for what you need to accomplish. This includes work-life balance. What is important in your personal life? Is it time with friends or time spent doing a hobby? Is it family? Is it connecting with nature? Make sure you include yourself in your goals, not just your residency and professional goals.
  3. Track yourcurrent time expenditures: Be honest when you do this. How much time did you spend on social media? How much time did you spend dragging your feet to get to the hospital when you could have arrived early? Time management is about looking for those morsels of time that are wasted every day and turning those into productive times. Part of productive time is relaxation, but it is often replaced with distraction.
  4. Consider behavior: Many physicians report that interruptions are a big time challenge in the medical profession. A behavior as simple as closing your office door or silencing app notifications on your phone can increase productivity. Don’t let yourself be that person that doesn’t have time to use the bathroom. It doesn’t result in beneficial outcomes in the long-run.
  5. Manage Your Schedule and Behavior: Of course, the duty to patient care gets in the way of time management, as it should. The challenges of the human body are unforeseeable, but prioritization of your schedule combined with the elimination of time-wasting behaviors makes room for the challenges of variable schedules and unexpected changes.
  6. Don’t try to multi-task: Nobody can multi-task efficiently. Studies show that multi-tasking actually results in a loss of productivity (possibly around 40%). It also increases the chance for errors and increases mental fatigue. Instead of multi-tasking, focus on one task at a time. If you have to break up your attention into 30 or 60 minute segments, that is fine. Those segments will be much more productive.

Time management capabilities are a huge indicator of job satisfaction in the medical field. Being satisfied in your career prevents burnout. Therefore, if you want to be successful in your medical career, you must invest in yourself by engaging in time management efforts.

Other Recommendations from Residents and Physicians:

  • Make to-do lists
  • Set goals
  • Be part of the team
  • Network
  • Ask for help early
  • Establish a handover system for patients
  • Avoid procrastination
  • Learn your IT system
  • Say no when necessary

As you can see, preparation is half of the battle when it comes to time management. A good support system along with some attention to the baseline knowledge you need to function in a facility can go a long ways toward minimizing time spent on overwhelming jobs such as bureaucratic tasks that must occur alongside patient care. Additionally, making sure you have a network of support on a personal and professional level helps to maintain connections and make sure you have a life outside of your profession. Many consider the medical field to be a lifestyle, and in many ways it is, but there is still room for your own personal lifestyle if you manage your time effectively.

The Key to a Successful Match Could be in Networking

Networking is communication among people in a similar profession or interest typically in an informal setting. It is networking that lets people become interesting because of its casual tone. If you want to avoid being passed by as “just another applicant” for a residency slot, you need to engage in networking.

It can be difficult to network as a foreign medical graduate (FMG), which is why you need to pursue every opportunity for meeting residency staff and faculty.

5 Ways to Network

  1. Conventions

One great way to get to know people in residency programs you are seeking is to go to conferences. Bring business cards and get out there and mingle. MDlinx.com is a great place to find conferences that cater to the specialties in which you are interested. After you network, follow up with the people you meet. If you are in their area, visit the hospital. Ask a faculty member if they wouldn’t mind giving you a quick tour. If you do this professionally, they will remember you, and you may have moved your way up their rank order list.

  1. Away Rotations

If you can find an away rotation at a place where you’d like to stay long-term, this is a great way to become a shoo-in for a residency program. This gives the program faculty a chance to get to know you and know whether or not they think you are a good fit. This does make away rotations a bit risky, but if you are a good fit, this should elevate your status when it comes time for a match.

  1. Connections

As a FMG, you may not have a lot of family in the area, but surely you have some friends and other connections. Make sure you scour your contact list for connections with residencies, and then talk to those people. You may be able to meet a residency program member in a casual setting prior to having your application reviewed. This may get you an interview.

  1. Current Residents

There is nothing wrong with reaching out to current residents. After all, you may be working with them in the future. Hang out with them, and find out what they think of the program. If you befriend some of the residents, they will put in a good word. Remember, everyone that works for the residency program has some influence over whether or not you are considered for the residency. Whether it’s a physician or a file clerk, use your connections to make yourself stand out.

  1. Letter of Intent

If you’ve already interviewed, and you know you’d be a good fit for the residency program, you may want to send a letter of intent. This lets the program know that you are very interested in pursuing their residency and that they’ll be on your rank order list. There are varying opinions on whether or not this will move you up on their rank order list, but the overall consensus is that it won’t do any harm. Basically, if you weren’t being considered, it probably won’t change that. But if you were being considered, it could move you up on the list.

Selling Yourself

Networking is a big part of a successful match, but it can be done in the wrong way. Don’t be pushy, unprofessional, or desperate. This is not the way to sell yourself. Instead, be genuine and show true interest. Don’t be afraid to boast about specific research or clinical experience that makes you a great candidate. Don’t be braggadocios, but be proud of your accomplishments. Highlight the things you have done, and don’t let test scores hold you back. Even if a residency “requires” a certain score, they will make an exception for a candidate who is likable and whom they could see working with in the future.

Getting Over Nerves

If networking makes you feel stressed, you are not alone, but you need to practice. Talk with your friends about your accomplishments and get over any reservations you have about selling yourself. Then, move on to people you don’t know as well. You need to be confident when you meet residency faculty whether this meeting is at a conference, at a café, or during an official interview.

Is it too late?

If you are already in the Match, there aren’t likely to be conferences with residency program directors in attendance because they are very busy looking through applications and making their own rank order lists. However, it’s not too late to engage in other networking methods. The biggest thing to remember is that you need to stand out among a pool of applicants with a similar background. The best way to stand out is to meet people outside of the work setting, so they can see you as a real person who would make a good team member, and not just another applicant.

Foreign Medical Graduates Filling Primary Care Gap

There is a primary care provider shortage in the United States that is only growing as elderly and obese populations grow and increase demands on the medical community. Much of their treatment involves a heavy concentration on family or internal medicine to help patients adhere to effective health maintenance strategies. Yet, most U.S. medical graduates seek careers in sub-specialty medical fields where the pay is higher, and the paperwork is less.

While it is understandable to want a higher paying career with less paperwork, primary care physicians are not low income workers. The average income of a primary care physician in the United States is over $200,000 per year. Primary care workers also get the advantage of knowing their patients, and they get to take part in the continuance of care where real results often take place. Their place in the medical community is essential for all populations, and primary care doctors should be proud of their role in society.

Opportunity for FMGs

The current predicament of low numbers of U.S. Medical Graduates seeking primary care positions is an opportunity for Foreign Medical Graduates (FMGs). The number of family medicine positions available, for example, has increased each year since 2008. However, the amount of U.S. Medical Graduates seeking those positions has remained stable. This means that there are more available family practice positions, but U.S. Medical Graduates are not filling them.

Foreign Medical Graduates frequently struggle to get into residency programs during the Match. This is hopefully becoming less common, as the nation (and program directors) realizes the advantage of adding physicians who have been trained abroad to the mix of U.S. health care providers. However, it is still a struggle.

A lot of this struggle has to do with the unknown, and different areas of the world have different requirements and different demands for excellence. The Educational Commission for Foreign Medical Graduates (ECFMG) tries to alleviate the number of unknowns by using its own set of credentials including requiring that medical schools belong to a list of accepted schools. However, there is still a bit of uncertainty about exactly how one country’s approach to medical education compares to the United States’ approach.

There is also a want to give opportunities to medical students who received their education within the United States in an effort to better the country’s resources. If U.S. Medical Graduates aren’t seeking primary care professions, this ability to give opportunity will have to be shifted to FMGs.

Rural and Underserved Regions

One of the biggest challenges to providing primary care to all individuals within the U.S. is getting care to those who are in rural or otherwise underserved areas. Physicians who specialize are often in or near the city. There are also a lot of primary care providers who live or work in the city. This leaves little care for those who live in rural and underserved areas.

What does this mean for FMGs? It means the ability to start your own rural healthcare practice with little competition. It means being on a first-name basis with most of your patients. It also means having time to care for your patients and not having to run them through your exams like they are cogs on a wheel. Rural healthcare has lost its appeal for many entering the healthcare field who want the chaotic urban healthcare environment, but there are many benefits to rural healthcare that are taken for granted.

Choosing Primary Care During the Match

If you are a FMG with dreams of a particular sub-specialty, you should follow your heart and your brain. However, if you think providing care in a rural area, or providing general care to the public, is within your realm of happiness, opt for primary care. Not only do you have a better chance of getting into a residency because of the larger number of slots available for FMGs, but you would be filling a gap in the U.S. Healthcare System that is badly needed to be filled.

What about pay and paperwork?

The average pay for a physician in a rural area is enough to support a very comfortable lifestyle, pay off student loans, and save for retirement. Rural areas of the U.S. generally have lesser living expenses, so average physician salaries amount to higher amounts when all things are considered.

As far as paperwork, EHRs have made data entry a requirement for the job, and primary care providers seem to have to highest amount of information to enter because all body systems are involved in the primary care wheelhouse. There isn’t much that can be done about this chore, but hopefully the act of caring for a patient in his or her entirety makes up for the paperwork somewhat.

In many cases, the occupation of a primary care giver is what made medical graduates choose their profession in the first place. You will know your patients, and they will depend on you in order to take care of their medical needs.

The Misguided Importance of the USMLE Score

Most people would agree that one test score does not declare the success of a physician, but for medical graduates applying for residency, it can mean a successful Match. The average number of residency applications per applicant has increased from 79 to 91, and according to the Association of American Medical Colleges (AAMC), residency programs may receive 1,000 applications for only a handful of residency slots. They have to sift through these candidates somehow, so test scores receive an elevated importance.

Sifting Through Scores

Instead of looking at each candidate as a whole, residency programs cull program applicants by eliminating those with low test scores and only considering those with scores well above passing. The result is that quality applicants may be removed from applicant pools based on a number instead of more important skills that can be understood through experience and in-person interviews.

A Necessary Evil

This year, the Invitational Conference on USMLE Scoring (InCUS) convened and discussed ways to improve the USMLE. One of the recommendations they created was to make USMLE Step 1 pass/fail. Another idea was further examination of the reliability of USMLE scores in predicting residency success. Lastly, the conference sought to find ways to address racial disparities in test scores, as white students statistically have higher test scores than any other demographic.

Ultimately, there was no solution that eliminated the value of a real test score. In order to handle the number of applications, program directors have to eliminate candidates by some quantifiable measurement regardless of talented physicians who score poorly on the USMLE exam.

Negative Impacts of USMLE Now

There are other negative impacts of the USMLE besides removing otherwise talented physicians from applicant pools. The biggest one is mental health. USMLE test takers suffer insurmountable stress because of the importance placed on test scores during the Match process. If you are currently getting ready for the Match, you have already suffered this predicament. The score predicts your future success, and placing that importance on ONE TEST creates a level of stress that is difficult to pile on the stress of the Match process and the future of a medical career.

This is the type of stress that causes medical students, residents, and physicians to burnout, which is why there are efforts to change the test to possibly pass-fail or something that would reduce mental health issues and increase equitable acceptance into residency programs.

Accepting the Way It Is…For Now

Right now, medical students don’t have a choice when it comes to the importance placed on USMLE scores. If you score poorly, you can retake the test up to six times. This may not reduce stress, and it takes time to wait for another test to be available, but at least one bad test score does not have to equate to the end of your medical endeavors.

The only other thing you can do is make sure that a lackluster score on the USMLE test is met with exemplary training, volunteer experiences, and excellent interviewing skills. If your scores qualify you to get into a program, you’re going to have to shine the get an interview. A little pre-planning by volunteering or being an intern at locations that are top picks for your residency applications can also help you to stand out above the rest.

Especially for FMGs, USMLE scores are very important because FMGs are considered a little bit of an unknown due to different education systems. The Educational Commission for Foreign Medical Graduates (ECFMG) has done its best to ensure that only quality medical graduates are accepted by U.S. medical residencies, but it is not infallible. Program directors may have biases against foreign applicants, so high USMLE scores ensure that you won’t be automatically dismissed for a U.S. medical graduate who has known medical training.

Preserving Mental Health

Hopefully, the future of USMLE testing will result in the best applicants being accepted for quality residency programs and promoting the best results for the healthcare system. Until then, we work with what we’ve got, which means USMLE scores are very important.

USMLE Step 1 and 2 should be completed before applying for residency programs through the Match. If you want to shine a little more, consider taking step 3 as soon as possible. This will give further confidence to residency program directors that you’re a good fit for their program.

Other than that, you can preserve your mental health with proper diet, exercise, and sleep regulation to ensure that your body and mind are in as good of shape as possible to handle the demands of the exams.

It May be Misguided, But it is Important

Suggesting that the USMLE exams should be pass/fail does not diminish the importance of these exams. The ability to pass this three-step test does determine to a certain extent whether or not you have learned the skills required to practice medicine competently in the United States. Until the format is changed to one that more accurately represents medical knowledge and skill, your score will remain an important part of the Match process.

6 Prejudices All Medical Graduates Must Avoid

Having a certain attitude about a group of people grounded on assumptions and preconceived notions of reality based in fiction has a negative impact on the quality of care given by medical professionals. Foreign Medical Graduates (FMGs) are very familiar with receiving prejudice. They face it during their residency match, during training, and by patients and colleagues. They are criticized because they are unknown, and these prejudices affect their medical training experience. However, FMGs are not immune to having their own prejudices. Each physician, no matter where he or she went to medical school, must make a concerted effort to avoid common prejudices toward patients. In this way, you can ensure you are giving equitable care to all human beings.

6 Prejudices All Medical Graduates Must Avoid

  1. Weight Prejudice

An August 2019 article from Medical News Today notes that physicians may be prone to unfairly judging patients based on their weight. It told of a study where medical students used obesity simulation suits to appear like a diabetic patient with a body mass index of over 30. Researchers performed an Anti-Fat Attitudes Test (AFAT) to measure prejudice. The test was a 5-point Likert scale to rate statements about obesity. The statements blamed people for being fat, denied genetic variables, and linked obesity to laziness. Students reported that the suit enabled normal stereotyping of obese individuals. Females were stereotyped more than males, and previous research has shown that these attitudes make physicians less likely to pursue alternative treatments to weight loss. This could greatly reduce efficacy of treatments for obesity where depression or other health conditions were the root causes of obesity.

  1. Sexuality Prejudice

According to Flórez-Salamanca et al., there are negative health outcomes for homosexual people due to feelings of discomfort, communication problems, and the inability to develop a positive alliance between a provider and patient (2014). These authors also pointed out that homosexual people received unequal and lesser quality care. They recommend identifying these prejudices as a first step in eliminating them. Logically, it can be assumed that this would apply to all non-heterosexual preferences.

  1. Age Prejudice

Geriatric medical practice comes with its own set of challenges, and the elderly may have multiple morbidities that require complex treatment in an environment of poor understanding and compliance. However, not every elderly person has the same level of ailments, and those in the community may function as well as young adults. In either case, it is important to have compassion for those suffering from cognitive decline while also acknowledging that age does not automatically equate to cognitive decline. One of the very apparent results of this is under-treatment of geriatric patients because of an acceptance that their decline is inescapable.

  1. Cultural Prejudice

Foreign medical graduates come from different cultures and may face cultural prejudices every day, but they cannot extend those to their patients without risk of compromising care. The goals of medical outcomes for people from different cultures may differ from patient to patient, and this must be acknowledged by physicians in order for those outcomes to be positive. Additionally, the customs and etiquette of different cultures must be understood in order to properly communicate and come to a treatment that will be effective and the patient will understand.

  1. Education Prejudice

Education prejudice may cause a physician to dumb down language to a level that is insulting to a well-read patient. It may also be insulting to use elevated language in a way that offends the person with lesser vocabulary. Both of these situations can be frustrating and cause prejudice. A physician may feel that a person will not be inclined to comply with treatment if they view them as “lazy enough” or “dumb enough” to have not pursued education. Instead, physicians should try to see all people in a manner that requires “effective” communication instead of viewing it as substandard or elevated.

  1. Poverty Prejudice

Lastly, medical graduates may feel prejudice toward people who come from impoverished backgrounds, and they may not elevate treatment options like they would for a patient with private insurance who seems affluent. Sometimes, these treatment options need to be removed from the table since insurance nor the patient may be able to cover them, but they should still be considered as options until financial barriers are confirmed by the patient. Patients with less resources are no less worthy of care, and physicians must make sure they do not practice medicine with this prejudice clouding their judgement.

Prejudice Isn’t Always Known

Many physicians get involved in medicine simply because they want to help people, and these altruistic purposes do not coincide with prejudice. However, prejudice may be unknown and stem from environments where one was raised or exposures one has had to particular communities. The first step in eliminating their impact on medical outcomes is to identify them, and these six prejudices are common even among the most well-intentioned physicians.