Preparing for Residency after The Match

Once The Match is over and you have found your residency program, there are only a few months before you start your life as a bonafide medical resident. The feeling is overwhelming, and you are probably still feeling the inertia of placement. This is not the time to spin out of control with excitement an eagerness. Although post-Match time is a time for planning, it is also a time to take care of yourself. Here are a few tips to help you manage life during your time in limbo between The Match and your residency:

Relax:

You’ve done it. The interviews are over. Not only have you picked your residency, but they’ve picked you too. It is especially difficult to relax as a Foreign Medical Graduate (FMG) because the Match is more difficult. The momentum change from the Match to a few months of “regular life” is difficult for the brain to process. Here are a few tips:

Sleep: Making sure you have a good sleep schedule is essential for your success as a resident. That may seem impossible with call schedules, but it is doable if you make it a priority. If pulling an all-nighter, make sure your free time prioritizes sleep over recreation…and sometimes over studying. Not prioritizing sleep could make all other efforts futile.
Exercise: Long hours and lack of sleep don’t make a person want to exercise, but it will help the mind and the soul. People who exercise are healthier and less-stressed. With that said, any opportunities for outside exercise should be taken.
Meditate: Everyone needs time for themselves, and the new resident is no exception. Yoga, meditation, or even people watching can give the body the self-appreciation it needs.

Connect:

While relaxation may be an important thing to consider, so is making or maintaining relationships. Personal and professional relationships prevent burnout and provide opportunity.

Current Residents: As an FMG, it is very unlikely that you know the area where you will be a resident. Nobody is a better information source than current residents. Not only is it a great opportunity to make friends, but they know the best places to live and eat. They also can give advice on the details of the residency that you cannot get during The Match.
Support System: You should also keep in touch with your friends and family even if they are abroad. Keep them informed of your schedule as much as possible, so you don’t end up isolating yourself because of a busy schedule. Ultimately, you will build strong relationships during your residency, but you don’t want them in lieu of losing old relationships. Explain to them the truth about time constraints, so nobody feels left out.

Maintain:

Yes, relaxation is important but not at the expense of your hard work. The few months before residency can provide time for yourself that may not be available during residency, but that doesn’t mean it’s time for a vacation. Brush up on your skills and keep your training and education fresh by continuing to study.

Advanced Cardiac Life Support (ACLS): You may already be certified, but observing critical care can provide a good segue into care provided as a resident. Take any opportunities to observe, and you’ll be that much more ready to start.
USMLE Step 3: You can only apply for step 3 of the USMLE after graduating medical school, so you may be taking this test after The Match. This means more studying!
Medical Journals: As a physician, learning is never finished. Medical journals should always be on the “to-do list,” as it will keep you up to date and cutting edge.

One of the biggest risks after matching into a residency program is lacking direction. Prioritizing yourself, your connections, and your education will keep you from becoming stagnant and stressed about starting the last step on your way to becoming a fully-autonomously practicing doctor.

Taking care of yourself means taking care of your personal needs as much as your professional needs. That is why things like sleep, exercise, and mediation are essential to your regrouping and preparation for residency. It is easy to become isolated during this time out of a lack of direction but also out of a lack of prioritizing relationships. Success in life is largely dependent on relationships, and cultivating relationships helps maintain friends and family while building professional networks. Lastly, physicians should all consider themselves lifelong learners, and the time between the Match is no exception. Read, study and observe to maintain and build additional skills prior to residency.

There is no such thing as an easy residency, and during this time you will be stressed, hungry, tired, and overwhelmed. That is why the time between the Match is crucial for a successful residency. It is a break from the impossible workload of the medical graduate, but it is not a time to forget about your priorities.

California

WESTERN/CALIFORNIA

Rural Health Opens Opportunities for Foreign Medical Graduates

According to the Association of American Medical Colleges, the U.S. will face a doctor shortage of around 100,000 by the year 2030 if something is not done to increase new residency positions.

The shortage is happening because of an ever-growing population but also because the amount of new medical school graduates allowed into residency programs has not kept up with the pace of population growth. Why would anyone restrict residency positions in a time of projected shortages? The answer is all about the budget and how much the government will fund positions in teaching hospitals.

Thankfully, 2019 has presented some hope for residents with the introduction of the “Resident Physician Shortage Reduction Act of 2019.” This bill would open 15,000 funded residency positions within the next five years.

One of the shortages bills like the Resident Physicians Shortage Reduction Act plan to address is the rural physician shortage. A Becker’s Hospital Review article states that 20 percent of the U.S. population lives in rural communities, and the doctor shortage is revealed in their ratios compare to this population. For every rural physician, there are 2,500 rural residents.

Why is a Rural Physician Shortage a Health Crisis?

One might think the rural physician shortage is not a significant problem. After all, people do go to urban areas to shop, and they choose to live at a long distance from health care services. However, many rural communities are poor communities, so they have difficulty with travel costs. Additionally, many elderly persons live in rural communities, and they may face transportation difficulties as they age out of the driving population.

More importantly, people are unlikely to seek out cost-saving preventive health services if they are not conveniently located. They may also put off subsequent visits meant to monitor chronic health conditions. Telemedicine has attempted to bridge some of this health care gap for rural areas with telemonitors and telehealth services, but often rural communities have technology knowledge gaps and limited access to these services.

If you have ever lived in a rural community, you might understand the importance of the local physician. Everyone in the town depends on him or her for everyday health needs, and if that person retires or moves, it can stress the entire community. There needs to be motivation for physicians to train and work in the rural health care sector in order to decrease this disparity.

What Does this Mean for Foreign Medical Graduates?

For years, there has been tension between people who want to support U.S. medical graduates and those who recognize the need to fill the doctor shortage with foreign medical graduates (FMGs). As the physician shortage continues to grow, the benefits of FMGs are becoming recognized. In the past few years, there have been articles noting the abilities of FMGs rather than only the need for them to fill the shortage. Ultimately, the U.S. is realizing that they need FMGs in order to deliver proper healthcare to all of its residents and visitors. Now, they just have to make it easier for them to get residency positions and practice in the U.S.

Rural J-1 Visa Waiver

The Rural Health Information Hub is an organization that supports the improvement of rural health services across American, and they have one page on their site dedicated to information about the J-1 Visa Waiver, an opportunity for foreign medical graduates to remain in the United States.

With a J-1 visa, a resident must return to his or her country following residency and then apply for a H1-B visa, which will allow them to work in the U.S. If a resident is willing to work in a rural community, they can apply for a waiver, and this allows that resident to stay in the U.S. to work. This is a mutually beneficial situation for rural community members who need a quality physician and the FMG who will have much less red tape to get through.

Saving Lives by Improving Access

Studies show that people who live in rural areas are more likely to die from everything from treatable chronic diseases to accidents where they cannot reach timely access to care. Increasing the number of rural physicians would help to improve these numbers.

As a FMG, you may be wanting to work in an urban area with access to high-technology and physicians who are working with the best resources available. However, it can be difficult to dodge all of the red tape that it takes to get to stay in the country after residency. Considering working in the rural area for a short while will not only give you a unique experience, but it will also allow you to practice in the states immediately after residency instead of postponing your career until you can apply for your H1-B visa.

Rural health is not only an opportunity for Foreign Medical Graduates to stay in the United States following their graduate education, but it is also a chance to save lives. Rural communities do not have access to the resources of the city, and one resource that can be brought these underserved areas are physicians.

Need help with residency placement?Contact us today!

FMG Portal: Assisting FMGs to become U.S. Medical Residents

Becoming a physician in the United States as a Foreign Medical Graduate (FMG) requires some hands-on medical experience within the states. That is why FMG Portal has dedicated its services to helping FMGs through every step of becoming a practicing physician in the U.S. We do this by offering connections to clinical externships, clinical electives, clinical clerkships, clinical rotations and clinical observerships. We also offer assistance with CVs and Visas, so there is no kink in your pathway to a U.S. Residency.

Services

Getting U.S. experience is the impetus behind most of FMG Portal’s services, and it does this by connecting you with programs that provide differing levels of experience. Many of the services, such as clerkships vs rotations are the same if not similar, but knowing specifically what they are will help the FMG to understand what they are seeking.

Clinical Externships

Externships are only available to medical graduates, and they do not qualify for medical school credit. They give FMGs the hands-on experience that will be required by many residences in which applicants apply. Some externships cover specific specialties, which can be very beneficial during the Match process if you are looking to join a certain medical specialty.

Some of the other skills that may be learned in an externship are how to write SOAP notes, participate in diagnosis teams and learn how to use an electronic health record (EHR). While FMGs may have already learned adequate diagnosing skills during their medical training abroad, hands-on experience within the U.S. allows them to learn any nuances that could hinder the medical process by being performed in a manner inconsistent with U.S. healthcare system norms.

Clinical Electives

For foreign medical students, clinical electives are a good opportunity to get hands-on training, and FMG Portal has connections with multiple teaching hospitals. This allows the student to get to work closely with attending physicians in a U.S. healthcare setting.

Foreign medical students who have clinical elective experience in the U.S., especially in their desired specialty, have a much better chance of getting a residency match. Not only does it show experience in the U.S. healthcare field, but it also allows for the opportunity to get U.S. letters of recommendation.

Clinical Clerkships

Clerkships and electives are terms that may be used interchangeably, as they are very similar. In some curricula, they are compulsory. However, U.S.-based clinical clerkships offer a unique opportunity for foreign medical students to participate in healthcare delivery with experienced physicians. This will not only aid the student in passing their USMLE tests, but it will also give the opportunity for cultural adjustment. Cultural adjustment may not seem like a huge component of U.S. healthcare experience, but it greatly aids in communication, which can enhance an interview.

Clinical Rotations

Rotations are very similar to clerkships, and again, the names can be used interchangeably. The word rotation is significant in U.S. rotations because it implies that a student rotates through different specialties in their final year of medical school while supervised by a physician in order to obtain a well-rounded medical education.

Clinical Observerships

Observerships are established when an FMG gets to observe a specialty by participating in a 2-4 week program. This is meant to allow the FMG to get an idea of how the American culture of healthcare works, and it allows the FMG to establish connections along with witnessing firsthand how the medical care is provided in the particular specialty.

Other Services

Visas

Immigration laws are constantly changing with the current administration, and this can make applying for visas difficult and confusing. That is why FMG offers assistance in this endeavor, so you can focus on the more important matter of your education and residency placement.

CVs

Having a thorough CV is essential to residency placement, but it can be difficult to pare down a full resume to fit the needs of a certain specialty. Our experts can take out the unnecessary details in order to highlight the parts of you that will make you appeal to your residency program director.

ERAS Application

The ERAS application is obviously one of the most important parts of the Match, and filling it out properly could mean the difference between consideration and simple rejection. FMG Portal’s staff can help you fill it out properly, so you don’t miss your change based off of a minor issue.

If you are a Foreign Medical Graduate or a Foreign Medical student looking for resources to get Matched and become a successful physician in the U.S., FMG Portal has the skills, resources, and the connection you have tohave to get you there. As an FMG, you must prove the quality of your education through ECFMG certification, CVs and applications that show that you are the type of resident a program would want to have educated under them.

Don’t travel the FMG road to medical practice in the U.S. alone. Get help where you need it with FMG Portal.

2018 Trends for non-U.S. IMGs in the Match

When you are ranking programs for the Match, it is best to go with your heart. That is, try to join a specialty that you are passionate about. It will help you to be successful and lessen your chances of burning out. However, you may be passionate about more than one program. This is understandable, and that it why it is helpful to pay attention to statistics and what other non-U.S. international medical graduates (non-U.S. IMGs) have done to get Matched.

Rank Order List

Ranking programs for the Match should be based on passion, but it should also be smart. For example, the NRMP’s 2018 Match report indicates that longer rank order lists tend to produce a larger percentage of Matches. For non-U.S. IMGs, it may be difficult to find a long list of programs that are likely to accept you for one reason or another. You may feel like some programs are a long shot or that it is a waste of time to rank them. Get this thought out of your head. If there is a chance, and you wish to enter the program, get it on your list. Once you have to start paying extra to add to your rank order list (20 unique programs before extra fees on primary rank order list), you might be more selective. But if your list is short, add those long shots!

USMLE Scores

There are many factors that determine whether or not any medical graduate is considered for a residency program during the Match, and one of those factors is USMLE scores. High USMLE scores are obviously a positive element of your overall application, but lower scores do not eliminate your possibilities of a Match.

In USMLE Step 1, non-U.S. IMGs who Matched had higher scores than those who did not in most specialties. However, this was not true in the orthopaedic surgery and plastic surgery specialties. In step 2, the same was true except in OB-Gyn, orthopaedic surgery, plastic surgery and vascular surgery (see NRMP’s 2018 Match report).

Other Factors

Other factors that may determine whether or not a non-U.S. IMG is chosen for a residency program during the Match are work experiences, research experience, publications, volunteer experiences and Ph.D. or graduate degree.

In competitive programs such as dermatology and neurological surgery, non-U.S. IMGs that Matched had more research experience than those who did not Match. Publications had varied success for all IMGs, but it is worth noting that non-U.S. IMGs had 6.2 publications on average compared to 2.9 for U.S. IMGs. Similarly to publications, there was no clear trend of successful Matches based on work experience. Volunteer experiences were higher among Matched IMGs among both U.S. and non-U.S. IMGs. Having a Ph.D. was a factor for the Match for non-U.S. IMGs, but graduate degrees were often reported more among the non-Matched.

What Does this Mean?

Clearly, the results of the 2018 Match report are varied, and the take home message is that everything matters, but none of the factors will eliminate you from consideration as a non-U.S. IMG. This is why other recommendations are as important as these trends in order to be successful during the Match.

What are Other Recommendations?

Despite the ECFMG certification process, some residency program directors may be uncomfortable with foreign education. This may be due to some deeply held bias (which is unfortunate), but it is more likely that program directors are not able to decipher exactly how you were educated abroad. There are different standards across the world, and your education may be more extensive than U.S. medical schools, but program directors need to know that it was at least as good as U.S. medical school.

Study Match trends to increase your odds of success.

That is why U.S. experience (observership programs) and recommendations are crucial for the Match. Residency program directors want to know that you can work in the U.S. healthcare environment. They want to hear it from you, and they want to hear it from American peers who can testify to your abilities.

It is also very important to do well in your interview, and this may be the most important part of the Match process. Your language ability, your confidence, and your personality will need to fit the program. You may have excellent scores and a full CV, but if you lack any passion or interest, it is unlikely that you will be chosen. Making yourself interesting may include talking about hobbies outside of medicine instead of the residency program. Be prepared to talk about yourself as a normal person, not only a residency candidate.

Yes! It is stressful to consider everything that matters when applying to residency programs. The number of non-U.S. IMGs entering the Match is declining, but the numbers being Matched is at a high point compared to the last couple of decades. The reduction of non-U.S. IMGs may be due to Visa issues or rumored difficulty getting Matched, but the numbers show that if non-U.S. IMGs are ranking residency programs, they are increasingly finding residency programs.

NEW YORK / NEW JERSEY

OP = Outpatient Rotations		IP = Rotations w/Inpatient
525/wk	New Jersey, Paterson	OB/Gyn	OP
525/wk	New Jersey, West New York	Pediatrics	OP
600/wk	New Jersey, Atlantic City	Pediatrics	OP
550/wk	New Jersey, Wyckoff	Dermatology	IP
525/wk	New Jersey, Woodbridge	Family Medicine	OP
550/wk	New Jersey, Newark	Psychiatry	IP/Telemed
625/wk	New Jersey, Newark	Interventional Cardiology	IP
650/wk	New Jersey, Seaside Heights	Internal Medicine	OP
450/wk	New Jersey, Ocean Grove	Internal Medicine	OP
600/wk	New Jersey, Belmar	IM w/Geriatrics	OP
500/wk	New Jersey, Northvale	Family Medicine	OP
450/wk	New Jersey, Passaic	Family Medicine	OP
425/wk	New York, Bronx	Internal Medicine	OP
550/wk	New York, Manhattan	Podiatry/Podiatric Surgery	OP
525/wk	New York, Manhattan	Physical Medicine & Rehabilitation	OP
525/wk	New York, Manhattan	Family Medicine	OP
650/wk	New York, Manhattan	Internal Medicine	OP
525/wk	New York, Manhattan	Internal Medicine	OP
650/wk	New York, Manhattan	IM/Rheumatology	Telemed
650/wk	New York, Manhattan	Anesthesiology	OP
575/wk	New York, Astoria	OB/GYN	OP
475/wk	New York, Rego Park	Pediatrics	OP
425/wk	New York, Lynbrook	IM & Addiction Medicine	OP
650/wk	New York, Lake Success	Internal Medicine	OP
475/wk	New York, Islip	Internal Medicine	OP
500/wk	New York, Brooklyn	General Surgery	TeleMed
625/wk	New York, Brooklyn(Bay Ridge)	Interventional Cardio	IP
800/wk	New York, Brooklyn	IM/Oncology/Hematology	IP
800/wk	New York, Brooklyn	Oncology w/Hematology	IP
600/wk	New York, Brooklyn	Family Medicine	OP
450/wk	New York, Brooklyn	Family Medicine	OP
475/wk	New York, Brooklyn	Internal Medicine	OP
625/wk	New York, Brooklyn	Internal Medicine	OP
600/wk	New York, Brooklyn	Internal Medicine	OP
400/wk	New York, Brooklyn	Internal Medicine/Pulmonology	OP
625/wk	New York, Brooklyn	Gastroenterology	OP
600/wk	New York, Brooklyn	Internal Medicine	OP
650/wk	New York, Brooklyn	IM/Nephrology	OP
625/wk	New York, Brooklyn	Internal Medicine	OP
650/wk	New York, Brooklyn	Pediatrics	OP
600/wk	New York, Brooklyn(Greenwood Heights)	Cardiology	OP
575/wk	New York, Brooklyn	Nephrology	OP
575/wk	New York, Brooklyn	Internal Medicine	OP
575/wk	New York, Elmont	Internal Medicine	IP
550/wk	New York, Buffalo	Family Medicine	OP

Year: 2019