Hahnemann Closure News

Hahnemann University Hospital, a Drexel University College of Medicine affiliated hospital, has filed for bankruptcy and is closing. Despite large protests including the appearance of Bernie Sanders, candidate for U.S. President and Senator for Vermont, the hospital has started its long list of closures. Today (July 17), the hospital stopped admitting patients who are already in the emergency department. Technically, the hospital is scheduled to remain open until September 6, but the emergency room is scheduled for complete shutdown by August 16th. Those deadlines seem to creep closer to the present as Philadelphia Academic Health Systems, the hospital’s parent company, continues with its bankruptcy proceedings.

What Caused this Hospital to Struggle Financially?

Basically, low-income patients with Medicaid and people with Medicare were a large cause for the struggle because these insurance companies are contracted to pay less than private insurance companies. Private insurance companies are supposed to pay more to make up for the revenue gap for government-provided coverage. However, inner-city hospitals have a large number of low-income people seeking treatment at their hospitals, and according to an article by Steven Church, they can detract those with private insurance because they don’t appear to be the better option. Interestingly, rural hospitals have the opposite problem because there is not a large enough population to turn a large profit.

What will happen to Hahnemann’s patients?

Hahnemann University Hospital sees 56,000 people in its ER annually. It is an important source of medical care in the Philadelphia community. Despite its monthly financial losses of millions of dollars a month, the hospital was not supposed to close so quickly. At the end of June, the city and the Pennsylvania Health Department ordered that the hospital not shut down until it had submitted formal notice of its closure, but Hahnemann started diverting patients that week. There is a minimum amount of time regulations allowed for a hospital to shut down any operations, which is 90 days, but Hahnemann has disregarded these regulations. The shutdown is set to continue in stages, and the other medical facilities in the area will have to take on Hahnemann’s patients.

What will happen to Hahnemann employees?

In short, they will have to find new jobs. Hahnemann started laying off workers this spring due to financial woes, and they will continue displace workers who will have to find jobs elsewhere.

What will happen to Hahnemann medical residents?

Well, if getting into a residency program through the Match wasn’t stressful enough, what is worse is losing that residency program. There are 571 residents, fellows and medical students that will be displaced by the Hahnemann closure. They can look for other residencies, but the programs have to sign off on the transfer of their funding, so they are stuck right now. Residencies are highly competitive, and being in limbo may force some residents to lose potential slots.

The Association of American Medical Colleges (AAMC) tracks open residency positions at Find a Resident, and if there are unfilled residency positions available, Hahnemann residents will have the option of filling them if selected. Residency programs with the resources to handle more slots than they are currently allocated can apply for additional positions through the Accreditation Council for Graduate Medical Education (ACGME). However, it is not known exactly how Hahnemann medical residents will be handled. Most worrisome is the fact that there are 59 visa-holding residents who could be forced to leave without an alternative residency positions.

On a positive note, it looks like residents have been a top priority during this closure. The residency program may be sold to Tower Health for the price of $7.5 million, but it may not be large enough to take all of the residents. The ACGME has located 1,000 available positions, so this may not be a problem. Residents should not have too much trouble finding another program, but they are still being displaced, which adds to the stress inherent during residency.

A Tragedy on All Sides

It is rare to see a teaching hospital of this size close, and it is a great tragedy for the people of Philadelpha, PA as well as the nation. Losing a hospital means lessened access to healthcare services, and in this case, it will impact low-income populations disproportionately. This is one of the reasons there has been so much public outcry over corporate greed at the expense of the population. Hopefully it is not a sign of things to come, but news reports state many other hospitals in Philadelphia are struggling financially, so taking on an increased number of Medicaid and Medicare patients is not likely to help the situation.

For foreign medical graduates, this is one poor example of the dynamics of the United States Health Care System. Whether one agrees with the privatization of healthcare or prefers a universal system, it cannot be said that capitalism produced a good result for the public in this case.

Choosing a Specialty

If you have not chosen a specialty yet, you may have noticed that it is not as easy as it sounds. You may be drawn to one specialty, but more likely you are torn between a few or even many choices. Medicine is stimulating, relevant and fulfilling in broad specialties such as family medicine but also in narrower specialties such as radiation oncology. What draws you to one may be a lifestyle choice, or it may be a deeper calling. In either case, you want it to be a choice you can stick with for a long while.

What are my specialty options?

The American Medical Association (AMA) provides a database of 11,000 accredited residency programs, and that database is FREIDA. Common specialty choices are:

  • Allergy and Immunology
  • Anesthesiology
  • Cardiovascular Disease
  • Child and Adolescent Psychiatry
  • Colon and Rectal Surgery
  • Critical Care Medicine
  • Cytopathology
  • Dermatology
  • Emergency Medicine
  • Endocrinology, Diabetes and Metabolism
  • Family Medicine
  • Gastroenterology
  • General Preventive Medicine and Public Health
  • Geriatric Medicine
  • Hematology
  • Hospice and Palliative Medicine
  • Infectious Diseases
  • Internal Medicine
  • Interventional Cardiology
  • Medical Genetics and Genomics
  • Medical Oncology
  • Nephrology
  • Neurological Surgery
  • Neurology
  • Nuclear Medicine
  • Obstetrics and Gynecology
  • Occupational Medicine
  • Ophthalmology
  • Orthopedic Sports Medicine
  • Otolaryngology
  • Pain Medicine
  • Pathology
  • Pediatric Surgery
  • Pediatrics
  • Physical Medicine and Rehabilitation
  • Plastic Surgery
  • Preventive Medicine
  • Psychiatry
  • Pulmonary Disease and Critical Care Medicine
  • Radiation Oncology
  • Radiology – Diagnostic
  • Radiology – Interventional and Diagnostic
  • Rheumatology
  • Sleep Medicine
  • Surgery – General
  • Thoracic Surgery
  • Urology
  • Vascular Surgery

This list can be found on the AMA’s website with links providing more training information.

How to Choose One Specialty

There are many ways to choose a specialty, and the advantage of doing it early is that you have more time to plan. First year medical students who successfully decide on a specialty can tailor every medical school decision to that specialty. However, if you aren’t sure as a first-year medical student, it’s better to wait than to try to force a choice too early. Here are a few ways to help you along regardless of whether you are entering medical school or choosing programs for The Match.

Set Goals:

You have to know what you want before you can start looking for it, and many medical students have misplaced dreams about reputation or riches. Entering a specialty because of the pay will not ensure a successful path to residency. Instead, focus on more functional aspects of the specialty such as the population it serves, geographic limitations, and lifestyle provisions. For example, you may find that emergency medicine hours do not suit your lifestyle despite the pay, and family medicine affords you the lifestyle you want to live comfortably and have time for leisure. On the other hand, maybe you want the excitement that the emergency room can provide, and saving lives in traumatic situations is fulfilling. If you want to fight infectious disease, there may be geographic limitations. There are factors in residency programs and the subsequent medical careers that are much more important than how impressive it is or how much money you make.

Gather Information:

Once you know what you want, you should find out all you can about the residency programs available. One way to do this is by attending residency fairs such as the AAFP National Conference or the AMSA Residency Fair. Looking on program websites is another way to find out if they offer what you are looking for, and you can find out if you meet the prerequisites to enter the program.

Ruminate:

You should be fairly methodical about your choice. That does not mean don’t choose from the heart…or the gut, but make sure you verify that with more objective means. Make lists of pros and cons. Research facts about job prospects and the future of the specialty. Get an idea of where you are going to have to live to support a career in that field of medicine. For example, some surgical specialties may not have a lot of prospects in rural areas where hospital resources are minimal. Spend a good amount of time reflecting back upon your goals and making sure your specialty reflects those goals. Then, make sure your heart…or your gut agrees. You should objectively and subjectively feel good about your choice.

Follow Your Passion

Money should not be the driving force behind your medical specialty choice, but it may be a factor. In order to live certain lifestyles and have the means to travel, you will need to make a certain amount of money. However, if you are miserable doing it, you probably won’t last. Physician burnout is a real thing, and even if you think you can hack it, long hours in a position you don’t feel passionate about will wear on you. Instead, choose a specialty in which you have passion. Stanford University has a comprehensive questionnaire to help guide you in your specialty selection. It offers a roadmap for the selection process, but there is no one way to pick a specialty. That is why this choice is worth so much of your time.

Foreign Medical Graduates’ Barrier is Red Tape

According to the Association of American Medical Colleges, the United States will suffer a shortage of 122,000 doctors by 2032, which is similar to past predictions by other organizations. As aging populations with multiple, co-existing morbidities continue to grow, a shortage of this magnitude should be worrisome. People are living longer, and older physicians are retiring. For many Americans, the idea of not being able to see a physician when necessary is unimaginable. However, it is quickly becoming a reality.

One solution to the shortage of physicians in the U.S. is to enable more foreign medical graduates (FMGs) to practice medicine. There are plenty of FMGs trying to advance their medical knowledge and careers by entering the U.S. for a medical residency. There’s also too much red tape for many of them to get through. Limitations on visas and residency slots hamper America’s ability to produce enough doctors to fill this deficit.

J-1 Visa

Most FMGs apply for a J-1 visa. There are multiple requirements to be eligible for this type of visa including:

  • USMLE step 1 and step 2 CK completed and passed
  • ECFMG certification
  • Position in a graduate program or medical school
  • Statement of need from Ministry of Health

After training in the graduate program or medical school is complete, the visa holder has to go back to their home country for two years. This is intended to spread the wealth of their knowledge gained in the United States to their home country. This prevents nations from losing all of their skilled workers and increases levels of global health. It can also present significant hardship for visa holders who may not get a chance to return to the U.S. Following the 2 year return to the home country, FMGs can attempt to change their visa to an H-Temporary worker, L-Intra-company transferee or U.S. permanent resident.

J-1 visa waiver

The two-year return to home country can be waived in 3 circumstances:

  • If applicant can prove he or she will suffer in home country.
  • If applicant’s absence will be a hardship to immediate family members who are U.S. citizens.
  • Sponsorship by an Interested Governmental Agency (IGA).

Once an FMG gets a waiver and a medical license, he or she can apply for a H-1B or immigrant visa.

H-1 B Visa

To get an H-1 B visa, an FMG must have passed all USMLE exams and have an unrestricted license to practice medicine. There is no 2-year home requirement, and the FMG can be employed in the U.S. for up to 6 years. This is the best visa option for FMGs looking to enter the U.S. for a medical residency.

H1-B visa requirements

  • Position in residency or fellowship
  • Medical school graduate
  • ECFMG certification
  • USMLE steps I, II, III passed
  • State medical license if required

The story behind H1-B visas

The purpose behind H1-B visas is to get employers the skilled workers they need for their businesses. Employers petition for a pool of visa numbers, and there is a cap on the amount of visas offered at 65,000 new hires per year with 20,000 extra slots for those who have graduated with a U.S. master’s or doctorate degree. This cap is always met quickly, and the majority of H1-B visas are not in healthcare positions.

Residency Positions

Although medical schools are trying to produce more medical graduates, residencies are not able to create more slots because of a cap set by congress on the number of Medicare-funded residencies. Congress has control of how much money is allocated to teaching hospitals for residencies. The 1997 Balanced Budget Act of 1997 and 1999 capped funding, and at that time, America was looking at a surplus of physicians in the future. Things have definitely changed, but the cap has not been adjusted to make up for the shortage, mostly based on budgetary concerns. Some hospitals privately fund extra residency positions, but the majority are funded by Medicare.

Protecting the U.S.

Much of the red tape surrounding FMG visas has been an attempt to maintain the opportunities for American citizens. However, H1-B visas bring in skilled workers, and studies show that they improve the economy. One study of an increase in H1-B visas predicted that it would create 1.3 million jobs by 2045. Foreign skilled workers and FMGs are not a threat to U.S. citizen opportunity. In fact, Americans need more FMGs training to become U.S. physicians to address the shortage of physicians.

It is clear that the consideration of FMGs has not been paramount to the decision-making of the U.S. government, or else there would be more residency programs and better visa options for FMGs. However, change is coming. The looming physician shortage is scary to all Americans, and it is stimulating people to come up with solutions. One of those solutions will surely be the promotion of more FMGs into U.S. residencies. There are not many suitable alternatives.

It starts with an ECFMG identification number.

What is EFMG?

The Educational Commission for Foreign Medical Graduates (ECFMG) is the organization that certifies foreign medical graduates for U.S. residencies that are accredited by the Accreditation Council for Graduate Medical Education (ACGME). It is essentially like a Dean’s Office for all medical schools outside of the United States. The ECFMG certifies that the education you received abroad meets or exceeds the standards of the United States Medical Education System. Their stamp of approval means you are free to continue with the USMLE exams and onward into the Match to apply for residencies. ECFMG certification is not an approval into any residency program, but it makes you eligible.

How to get an ECFMG identification number

The first thing you will need to move forward with ECFMG certification is a USMLE/ECFMG identification number (web application here).  The information in the application must be legal and current, or you will not be assigned a number.

An ECFMG identification number will be used on all of your future USMLE and ECFMG application forms. For more information about ECFMG number details, see the ECFMG website.

How Much Does It Cost?

An application for certification from ECFMG cost $135. For USMLE step 1 and 2 (Clinical Knowledge, the fee is $940 each. Step 2 (Clinical Skills) cost $1,580. Rescheduling the exam or changing the testing region can add fees. For a schedule of all fees through ECFMG, check out this link.

What are the USMLE exams?

In order to get certified by the ECFMG, you have to pass the United States Medical Licensing Examination (USMLE). Step 1 and Step 2 CK are considered the medical science part of testing, and this requirement can be replaced with a passing ECFMG examination, Visa Qualifying Examination, Foreign Medical Graduate Examination in the Medical Sciences, or part 1 and 2 exams of the National Board of Medical Examiners. The clinical skills portion of the USMLE is also required and can be replaced by passing both the ECFMG Clinical Skills Assessment and an acceptable English language proficiency test.

Is there a time limit?

The ECFMG requires USMLE exams to be finished within a 7-year period. The period starts on the exam of the first exam passed. You cannot get an ECFMG certification if you do not complete all of the exams within this time period.

Developing a Lifestyle for Success

Beginning the ECFMG certification process is arduous, but this process preps a medical graduate for the process of the Match and then residency. Rather than thinking about the extra work involved in becoming a medical resident, it is better to plow through the paperwork and make sure everything is done properly. This is part of developing a lifestyle for success that will get you to your end goal of becoming a practicing physician in the United States of America.

A Healthy Lifestyle is a Successful Lifestyle

The USMLE exams are tough, but so is the Match process. All the while, you need to keep your medical knowledge and skills updated by participating in clinical externships and anything that can add medical experience to your curriculum vitae. If that weren’t enough, it’s never too late to work on your interviewing skills. For the foreign medical graduate, it can be tough to get into a medical residency, so they must keep their health in top shape.

This means eating right, getting enough sleep, and exercising. A person who stays up all night studying will not retain information better than the person who stopped studying and got a good night’s sleep. Getting enough water, health food, and exercise also has performance benefits. You want a clear mind when you go through this whole process.

Planning is a Recipe for Success

There are many dates, fees, and plans that must be made in order to successfully get to the Match and land the residency of your dreams. It is important to keep track of all the dates because missing one can set you back an entire year. That may not be a lot in the whole scheme of things, but it will seem like a long time while you are waiting.

The Foreign Medical Graduate Bias

Unfortunately, the foreign medical graduate bias is not a myth, but thankfully, it is more often an implicit bias than something people outwardly feel and support. The world is more globalized than ever, but old habits and thoughts will persists through the generations. What this means for the foreign medical graduate is that you must now live the life of the physician you one day will be. In order to show residency directors with hidden biases that you are an excellent candidate for a residency despite your FMG status, you will have to make sure you meet all the requirements, but you will also have to present yourself in a way that is likeable, intelligent, and organized. It all starts with an ECFMG identification number, and you will begin your path to residency.

Clinical Rotations and Foreign Medical Graduates

What are Clinical Rotations?

In the U.S., the first two years of medical school are typically classroom lectures and book-inspired learning with very little hands-on experience. But applying these skills to real life medical situations is difficult without actual experience. That is why the third and fourth years of medical school include clinical rotations.

Clinical rotations are time spent shadowing physicians and residents in order to see what it’s like to truly experience practicing medicine. Students get to participate in the medical decision-making process, and they gain the invaluable experience about uncertainty and solution-making inherent in medical practice. This may be the first time medical students have dealt first-hand with patients, so it is really an opportunity to understand the physician-patient relationship.

Core Rotations:

Core rotations are not elective, but they may vary depending on the medical school. These rotations cover the breadth of general medicine. They may include family medicine, internal medicine, pediatrics, OB/GYN, psychiatry, emergency medicine, and surgery. The learning opportunities expand as the student progresses through the rotations, and they leave with a greater understanding of their future responsibilities and skill requirements.

Elective Rotations

Elective rotations are specified and more applicable to your future hopes and dreams in the medical field. These rotations may cover subjects such as ophthalmology or plastic surgery. Elective rotations typically occur during the fourth year of medical school. Because of this, it is easy to get distracted and focused on residency rather than rotations. This can make it difficult to select rotations, and the help of an adviser or mentor is suggested to keep you on the right path.

Clinical Rotations are a Job

One thing about clinical rotations is that it can be very much like a job, and it should be treated like a job. Even though there is no pay, and you may work long hours, this is very similar to what you will do as a resident and then a practicing physician. The hours and the work environment will be similar, and rotations are a first opportunity to experience “the real world” of a physician.

It would be a mistake to underestimate the importance of rotations, and a medical student should take it seriously. This means dedication, attentiveness, eagerness, and self-care to make sure you are getting everything you can from every moment observing others in the medical field. It is also a chance for networking, and some of the professional connections you make during this time will be life/career-long.

Clinical Rotations and Foreign Medical Graduates

As a foreign medical graduate, U.S.-based experience is a must. It may be helpful to get assistance from an outside source such as FMG Portal to help you get started. Any U.S. experience obtained prior to the Match will help a student get into to more residency programs, as it will look better on applications and during interviews.

Advantages of Clinical Rotations for Foreign Medical Graduates

  • Hands-on Experience: For all medical graduates, foreign or not, clinical rotations add valuable hands-on experience that cannot be replaced by classroom lectures. Students will learn from actual doctors and in the professional setting.
  • Letters of Recommendation: When applying for residencies through the Match, foreign medical graduates will need letters of recommendation from colleagues within the United States. This sends a message to residency directors that your educational background includes cultural acclimatization and that you have experience practicing medicine in the U.S. Healthcare System.
  • Performance Evaluations: Most clinical rotations offer performance evaluations where you will be informed of you strengths and weaknesses in certain areas of medicine. This is very valuable for future studying and in order to know where to get more experience.
  • Pathway to Residency: As a foreign medical graduate, you need local training to be considered for many residency programs, and clinical rotations provide a pathway for that to occur before graduation, so you don’t have to spend time after graduation getting experience before the Match.

The outlook for foreign medical graduates is constantly getting better despite political issues causing problems with visas, etc. There is a physician shortage that must be filled, and the American people and residency directors are consistently looking at foreign medical graduates as hope for a system that is lacking.

One of the ways that you can help foreign medical graduates (yourself) along is by making sure you have the background to show that you will be a formidable physician in the U.S. Clinical rotations are one way to do that. Not only do they give you added knowledge, experience and skills to help you practice better medicine, but they also make you look good to residency directors who may be concerned about your medical school experience. This shows them that not only is your educational background strong, but you have already had success applying it to patients in the U.S.

10 Habits to Prep for the Match

If you are getting ready for the Match, you should have already picked your specialty and are looking at different options for residency programs. As any medical graduate, this is not a time for rest following graduation. However, foreign medical graduates have a few more things on their list if they want to be eligible for the Match (visa, ECFMG certification, etc.) Your time during The Match should be spent actively engaging yourself in the medical community and gaining any experience available through internships or mentorships. It can get pretty hectic, and one of the keys to success during this time is the proper management of life. Here are a few habits that will prep you for your life during the Match.

  1. Schedule:

There are all sorts of deadlines and appointments you will have during the Match. You should have already developed your own system for successful scheduling. If not, now is the time. An electronic schedule via Google or other technology is advised as a primary calendar, but don’t be afraid to get creative. Always keep a master calendar, but if post-its help you to get certain things done, recognize that. Use the tools at your disposal, but develop good habits to make you less reliant on your creative tools and more reliant on dependable primary schedules.

  1. Look at Requirements:

Start studying residency programs immediately. Look at their requirements. Look at their statistics in regards to accepting foreign medical graduates. Talk to other residents, and make sure you like the environment surrounding the programs you consider. You cannot have enough information about your residency. The more informed you are, the better you will perform during interviews.

  1. Study:

You still have exams in the horizon, so this is no time to lose your knack for information retrieval. The medical profession is a profession for lifelong learners, so never stop. With that said, studying beyond your capacity will not yield any better results.

  1. Eat:

It is important to take care of yourself in order to maintain a smart mind and an active body. Both are going to be required if you are to make it through this time. Don’t celebrate your graduation from med school too much, and don’t waste your money on fast food. Drink your water, and prep your own food or choose healthy options. This will make you ready for every day on this adventure and keep your mind sharp.

  1. Sleep:

It will not help you in any way to stay up late studying. Your mind will be tired and won’t retain anything more than it would had you spent very little time studying. Save room for sleep in your schedule, and you’ll be more productive.

  1. Build your Team:

The path to residency can get lonely because there is so much to do. Don’t set aside friends and family, as it increases your risk for burnout. If you are in a new area, meet new people. You will need them to bring some of the humanity back to this process.

  1. Practice:

Practice your interviews from the beginning. By the time you get to actual interviews, you should have your answers polished and be able to answer unexpected questions with ease. Half of the battle with interviews is making sure your personality shows. Interviewers don’t want an automated response from a memorized answer. Practice is the only way you can deliver real responses to tough questions.

  1. Meditate:

Meditation can mean so many things, but in this case it means spending some time on yourself for reflection. A residency is a career path, and you want to make the right choice professionally but also personally. Add time for reflection, so you make the right choice for your personality and strengths.

  1. Have Fun:

While you do need reflection, you also need fun. Go to a comedy show, or go on a date. Laugh a little. Remember that you are a normal person and a physician. Forgetting that you are a normal person with normal needs will make your journey tough, but a little laughter can fix it.

  1. Exercise:

Exercise can be your way of meditating or your way of remaining healthy. It is a stress reliever and a mind clearer. There are rarely any bad side effects and typically only good side effects. It can be difficult to develop a routine with non-routine schedules, so make sure you have some way of fitting it in.

Does it seem like all of these things are impossible to accomplish? They probably are. You will not be able to check all of these things off of your list every week, and prioritization is essential. However, remembering that each of these things is important will help you to fit some of them in on your schedule, and your sense of self will survive this process.

How to Take Care of Yourself as a Medical Resident

If you’ve recently Matched into a medical residency program as a foreign medical graduate (FMG) or are just beginning the Match process, then you have been warned about burnout syndrome. This warning came not because of your status as an FMG but rather the overwhelming amount of residents and medical doctors who leave the profession because of burnout.

Burnout is described as mental fatigue caused by constant stressors. Stressors during the first year of residency may come from adjusting to a new location, missing family, large workloads and learning/studying demands. Additionally, physicians are expected to exercise empathy with patients in order to provide better quality care. This caring for others is essential but does take a toll on the physician’s self-care.

The results of burnout do not affect the resident only. While new physicians may experience depression, anxiety, disturbed sleep and co-existing effects of burnout, patients also suffer. Evaluation and treatment from a provider who is burned out will not have the same level of quality. The provider may not have the focus necessary to make a diagnosis, and they may lack the empathy to deliver care in a way that fits the situation. In more extreme cases, the resident will leave the career path. All of that hard work for nothing.

As a new medical resident, you might think that burnout is not in your future. Especially after getting Matched, you’re likely pumped up and ready to get in there and practice medicine. This is normal, and you should be proud and excited, but don’t forget that you need to care for yourself during this time. Preparation and studying is essential to a successful residency. Also essential is self-care. A little focus on yourself will make your hard work less of a stressor, and you will reap many rewards in the form of motivation and mental health.

Ten Ways to Take Care of Yourself as a Medical Resident

  1. Have a hobby:

Your hobby should not be your career. Since you’ve made it this far, you are likely very passionate about medicine. However, this isn’t what your colleagues are going to want to talk about at dinner parties (at least not the entire time). Not having anything else can remove your sense of self, and it can make you feel beholden to your career at an unhealthy level. You are not a physician only. You are a person who happens to be a physician. Right now that might be hard to believe, but if you have a hobby, you’ll get some of that back. Part of the reason burnout happens is because physicians get absorbed by their careers leaving very little left of the actual person.

  1. Live with people:

Another reason for burnout is that much of medicine is emotionally charged. You will deal with death and grief, pain and suffering. It takes its toll, and you need to talk about it. Living alone is a perfect way to sink into solitude and depression, but having a couple roommates will save you. They will not only notice your slippage into the doldrums, but they are there to lend their shoulders or simply their ears. Especially if you’ve moved away, having these types of connections can be very good for emotional health. If you are a private person, make sure you have your own private areas.

  1. Exercise:

As a physician, you know about the health effects of exercise. Don’t forget about the mental health benefits. If you can do it outside, even better.

  1. Journal:

Much like communicating with others, expressing yourself on paper is an excellent stress reliever. This is particularly important when you can’t really talk about certain situations aloud.

  1. Start a project:

Much like a hobby, a project is a distraction from your career and a reminder that you are more than your position in the medical field. Any project, even doing your backed up laundry, can have a meditative effect. At the end, you get a normal, everyday sense of accomplishment without the stressful grandeur that medical accomplishment can sometimes create.

  1. Eat and drink healthily:

Avoid caffeine, alcohol, and fast food. If you eat healthy, your mind will thank you. You’ll be less likely to suffer volatile emotions, and you’ll be able to persevere during those long nights and trying circumstances.

  1. Sleep:

Yes, you can sleep as a resident. And you should…any time you get. Long hours happen, but ensuring that you get enough sleep is important for your physical and mental health.

  1. Engage in leisure:

Leisurely activities are closely connected to well being. This isn’t to dissuade a person from hard work and studying habits, but even the grueling expected work of being a resident needs to be coupled with some leisurely activities.

  1. Meditate:

If you haven’t practiced meditation, it is a great way to center yourself and awaken your mind to the positive aspects of life. Finishing an effective episode of meditation is like taking a huge breath of fresh air. It is cleansing and invigorating.

  1. Laugh:

In the midst of everything, don’t forget to laugh. It truly is the best medicine for physician burnout. Get together with friends, watch funny movies, and tell jokes! Life is too short to live without laughter.

Residency is not easy, and you won’t have time to fit all of these activities in between the necessary demands of your career. But try to do some of them, and don’t forget to take care of yourself during this incredible and rewarding journey.

Residency Match Program Types

When you are considering residency programs, one of the things to consider is the type of program in which you will be seeking. This includes evaluating how you will personally fit into a program, if you got along well with current residents in the program and whether or not you can see yourself their long-term. It is less about how programs rank and the reputation of the program. If it doesn’t feel right during your interview and other interactions with people in the program, then it shouldn’t appear on your rank order list.

Beginning the Match process can seem overwhelming, especially after recently finishing the USMLE-2 exam. It seems like life is one whirlwind after another, and for the foreign medical graduate (FMG), there can be added stress in communication and logistics. With this may also come difficulty over Visa processing or difficulty getting ECFMG certification. It is not easy to maneuver life throughout your transition to PGY-1 (Post-graduate year 1), and one thing that can help is understanding how residency programs are set up. If nothing else, it clarifies a bit of the “mud” when you are trying to navigate the NRMP process.

One thing you may not completely understand is the program types offered through the Match. There are 5 program types available, and they each specifically coded for your rank order list.

How are programs coded?

Each program has a 9-character code that is recognized by the rank order list computer algorithm when you create your list. The first four characters are the institution code. The next five to seven characters are the ACGME specialty code, and then comes the program type or letter. Last is the track number, which is typically zero unless there is more than one track in the program. If there are more tracks, they are listed sequentially.

For example, anesthesiology programs at George Washington University – DC have the codes 1802040A0, 180204C0 and 1802040R0. Emergency medicine programs at the same university have the codes 1802110C0 and 1802110C1. The first four characters remain the same for the university. 1802 is the code for George Washington University – DC. The number 040 is the code for anesthesiology, while the number 110 is the code for emergency medicine. Anesthesiology offers three program types, advanced (A), categorical (C) and physician reserved (R).  Emergency medicine only offers categorical (C). The anesthesiology programs only offer one track, while emergency medicine offers two tracks. The second track is an international track.

You may not think it is important to understand how the programs are coded, but understanding the codes can help you to avoid errors when choosing programs for your rank order list. It also helps to understand that there are different categories of programs for planning purposes. For example preliminary and advanced programs are meant to be ranked together but separately, as the advanced program will be on your primary rank order list, while the preliminary will be on your supplementary rank order list.

What are the categories?

There are five categories of programs, and they tell you what post-graduate year they will start in along with the level of training offered.

  1. Categorical (C).

    If the program code has a C as its second to last character, it is categorical. This means it starts in PGY-1 (year one following medical school), and it offers full residency training. At the end of the program, a resident should be prepared for specialty board certification. Common categorical specialties are internal medicine, family medicine and neurological surgery. The length of categorical programs is 3 to 5 years.

  2. Primary (M).

    Primary programs are very similar to categorical programs in that they begin in PGY-1 and prepare the resident for boards. What makes M programs different is that they focus on primary care in that specialty. For example, they may focus on primary care in internal medicine or pediatrics. These programs may only take 3 years.

  3. Preliminary (P).

    Preliminary programs are to be coupled with Advanced programs (A). Common examples of preliminary programs are internal medicine and surgery. In P programs, the skill set learned is broader and covers a variety of disciplines in preparation for Advanced programs. They may take 1 or 2 years and begin in PGY-1.

  4. Advanced (A).

    Advanced programs follow preliminary and complete the full course of training began during preliminary training. Examples of Advanced programs are anesthesiology or dermatology.

  5. Physician Reserved (R).

    Physician reserved programs are advanced programs for physicians with graduate medical education. There are not many positions available in these programs, and they are for physicians that already have prerequisite resident training. These programs begin in PGY-1.

If you are beginning your journey to the Match, you may feel like it is a little premature to start figuring out the details of programs and how they are handled by NRMP to make sure your Match meets your needs and the needs of the program. However, there is a wealth of information and small details that can confuse the process if you aren’t adequately prepared. Casually studying these details will reduce the stress of the Match once it comes time for interviews and ranking.

Handling Doubters after a Successful Match

March 15th has come and gone, and the Match is over. Congratulations! You are now a first-year resident. You are also still an International Medical Graduate (IMG), and you might still face some criticism because of it. Don’t let this alter your excitement about your program. After a successful Match, every resident should be proud of their accomplishments.

You may have heard that people don’t care where you went to medical school. This is true, but only after you’ve established yourself. This means you may get asked and face unwanted opinions until about your second year as a resident.

Why Does IMG Criticism Persist?

The biggest problem medical professionals and the public have with international schools is that they are unfamiliar.  For the average American, The Medical School for International Health at Ben-Gurion University of the Negev could just as easily be a fraud as it could be a reputable medical school.

Additionally, fraudulent and substandard medical schools have made it to news headlines. Certain medical schools in the Caribbean have been criticized for overcrowding, high drop-out rates, and low Match rates. People don’t remember good stories. They remember the bad, and any bad press builds a bad reputation. Regardless of the truth, people associate foreign education with substandard education.

Of course, this is not the truth, and you wouldn’t be Matched if you didn’t receive a good education. So, what can you do about this persistent doubt people, even colleagues, have about your educational background?

What to do when they doubt your education:

  1. Be Proud.

You know what you had to do to get your medical degree. You know why you chose your medical school. Not only that, but you know what it took to get certified by the ECFMG. None of these things are easy, and you should be proud of what it took to get where you are today.

Furthermore, you must be sure of yourself in order to practice medicine well. If you are seeing patients and doubting your education, then you won’t be able to correctly make life-saving decisions.

Lastly, you are now a resident, but that does not mean you won’t burn out. You still have crazy schedules, stressful situations, and not much time for personal life. If you add guilt over your education, it may be too much. Be proud of your accomplishments because you should be proud, and that pride will give you the boost you need to practice good medicine.

  1. State Facts.

If you must, defend yourself. The ECFMG won’t certify a person that was education in a substandard institution. Also, all IMGs take the same USMLE exam as non-IMGs. The criteria are the same for all medical students. Explain to people how you took the same tests and went through the same Match process, and open their eyes.

Many opinions about foreign education are not well thought out. It’s more of a prejudice than a real opinion. It’s like thinking all Germans like beer and all Chinese like math. Nobody logically believes that this overgeneralization can be true, but people will think they believe things until presented with facts.

Even your peers and colleagues may unintentionally harbor prejudices against your training abroad. Simply reminding them that you had to face the same hurdles as other residents can be a good reminder to them, so they don’t forget and fall back on their prejudice. Just remember, don’t get defensive. As the saying goes, the best defense is a good offense. Be prepared with facts, but don’t get offended.

  1. Ignore it.

If you can muster the internal fortitude to ignore criticism, go ahead! This too shall pass, and eventually you will either show people your ability, or eventually people will stop caring where you went to medical school. You are a physician, and once you get through residency, most everyone will accept that you are trained well.

Ignoring criticism about your education is only an option, and if you must say something, that is fine. Opt for ignoring criticism when it will not help the situation or when you fear you may get argumentative.

  1. Engage.

Don’t hide from people, so they don’t find out that you went to an international medical school. Engage with people. Throw it in their face. The more they have to work with you, the more you will validate your education. Not only will this help others to appreciate your education, but it will help you to build pride in yourself.

  1. Make Connections.

Make sure you take care of your mental health by making connections. Join a social media group, or network with friends, so you can have a forum for discussing things like this. It is difficult to find time for things like this during residency, but you must. If you face a lot of criticism, it may get into your head. There’s nothing like like-minded friends to get you back on your feet.

Congratulations!

You have Matched, and your training and experience are awesome, which is why you Matched. Unfortunately, you will face a bit more judgement about your education abroad, but dealing with it appropriately will help you through this. Be proud! You deserve to be here!

Strategy, Stamina and Truth: The Path to a Residency

There are many motivating factors that influence one to enter medical school, and some of them are better than others. Your passion for medicine is a good one, and it may be coupled with family pressure or monetary expectations. These are not bad motivations, but becoming a doctor is more difficult than motivation, and if you are preparing for the Match, your path to a Match is far from over. That is why there are a few tools you can use to mentally prep yourself into a successful medical career.

Three Tools for a Successful Match

Strategy

Strategy is basically the planning process. You don’t just go to medical school, get a couple good recommendations, and Match in a residency program. Of course, there are the tests necessary to apply for residency, such as USMLE step 1 and USMLE step 2. However, more importantly is knowing what you need to get into the program you want.

When you entered medical school, you probably had an idea of the direction you would go. Maybe you were interested in pathology or plastic surgery. By your third year in medical school, you should have it narrowed down to one or two specialties.

After you know where to focus your efforts, you need to look at the requirements. What test scores are required to be considered for that residency program? How are you going to study for the boards? Are there sub-internships available? Find an overseas rotation in the U.S. and make sure you are doing it.

Your efforts should be targeted, and the target should be clear. This will make all of your efforts efficient, so you won’t waste time where it doesn’t need to be spent. You don’t need to study 12 hours a day to get into the residency of your dreams. In fact, over studying can diminish retention. So, focus and plan your efforts to a Match.

Stamina

You must already have a can-do attitude, or you wouldn’t have made it this far. From now on, any procrastinating tendencies you have must be disregarded for committed action. This means committed action in all walks of life.

It is natural to find excuses why you cannot or should not do something. When faced with adversity, our natural inclination is to preserve and protect instead of fight until the end. Some physicians will reflect on residency as “not that bad” or “most people could do it if they tried.” This is not true! They are either remembering incorrectly in a fit of nostalgia, or they are one of a handful of geniuses on the planet gifted with unreasonable talent.

Don’t expect anything to be easy, and don’t plan on waiting for anything. If you want to do something to prep for the Match, get started now and keep going.

Truth

There is some hard honesty that must be had during this journey. One of those truths involves self-reflection. If you are holding on to dreams of a surgical residency, but you just don’t fit in with that group of people or are having second thoughts for other reasons, go with your gut! This is going to be your life. Good physicians don’t clock out at 5 p.m. on the dot, and neither do happy physicians. Recognize the places where you fit, and you’ll shine.

It can cost some money to prepare for your tests, but you need those scores to get into your program of choice. Accept the reality that prep courses work, and you’ll maximize every second spent studying. Some courses to consider are Kaplan, UWorld, and Doctors in Training. You may spend thousands on prep, but think about the time and money you’ll save in the long run. A couple thousand is worth it to capitalize on the hundreds of thousands you may have spent on education.

Lastly, be honest about the integrity of the advice you receive. Listen to the person who bombed their step tests, but take any advice with a grain of salt. They don’t know how to get to where you want to be, as they weren’t able to do it themselves. Unfortunately, these people are typically forthcoming with their advice.

Learn from the mistakes of others, but seek out advice from people who have been successful. They know how to get over the hurdles of residency. Hopefully, they are willing to share. You don’t need to know how not to pass the USMLE or how not to succeed in an interview. The accounts of people who have failed may contain a few useful do-nots, but they contain no how-tos. The tips from successful applicants will be much more valuable.

You are getting so close to becoming a physician, but you still have a long and tough road to travel. With strategy, stamina, and truth, you will be able to reach the end of that road with a career that was meant to be, and one which you will be able to enjoy. Success is not just about money and prestige…but you can have it all in your medical career if you listen to yourself and plan accordingly.

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:

  1. 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.
  1. 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.
  1. 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.

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.

Writing an Excellent CV as a Foreign Medical Graduate

When you are looking for a residency program as a Foreign Medical Graduate, there are many items that must be covered. Visas, letters of recommendation and ECFMG certification are only a view of the requirements to get started on the path to residency. Possibly one of the most important items residency program directors will look at is your CV.

What is a CV?

CV stands for curriculum vitae, which is Latin for “course of life.” That is an important thing to remember because it is what makes a CV different from a resume. It is not just a list of skills and experiences, and it is a much more detailed account of your accomplishments. It is comprehensive, and it can include all or any aspects of your professional life.

It does not need to include pre-college information, and in many cases, the oldest information you will find on a CV is from graduate or undergraduate education. If there are any time gaps once beginning undergraduate school, they should be accounted for.

Because of the detail required for an effective CV, it is recommended that students begin compiling the information for their CV during the first year of medical school. This document will follow you for the rest of your professional career, and it will be used time and time again for credentialing once the FMG is practicing medicine.

How long is a CV?

While a resume should only be one or two pages, a CV can extend to a much longer length. This is because every relevant accomplishment is included, and every time gap explained.

With that said, a CV should not be too long. CVs should be organized an only include relevant information. Time gaps should not be over-explained, and everything should be succinct. A CV should be jam-packed with information, but wordiness or unnecessary items will fill it with too much fluff, and residency directors will not be impressed.

What should be in my CV?

A CV is not a place for examination scores, as directors will have that from your application. Instead, a CV is a place for educational, leadership, and research experience.

You don’t’ have to use complete sentences in a CV, as it is not a narrative account of your professional life. Instead, short comments with no “fluff” help to keep it organized and remove some of the length from the document.

Employment experience, awards or recognitions, and publications should be included in your CV. What you have to ask yourself is, would my program director want to know this about me? If the answer is yes, then find a way to include it.

There is no set way to write a CV, which makes research necessary to make sure you are covering everything in a manner that is standard but at the same time stands out. There is a TON of information online, and talking to other medical providers or mentors is also a good place to start getting information about what to include.

Lastly, what to include is not standardized but rather dependent on the position you are applying for. For instance, if you are applying for a pediatric residency, volunteer work at an elementary school may be more relevant than that same volunteer work used in a surgical residency.

What are the sections of a CV?

As previously stated, every CV is different, but there are a few things you should expect to include:

  • Personal Data: contact information
  • Education: current first with expected graduation date, then reverse chronological order
  • Honors/Awards: anything that will gain the attention of directors including community awards
  • Professional Memberships: include years and any positions held
  • Employment: only since medical school, include position and dates
  • Extracurricular Events/Activities: volunteer work, second languages, special talents
  • Publications: title, place and date…include things currently being published as “forthcoming”
  • Professional Interests: (Personal Interests too!): this section is to make sure your character is represented on your CV, and sometimes things don’t fit in any other category. Don’t be afraid to add personal interests if it is relevant.
  • References: For FMGs, local letters or recommendation are essential to proving you know how the local healthcare system works. Don’t disregard quality letters from your home country or other places abroad, but make sure to include letters from the residency’s country as well.

How do I use my CV in the Match?

ERAS will create a CV for you during the Match application process, but this information should come from your own, personal CV. A “master copy” of your CV should include all information that may be relevant for any professional application, and information can be removed for specific purposes where some information becomes irrelevant.

A well-written CV is essential for residencies and for a professional medical career. If you have not started one or are unsure about yours, get help ASAP. There are many resources available to help you write a stellar CV that will make you a shoo-in for a residency program.

Health Security and the Foreign Medical Graduate:

Foreign Medical Graduates (FMGs) face skepticism from Americans and healthcare professionals, but that is changing quickly. While many FMGs come to the United States to obtain a quality residency and return to their home country, many stay in the U.S. to continue practicing medicine as a career. This has many switching from skepticism to thankfulness as FMGs fill gaps in the accessibility of healthcare.

By the year 2050, 20 percent of the U.S. population will be made up of adults 65 year’s old and older. That is an increase from 12 percent in the year 2000. Currently, there is a physician shortage of over 30,000. This number will increase to over 100,000 in the next 30 years.

Elderly patients cost the healthcare more than younger populations because of chronic metabolic and geriatric disorders such as type II diabetes, heart disease, and dementia. They need physicians for continued care in order to manage their health. Telemedicine does a lot toward improving healthcare accessibility, but there is still a growing need for physicians in order to meet face-to-face and tele medical needs.

The physician shortage will not be eliminated by nurses or advanced-practice nurses. It will only be somewhat lessened. With the growing shortage of physicians will come an equally burdensome shortage of nursing and ancillary staff. This leaves the mystery of why FMGs are met with skepticism instead of appreciation.

Similarly to residency program directors, the general public does not know if the education FMGs receive abroad is equal to what would have been received within the United States. Of course, FMGs know that they are thoroughly checked out via the ECFMG certification process, but that is hardly common knowledge.

It is important therefore for the American public to understand how FMGs are vetted. It is also important for FMGs to be able to communicate the vetting process, so patients can have faith that they are getting quality care. Americans need to rely on FMGs in order to get access to quality care, so confirmation of quality education will go a long way to building trusting relationships between FMGs and their patients.

How are Foreign Medical Graduates vetted?

Educational Commission for Foreign Medical Graduates (ECFMG):

We already mentioned ECFMG certification, but it is integral to the vetting process of FMGS. It is essentially a Dean’s Office for international medical graduates. It is the ECFMG’s job to make sure that education received abroad meets the standards of the American Healthcare System. It also ensures that a resident has the communication skills necessary to treat English-speaking patients.

ECFMG certification requirements

  • Medical Schools must be listed on World Directory of Medical Schools
  • United States Medical Licensing Examination (USMLE)
    • Step 1 and 2: clinical knowledge
    • Step 2: clinical skills
      • English proficiency requirement
    • Diploma and credential verification

By the time FMGs have been certified by the ECFMG, it is established that they have had sufficient education and can perform well in a clinical setting.

  1. Visa:

It can be very difficult to get a visa to enter and stay in the United States, and travel bans increase the challenges faced by FMGs. However, U.S. Citizens should rest assured that FMGs are not only trained adequately, but they are not criminals and are welcomed by the U.S. government. The hurdles to getting FMGs in the U.S. are controversial, but they can be a positive item too.

USMLE Step 3:

This last stage in USMLE testing is a final assessment of a physician’s ability to practice medicine alone in the United States. It determines their ability to be independently responsible for patients and is a final step in medical licensure.

Residency:

Every state requires at least one year in an accredited residency program. This means that before the FMG is released to practice medicine, he must practice it under the supervision of other physicians. The FMG has to do basically everything every other doctor does, but they also have to prove it.

Health Security and the Foreign Medical Graduate

In order for the United States citizens to have security in their healthcare system, they are going to have to embrace international medical students rather than question their abilities. That does not mean eliminating the vetting process, but it does mean streamlining it.

Americans need to remember that FMGs bring diversity and unique medical knowledge to the healthcare system. They also represent one solution to alleviate some of the physician shortage present and growing in the U.S.

With that said, FMGs must remember that they have been thoroughly vetted, and they are fully equipped to practice in the U.S. They also must be able to communicate that to patients.

Hopefully, as the world continues with globalization efforts and communities become more diverse, FMGs will be looked at similarly to any other trained physician. FMGs are not a questionable entity with a questionable background. They have been scrutinized in many ways more than the American Medical Graduate.

January Agenda: Rank Order List

As 2019 approaches, it is time to consider which residency programs you’d like to attend, and this decision is integral to successful placement in the Match. On the one hand, candidates need to consider residency programs where they feel they’d be a good fit and be able to pursue their medical career successfully. On the other hand, candidates also need to pick programs where they will be successfully matched.

A word of caution: don’t pick residency programs simply because you think you’ll be matched. There are worse things than not getting matched, and you’ll get another chance to be matched through the Supplemental Offer and Acceptance Program (SOAP) where unmatched candidates fill unmatched residency program positions. The Rank Order List should reflect your best picks, not your safest.

Janurary 15th marks the opening day of the Rank Order List entry, which is located on the website of the National Resident Matching Program (NRMP). You should list programs in your order of preference, with those you most want to attend listed first.

Things to consider when ranking programs:

Which program did you simply like the most? This questions does not necessarily mean the program seemed the most challenging or that you would fill a provider gap in your future area of practice. It is more about where you would be a good fit. Did you get along with the people running the program? Did it seem to progress at a desired pace? Is there a good support system? Whatever you are specifically seeking in a residency program should be considered when ranking.

How was the interview? Was it amazing? Did you make connections? Did the interviewers seem receptive, or did you feel unaccepted. Especially for Foreign Medical Graduates (FMGs), this can mean the difference between a successful and an unsuccessful Match. Those who are FMGs should also be considering how the program handles the inclusion of all residents, so an FMG is not set aside as a viewer more than a doer because of cultural or language barriers.

Is the program competitive? Can you succeed at this level of competition? This would include considerations such as your USMLE scores and any education gaps you may have experienced. Especially for FMGs who may have had a different medical school curriculum, this can really impact success.

Is the program good from a logistics standpoint? Is it located in an area that will be acceptable for you to live for a while geographically? Does it pave the path to the medical career you are seeking?

Are the current residents happy? Physician burnout is real, possibly more than ever. Make sure the current residents are satisfied with their residency program. You don’t want burnout to begin early, and a good residency can provide a resident with the tools necessary to avoid it in the future.

It is recommended that you rank around 10 residency programs, but you won’t have to pay additional fees until you reach 20. It is also recommended that you have a qualified person look at your list and discuss any opinions about questionable choices. A mentor or a current physician may be a good choice.

Once you have your Rank Order List Complete, you must certify it in the R3 system. This must be completed by 9 p.m. Eastern Time February 20th 2019.

There are two other things that should be mentioned about Rank Order Lists:

1. If you did not interview with any residency programs, you won’t be able to generate a Rank Order List because no residency programs will be considering you as a candidate. It is not the ideal situation, but don’t forget that this does not mean the end of your residency hopes for this year. There is still SOAP in March.

2. If you are having a lot of difficulty deciding whether or not you should rank a program because you aren’t sure if you’ll be Matched, you can communicate with the programs, and they can reach out to you. Letters of intent may or may not have a positive influence on the Matching process, but they are allowed. Additionally, programs may reach out to you, but it is not recommended that you let this influence your Rank Order List. There is a Communication Code of Conduct that should be followed during this time, which highlights confidentiality and eliminates unnecessary communication.

Remember, your interview days were the time to fully vet each residency program, and your choices should be made based on the positive and negative qualities of the program, not whether or not you think there is a good chance you’ll be selected.

There are differing opinions on how Rank Order Lists should be created, and each person has a different experience based on personalities and professional backgrounds. For FMGs, there may be programs that are friendlier toward foreign education, but again, this should play a minimal role in your selection.

Match week is in March with Match Day falling on March 15th, so if you are in the Match as a Foreign Medical Graduate, your journey is almost complete!

Journeys in Medicine makes FMGs feel connected.

It is easy a foreign medical graduate (FMG) to feel isolated and even discriminated against, especially during the Match. The Educational Commission for Foreign Medical Graduates (ECFMG) is an organization committed to alleviating some of these feelings, but the world’s university systems are simply not set up in a way that completely remedies the added dilemmas FMGs face.

Thankfully, the ECFMG is constantly working on making conditions favorable for FMGs, and one of the ways they have recently accomplished part of this goal is by creating a blog. Journeys in Medicine is a blog that focuses on the true stories of foreign physicians and their experiences in the United States and in home countries through the Exchange Visitor Program.

The stories in the blogs are not terrible stories of failure or complaints about the stress of being an FMG. They are instead inspirational stories that confirm the importance of FMGs in the U.S. and abroad. They are also incredible tales about the amazing resources available for FMGs, and how to keep a positive attitude and perspective about training and education.

Sometimes, all it takes to remain motivated during studies as an FMG is to feel connected and like you are part of a community. Journeys in Medicine helps one to accomplish this goal by giving authentic accounts of experiences rather than analogies or fictitious tales of what should be. The stories are the real deal, and they are a reminder of the reasons FMGs should keep striving to do their best.

5 Reasons to Read Journeys in Medicine as an FMG

Anecdotal Evidence: The purpose of the stories in this blog are to encourage participation in the U.S. healthcare system. Sure, it is a difficult road, but the road is filled with heartfelt success stories. Often, the anecdotal evidence FMGs receive is negative and focused on discrimination and failures due to things out of one’s control such as Visa issues. This blog gives a person hope through real life success stories, which can encourage the FMG to keep trying no matter what obstacles get in the way.

Sense of Community: Reading Journeys in Medicine is a reminder that FMGs are part of the medical community. The stories remind FMGs of this by noting the accomplishments and importance of FMG contributions. It is not only the FMG that reaps rewards from their education while in the U.S. The patients in the healthcare system also benefit from the unique knowledge FMGs may possess. Sometimes, FMGs can forget that they are an asset to a nation that struggles with a physician shortage and lack of diversity.

Connections: In many cases, Journeys in Medicine gives FMGs connection to doctors who have shared similar experiences. One they have read a blog post, an FMG is free to try contacting that physician for more information or help with their own struggles. Admittedly, the blog does not have a discussion forum or contact information. However, the names of the physicians are included in the stories, so an FMG could look up the doctors in a physician’s directory.

Resources: Many of the blog posts in Journeys in Medicine give clear information about resources that aided the visiting physician and allowed them to have a positive learning experience. Being able to follow the trail of resources used to get to a certain endpoint can be instrumental in another FMGs successful finding of their own resources. It also confirms for an FMG who is feeling lost that there are resources available to put them on the path to success.

Authenticity: Lastly, Journeys in Medicine is an authentic account of real life experiences, so the reader is not getting a story about how things are SUPPOSED to be but how it actually is. Too often, FMGs are presented with promotional material that paints a false picture of reality. That does not mean that reality is not as good, but it does mean that the information in the promotional material may be inaccurate. Reading actual stories from people who have been visiting from abroad gives credence to the account.

The news is filled with stories about the challenges FMGs face, and the news is also filled with stories that question the abilities of FMGs. Much of this has to do with politics, but there is another story that is starting to emerge, and that is the story of how important FMGs are to an overburdened healthcare system. Not only do FMGs fill the gap in healthcare accessibility by creating more providers in the U.S. healthcare system, but FMGs gain a valuable education about state-of-the-art medical practice that they may not be able to receive in the U.S.

Journeys in Medicine highlights the positive aspects of visiting physicians from those physicians’ perspectives, and it is a must-read for FMGs who need a little connection and pick-me-up during residency matching and training.

American International Integrated Observership Programs

It is a difficult road for any international medical graduate (IMG) trying to practice medicine in a country different from the one where they graduated from medical school. Each country’s requirements for medical school are different, and pre-requisites for those medical schools vary greatly. As a result, other countries do not know what they are getting when they take on a foreign medical graduate. Although their education may be superior, there is no way of telling whether it was superior or greatly inferior.

Whether inferior or superior, education abroad combines many strengths and challenges. Being multi-lingual and multi-cultural is a definite advantage when it comes to bedside manner and diversity in care. However, language barriers, standards of care, and the overall practice of medicine may differ greatly from one country to another. There are also different exposure rates to the treatment of various regional illnesses. For example, experience in the care of dengue fever patients varies across different countries. While one country may have a large incidence of the illness, another country may have little to none. It is difficult to determine what medical graduates have had adequate training in all illnesses.

There are no “apples-to-apples” comparisons of international medical school programs, but this does not mean foreign medical graduates are inferior. Instead, it means that they have to prove their academic and clinical know-how in an effort to provide a comparison to those who need it.  The EFMG does a good job of serving as a Dean’s Office for foreign medical graduates, but residency applicants still need to have experience in the United States in order to confirm that their clinical skills and training fit the practice of medicine in this country.

The American Medical Association (AMA) registers American International Integrated Observership Programs (MedicalObs) to help foreign medical graduates become accustomed to medical practice in the United States. These observerships last for one to three months, and they allow FMGs to get a taste of American medicine and do a little networking along the way.

Program Elements

Observation: The first thing the program does for FMGs is gives them the opportunity to observe doctors in a hospital setting. This gives FMGs a greater understanding about the workflows of American hospitals, the types of patients they may encounter, and the relationships between physicians and other staff. Nurses are critical to the care of patients, and the doctor-nurse relationship is a huge facilitator of care. FMGs must understand this in order to perform successfully during residency training.

Evaluation: FMGs who are enrolled in observerships will also get reviews from the program director. This is critical feedback by professionals in the medical field, and it can be instrumental in helping guide an FMG into a successful residency Match.

Letter of Recommendation: The evaluating director will also provide a letter of recommendation. Letters from American medical leaders are critical for residency applications, as they prove that you have worked successfully in American healthcare settings.

Certification: The certification from an observership is a great credential because it shows that you are focused on integrating your culture with the American culture of healthcare rather than letting it be a barrier.

Mock Interviews: The interview process can be very intense for FMGs who have all the same struggles of American residency applicants and the added difficulty of language and cultural differences. Mock interviews are the best way to hone answers to interview questions, and they help to build confidence.

Review of Application: Acting alone in the residency application process is a mistake for FMGs, and personal statements made with the review from a qualified and experienced healthcare professional can ensure that personal statements contain the elements needed for program directors to see the candidate as a success.

Speech: For FMGs with strong accents, it can be difficult to practice medicine. Not only will staff and patients have difficulty understanding thick accents, but some patients may not be able to trust a physician whom they cannot understand. Accent reduction courses are available through observerships to combat this problem.

There are many other benefits to American International Integrated Observership Programs. Membership to the alumni network can be a good tool to help find connections with other physicians. Local community groups and events where FMGs participate in events helps to integrate future residents with community members.

In many cases, the challenges FMGs have in finding a good residency Match are unfair, as there are many good and in some cases better medical schools outside of the United States than within. However, residency program directors have no way of knowing what an FMG’s specific circumstance was, and they must be presented with evidence not only that training was sufficient but also that the applicant is ready to transition into the culture of the American healthcare industry. Observerships make it easier for residency program directors to see the quality of FMG applicants.

Difficult Residency Interview Questions

The purpose of residency interviews during the Match is to pair a medical graduate with an environment that will enhance learning and develop the skills of the physician. However, interviewers are not equipped with the time to get to know every medical student, so they must use challenging interview questions to really get to know what type of candidate a medical graduate is. For the foreign medical graduate, difficult interview questions can be particularly challenging.

The Easy Questions

Don’t worry. There will be easy questions, and medical graduates will have plenty of general questions in which they can rehearse answers. Typical “easy” questions are:

  • Why do you want to be a physician?
  • Why are you interested in this residency?
  • What are your strengths when it comes to practicing medicine?
  • What is your biggest weakness when it comes to practicing medicine?
  • What are your goals for the future?
  • Why did you choose your specialty?
  • Describe your medical school training.
  • Who has been your greatest mentor?
  • What will you do if you are not selected for this program?

These questions are easy because they can be predicted and rehearsed. Especially for foreign medical graduates who may struggle with cultural or language barriers, the easy questions are a stress reducer because they can be practiced.

These questions are also very important because they confirm your education experience and the quality of education received abroad. They also give the candidate a chance to insert some personal details that will allow him or her to stand out amongst other candidates.

Although rehearsing the easy questions is advisable, answers should not be memorized. This can make replies come out robotically and make answers seem disingenuous. When practicing the easy interview questions, it is better to use bullet points to rehearse rather than full replies in complete sentences. This will give the candidate a chance to practice delivering natural and semi-spontaneous responses. The interviewer is not seeking a prepared speech but rather a natural conversation.

The Difficult Questions

While the content and delivery of the easy questions is important to assessing your ability to communicate your skills, difficult questions are designed to see how a residency candidate handles stress. They may be bizarre questions that have nothing to do with the residency program, and how you react to them tells interviewers a lot about your ability to handle stress.

For the foreign medical graduate, the difficult questions can be extra stressful because the interviewee must understand first that it is an intentionally difficult question. This can be difficult if the contextual elements of the question are misunderstood. This may force the interviewer to ask the question in a different manner to try to get the FMG to understand the question, and if this does not work, the interview may take an awkward negative turn. Examples of difficult questions are:

  • What is your favorite color and why?
  • Have you heard any negative comments about our residency program?
  • If you were stranded on a desert island and could bring one item from home, what would it be?
  • Tell me a joke.

It is obvious that these questions have nothing to do with your skills or qualifications, but they can show a lot about what a person is able to handle.

Preparing for the Difficult Questions

It is impossible to predict what the difficult questions will be, but your response to them should be candid. Some questions are meant to evoke hard emotional responses, and how you handle your emotions matters. Remain calm, and answer the questions with as many facts as possible. Leave any feelings or emotions out of your replies whenever possible. This is a test of emotional fortitude, which is a requirement in medicine, and the only way your interviewers can judge your strength is by throwing out some unexpected lines of questioning.

When you are practicing with mock interviews, throw in some crazy lines of questioning, and practice responding in an intelligent and calm manner. If it is a funny question, don’t be afraid to give a clever or witty response. The difficult questions are a chance to show personality and uniqueness. Everyone has practiced, canned responses for the easy questions, and the difficult questions are an extra way to stand out.

Lastly, start thinking about the difficult questions as an advantage. They are really an opportunity more than an obstacle, as long as the candidate is prepared. They are an opportunity because they give the interviewee a stab at capturing the interviewers’ attention and showing how the candidate can think on his or her feet. If a candidate feels like this is where their weaknesses are, then they should practice more because the difficult questions are going to happen.

The Match is a lengthy process, and after all the exams, certifications, and residency hurdles, there is still one part of the residency application process that must be conquered to be matched, and that is the interview. Like everything else, it requires preparation, and practicing the easy and the hard questions will give the foreign medical graduate a big advantage in the interview.

The difficult questions during an interview are not necessarily graded by the quality of your answer but rather how you react to being asked such a question and then if you are able to shift your thoughts in order to answer thoughtfully. The interviewers are not expecting your answer to be as amazing as they expect from the easy questions, but they want to see that you are not easily thrown off by a little uneasiness in a situation.

ECFMG: The Starting Point for Residency Applications

In order for a foreign medical graduate (FMG) to apply for residency, they must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). This certification assures residency programs that a candidate is qualified to enter a program based on United States medical education requirements. This is an essential part of the residency application process, and it is important because medical education requirements vary around the world.

The quality and relevance of medical education around the world has been called into question by U.S. residency programs, as program directors are unable to compare standardized U.S. medical school education with that of education in other countries. While medical knowledge is easy to determine based on standardized testing, clinical experience is not as easy to compare. That is why FMGs must attend a U.S. residency program, but programs want assurance that their educational background is sufficient to begin practicing medicine.

U.S. medical graduates are labelled ready for residency by their Dean’s Office, but those offices are not available for international students. As a result, the ECFMG has aimed to create a Dean’s –like office that standardizes the process for FMGs through certification.

In order to get certified by the ECFMG, an applicant must apply through an interactive web application (IWA). This application allows the ECFMG to confirm an applicant’s identity, contact information, and education background. This act alone is indicative of how difficult it is to confirm FMGs’ education, as the simple identification process is extensive. Simply providing current identification is not enough.

The medical school attended by the FMG must be listed in the World Directory as meeting requirements for the ECFMG examination, which is the United States Medical Licensing Examination (USMLE). Applicants who do not have a resident status in the United States must also apply for a Visa. This is only part of the process leading up to the Match, but each step must be taken in order to meet the requirements for a residency application.

USMLE

The USMLE is separated into parts, and applicants must pass Step 1 and Step 2 of the USMLE in order to be certified. The third step can be passed during residency.  Parts 1 and 2 of the exam test medical science knowledge and clinical skills. 2006 statistics show that US medical graduates scored higher on these tests than international medical graduates, but non-US international medical students scored higher than US international medical graduates except in clinical skills. Preparation is key to passing these tests, and English proficiency has been blamed for poor performance among FMGs. These tests are administered throughout the year, but you must be certified by the ECFMG before the start of your residency program.

Visa

FMGs are typically not residents of the US, but they may have established some form of legal resident status prior to applying to be certified by the ECFMG. If not, the ECFMG is able to sponsor applicants for a J-1 Visa.

ECFMG services

While the ECFMG is responsible for certifying that candidates are qualified for American residency programs, they also provide many services to FMGs. For example, they will help an FMG apply for residency programs through the Electronic Residency Application Service. They will also help applicants create verified career portfolios. They are basically the go-to organization for FMGs who need to get ready for the Match.

The ECFMG was established in 1956, and its goal was to improve the U.S. education system by standardizing the evaluation process of FMGs. In other words, it recognized the need for diversity in the medical community and welcomed the opportunity to help FMGs advance their career in the U.S. healthcare system. It is important to remember that the differences in education received abroad versus in the U.S. are not labelled as inadequate. Instead, it is simply different, and it cannot be accurately compared without some sort of a mediating process. The ECFMG provides that mediation.

That is not to say that there is not extensive preparation involved in getting certified by the ECFMG. Applicants are advised to pay attention to the timeline of deadlines and opportunities for FMGs to get certified and further their journey on the path to the Match. It is a complicated process that can quickly fail if an FMG does not complete certain tasks at certain times. Test scores are also important, and study plans should be set up and carried out months prior to the testing.

Navigating the pathway to the Match can be very confusing, and although the ECMG helps applicants get to the Match through certification, it can be helpful to employ other agencies to navigate the system and make sure steps are taken at the right time. The key to success is preparation and the utilization of resources such as FMGPortal. Obtaining a U.S. residency is an attainable goal as long as an FMG is motivated and obtains the help needed to get from the beginning of the process with the ECFMG to the end of the process with the Match.

Coping Strategies for Foreign Medical Students

Some may argue that the journey to residency for Foreign Medical Students is equally challenging to that of American medical students, but this opinion lacks acknowledgement of the challenges Foreign Medical Students face when transitioning to a residency along with a new country.

While certain struggles, such as communication and culture are similar throughout time, foreign medical students also face hurdles such as constant political change. For instance, executive orders introducing travel bans can complicate visa processes. Many hurdles are well-beyond the control of the student, which is why it is important to develop coping strategies to maintain focus while navigating a medical system that can hold biases against foreign students.

Potential Struggles for FMGs

  1. 1. Communication: The most obvious struggle for Foreign Medical Graduates is communication barriers. While FMGs are required to pass a language proficiency test such as the TOEFL (Test of English as a Foreign Language) in order to obtain ECFMG Certification, passing this test does not eliminate all language struggles. In fact, an acceptable score on the TOEFL means a student is fluent and capable of conversation professionally in their profession, but they still may struggle with the language nuances developed among native speakers. This can be frustrating for students, professionals and patients. If the student is not careful to clarify any misunderstandings, this can lead to medical errors and unacceptable mistakes. As a result, communication can be a big struggle for FMGs.
  2. 2. Culture: A foreign country may have very different cultural norms than the cultural norms of America, which is not bad but can present challenges during interviews and professional processes. For instance, one country may find assertiveness to be a rude attribute, while it may be considered a strength in an American interview. Handshakes may be perceived differently in other areas of the world. The details of these differences are not as important as the fact that they cause added stress for FMGs in uncertainty and newness.
  3. 3. Team Work: Team work is essential in the healthcare field, and it can be difficult to insert oneself into a team when presented with communication and cultural differences. Additionally, once in a team setting, it is easy to fade into the background and not be a quality participant in the team. Not only must Foreign Medical Students have the courage to join teams, but they must conquer their fears of making communication and cultural mistakes in order to become a valued team member.
  4. 4. Logistics: On top of communication and culture, which can greatly impact one’s ability to engage in team work, FMGs must ensure that they are handling all the details of their transition to another country. As mentioned previously, things like visas can become complicated by political agendas. In addition, it can be difficult to develop a strategy for applying to residencies because it often involves a careful balance of applying to residencies that are known to accept FMGs without neglecting the residencies a FMG is truly passionate about. Organization, strategy, and perseverance is integral during this time, but it adds stress that the traditional medical student from America does not face.

Coping Strategies

There are many other struggles FMGs face, and many of them are unique to the student and their home country, but inherent in all of these struggles is increased stress that can negatively impact the outcomes of residency placement. That is why FMGs must develop coping strategies to handle stress and keep their minds focused on the goal.

  1. 1. Personal Resources: One of the most important strengths that a FMG can develop is personal resources. These are skills and actions that one takes in order to avoid fatigue and burnout, which can create an abrupt end to residency pursuits. For example, a FMG may practice breathing techniques, yoga or meditation in order to center himself or herself on his goals. FMGs may need to take personal time to reconnect with their own lives, which may seem displaced in a different country. Music can be a valuable reminder of home. There are endless possibilities when it comes to personal resources, and it is important that FMGs identify these resources prior to the time when they are needed. In this way, they will be emotionally prepared for stressful transitions.
  2. 2. Social Support: Alternatively, social support can be as essential as personal resources. It is very easy to hide from social interactions when faced with communication and cultural differences, but this actually increases stress for the inevitable social interactions that will need to take place for successful residency placement. Orientation and acculturation programs are available to assist FMGs in mixing American culture with that of their own, so they can achieve residency placement success without discarding their own traditions completely.

It is essential to FMGs that they remember their own cultural identities while blending that with American culture in order to provide effective care that is in line with American Medical School standards. It is a stressful challenge to maintain both the past identity of a home country while integrating that with American culture. This is why FMGs must focus on coping strategies, which will become easy to implement when needed if they are developed in preparation to stressors instead of on an as-needed basis.