Certify Your Perfect Rank Order List by Feb. 26

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

What is a Rank Order List?

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

Tips on Ranking

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

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

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

Certification of Your ROL by Feb. 26

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

What if You Didn’t Match?

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

Overall Message in Regard to Rank Order Lists

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

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

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.

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.
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.
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.
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.
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.

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.

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!

Residency Specialty Spotlight: Oncology

Cancer is one of the greatest medical challenges of our time. According to the World Health Organization (WHO), it is the second-leading cause of death worldwide, accounting for about 1 in 6 of all deaths–a total of over 8.8 million people in 2015. It’s also been the subject of considerable biomedical research in recent decades, leading to significant advances in treatment and prevention options, so if you’re a foreign medical graduate, now is one of the most exciting times to train for a career in oncology in the United States. Not only will you be making a positive difference in the lives of patients struggling with the disease, but you will also have the chance to learn about the most cutting-edge techniques, technologies, and therapies used for treating the disease. Read on to learn more about the road to a career in oncology and what you need to do to pursue this specialty area of medicine.

Oncology Residency and Fellowship Training Options for Foreign Medical Graduates

As an aspiring oncology specialist looking for residency and fellowship training in the United States, there are two training paths for you to choose from. Both offer excellent training for foreign medical graduates, so you can’t go wrong either way!

Option 1: Internal Medicine Residency (3 years) + Oncology Fellowship (2-3 years)

The traditional route to becoming an oncology specialist is to start by completing a three-year US medical residency program in internal medicine before completing a three-year fellowship in Hematology and Oncology or (less commonly) a two-year fellowship program in Oncology. For foreign medical graduates, this can be a great option, especially since the latest data from the National Resident Matching Program (NRMP) indicates that internal medicine is the most common residency specialty area for foreign medical graduates, accounting for about 43.9 percent of all successful matches in 2015. Spending three years studying internal medicine can also be helpful if you’re not yet sure which area of oncology you want to focus on for your career, because an internal medicine residency will give you in-depth insight into all of the different body systems that may be affected by cancer.

Although the most common fellowship option for aspiring oncology specialists in the United States is Hematology and Oncology, many institutions have also been adding more specialized programs, including some that last only a single year and are designed for physicians who have already completed both an internal medicine residency and a general oncology fellowship. Here are a few of the more specialized topics that you might pursue in a fellowship:

Breast Surgical Oncology
Cancer Anesthesia
Cancer Rehabilitation
Gynecologic Oncology
Head and Neck Surgical Oncology
Leukemia
Lymphoma / Myeloma
Musculoskeletal Oncology
Neuro-Oncology
Oncologic Emergency Medicine
Onco-Nephrology
Urologic Oncology

Option 2: Partial Internal Medicine Residency (1 year) + Full Radiation Oncology Fellowship (4 years)

An increasingly popular option, which has become available more recently, is to spend your first year in a medical residency in a generalist subject–such as internal medicine, surgery, or a related field–before advancing to a four-year residency program in radiation oncology. One of the advantages of this option is that the total training time is only five years, and you can start practicing as an oncology specialist as soon as you finish, without completing a fellowship program beforehand. However, it is important to note that you’ll have to go through the NRMP residency matching process again after the first year of your residency, which can be challenging and time-consuming, especially considering the obligations you’ll have as a first-year resident in your generalist program.

What to Expect from Oncology Residency and Fellowship Programs

Although oncology residency and fellowship programs differ in their scheduling and organization, there are certain things you generally expect from the training. After having gained a foundation of knowledge in your full or partial internal medicine residency program, you’ll have the chance to focus more specifically on oncology care, including cancer mechanisms, diagnostic imaging, treatment planning, side effect management, recurrence prevention, and even healthcare policy, among other topics. In some programs, you may have the opportunity (or be required) to conduct either basic, translational, or clinical research. With most programs, by the time you finish, you’ll be ready to achieve subspecialty certification in Medical Oncology and/or Hematology through the American Board of Internal Medicine (ABIM).

Pre-Residency Planning for a Career in Oncology

Oncology residency and fellowship programs can be highly competitive, so as a foreign medical graduate, you need to be able to show residency programs that you are a strong candidate. One way to strengthen your candidacy is to complete a graduate externship in oncology before you try to get matched. Completing a program like this can help you show an application reviewer that you are truly committed to the specialty area, and it can give you something to talk about during your residency interviews. It will also allow you to make connections with attending physicians in the United States, who may be able to write letters of recommendation to support your application.

FMG Portal offers graduate externships for foreign medical graduates in a wide range of specialty areas, including oncology. Contact us today to learn more about our programs!

What If I Didn’t Match? Do’s and Don’ts for Foreign Medical Graduates

Match Week 2018 is officially over! This week, thousands of medical students found out that they had been matched to the program of their dreams, including many foreign medical graduates. If you were lucky, you found out on Monday of Match Week that you had matched to one of the programs on your Rank Order List (ROL) — in which case, congratulations! If not, you may also have participated in SOAP over the course of the week, which is another way in which you may have found a position in a US medical residency program.

However, spots are limited, and even strong candidates don’t always end up getting matched. If that is the case for you, keep in mind that about one in four US medical residency candidates aren’t matched each year, including well-qualified foreign medical graduates. By playing your cards right, you may still find yourself in a US medical residency program in the future — whether it’s in 2018, 2019, or beyond. Here are a few do’s and don’ts that you can follow if you didn’t get matched this week, but you still hope to launch your career in a US medical residency program.

What You DON’T Want to Do If You Didn’t Get Matched

When you find yourself unmatched at the end of Match Week, it is important to avoid pitfalls that have the potential to derail your dreams of a medical residency for good. Here are a few DON’Ts that you can follow in order to stay on the path to success:

DON’T give up on a 2018 medical residency just yet.

After SOAP ended on Thursday of Match Week at 12:00 pm, all unmatched candidates were granted access to the post-SOAP list of unfilled programs. Now is a great time to take a look at all of the programs on the list and start contacting programs about a possible offer.

DON’T fall out of touch with your medical school.

After not getting matched to a medical residency program, some applicants are embarrassed and don’t want to face the dean or their instructors. It’s especially easy to fall out of touch with your medical school if you have just graduated and you were hoping to enter directly into a US medical residency program. However, if you stay in contact with your medical school, they may be able to help you find research opportunities, support your search for externships, and attest to your commitment to a US medical residency program when you submit your application the next time around.

DON’T assume that you need to apply in 2019.

Another common misconception among residency candidates who didn’t get matched is that the next logical step is to start polishing your application for 2019. However, you may want to consider taking a year off to strengthen your application for the 2020 NRMP Match. For example, within that year, you may be able to get a 3-month (or even longer) clinical externship in the United States, which can help you make more connections and develop a stronger application for the 2020 application cycle.

Important DO’s for Foreign Medical Graduates Who Didn’t Get Matched

As you move forward from an unsuccessful Match Week, making sure you don’t make mistakes is important — but what you DO over the next few days and months can make an even greater difference for your future attempts to get matched. Here are several DO’s that can help maximize the odds that you will eventually end up in a US medical residency program.

DO learn from your first application and interview experience.

Your initial inclination might be to try to forget about the 2018 Match, but you reflecting on your experience may also provide you with key insight into how you might succeed in the future. If you didn’t get any interviews, you may want to look for ways to improve your personal statement, strengthen your CV, and/or get better letters of recommendation. If you did interview, you may want to think about what you can do to improve your interview outcomes next time.

DO take the USMLE Step 3 Exam before you apply again.

As we discussed in an earlier post, foreign medical graduates have the option of whether or not to take the USMLE Step 3 Exam before applying for a US medical residency program. Experts say that taking (and passing!) the USMLE can significantly improve your competitiveness if you are applying for a second time. This shows programs that you are truly committed to success within a US medical residency program.

DO explore your options for future programs.

As you look ahead to your US medical residency program prospects in the future, you may want to broaden you options when it comes to specialty area and location. If you are more flexible about your choices, you may be more likely to get an offer from a less-competitive program in the future. If you are thinking about applying for programs in a different specialty area or learning more about programs in a different area of the United States, completing an externship program is a great way to explore your options.
For more information about improving your chances of getting matched in the future, contact FMG Portal today!

Participating in the SOAP Process: A Guide for Foreign Medical Graduates

The Supplemental Offer and Acceptance Program (SOAP) occurs during Match Week. As a foreign medical graduate looking to enter a US medical residency program, there are two ways in which you might end up participating in SOAP: if you don’t receive any interview offers, or if you find out on the Monday of Match Week that you weren’t matched by the algorithm after submitting your ROL. Read on for more information about each of these situations, and find out what you can expect from the SOAP process in 2018.

Next Steps if You Were Not Offered Interviews

After working hard on your application, it can be disappointing to find out that you were not offered any interviews. However, that does not mean that you won’t be starting a US medical residency program in July. You are still eligible to participate in the SOAP process during Match Week, so there is a still a good chance that you can find a spot in an unfilled program.

If you did not receive any interview offers, the only thing you need to do during the fall and winter is to register for the Main Residency Match. For the 2018 Match, the regular deadline passed on November 30, 2017, but the late registration deadline is February 21, 2018. If you haven’t yet registered, you will need to pay a late fee of 50 dollars, but you can still participate in the 2018 Match. Although the late registration deadline is the same as the deadline for creating a Rank Order List (ROL), it is important to note that you do not need to worry about creating one if you were not offered any interviews, because the algorithm will not match you to a program anyway. All you have to do is get registered and wait for Match Week to arrive!

Participating in SOAP During Match Week

If you did not get any interview offers for the fall or winter, you will know before Match Week that you will be participating in SOAP. However, you might also find out at 11:00 am Eastern Time Monday of Match Week (March, 12, 2018), when the NRMP releases the Main Residency Match results. SOAP begins when the results are released and candidates find out whether or not they got matched. If you find out that you did not get matched, SOAP is your best option.

At 12:00 pm Eastern Time on the Monday of Match Week, you can start preparing your SOAP application in the AAMC ERAS system. It is important to be prepared, because programs can start reviewing your application at 3:00 pm, and they can start contacting you as soon as they receive your application. Communicating directly with a program on the first or second day of the SOAP process can significantly boost your chances of getting matched to an unfilled program, since programs start preparing their SOAP preferences lists at 11:30 am the next morning (Tuesday, March 13). The deadline for programs to certify their preference lists for Round 1 is 11:55 am on Wednesday, March 14.

Five minutes later, at 12:00 pm Eastern Time on Wednesday of Match Week, SOAP participants receive the Round 1 offers. At that point, you have two hours to accept or reject your Round 1 offers, and at 2:05 pm, SOAP Round 2 begins. This time, programs have only 50 minutes to alter and re-certify their preference lists, and you will receive your Round 2 offers at 3:00 pm. Again, you have only two hours to accept the offers, reject, or wait for Round 3 offers.

Programs have all of Wednesday night to alter and re-ceritfy their preference lists, which means that SOAP applicants get their Round 3 offers at 9:00 am on Thursday, March 15, 2018. SOAP ends two hours later (11:00 am Eastern Time), which is the deadline to accept or reject the Round 3 offers. After Round 3, SOAP officially ends.

After Soap: The Post-Soap List of Unfilled Programs

Once SOAP ends, candidates have the opportunity to access the post-SOAP list of unfilled programs. At 12:00 pm Eastern Time on Thursday of Match Week, candidates who have not yet accepted an offer can access the list of unfilled programs, including programs that decided not to participate in SOAP. If you have not yet been matched, you can take a look at the programs on the list and immediately start contacting any program about a possible offer.

Preparing to Participate in SOAP

Clearly, participating in SOAP (or post-SOAP matching opportunities) is a highly a complex process with a tight schedule. In order to be successful, you have to be prepared — regardless of whether or not you were interviewed, since you might find out on Monday of Match Week that you were not matched. Going into Match week, you should have a strong familiarity with the schedule discussed above, and you should be ready to provide programs with an updated CV and other information that shows them exactly why you are an excellent candidate for a US medical residency program.

If you’re a foreign medical graduate looking for success in the matching process, FMG is here to help. From the moment you start considering a US medical residency program to the day you get matched, you can count on our resources to help you through. Contact us today for more information!

Creating Rank Order Lists for the 2018 Residency Match: What Foreign Medical Graduates Need to Know

In an earlier post, we discussed the timeline for the 2018 Residency Match. Even though you have made it through some of the toughest parts of the process — preparing your personal statement and CV, submitting letters of recommendation, and surviving the interviews — there is still work left to do. When the Rank Order List Entry opens (January 15, 2018 — mark your calendar!), you have a little more than a month to create your list and get it certified electronically in then NRMP Registration, Ranking, and Results (R3) System. In order to participate in the 2018 Match, your rank order list must be complete and certified by 9:00 pm Eastern Standard Time on February 21, 2018. Read on to find out what foreign medical graduates need to know about creating and certifying an Rank Order List (ROL).

The Basics of the Rank Order List (ROL)

The Rank Order List (ROL) is the place where you, as an aspiring medical residents, have the chance to provide the NRMP with a list of programs in which you are interested, ranked in order of preference. After residency interviews are complete, candidates and program directors both create ROLs, and the information on the ROLs is used to determine the outcome of the Match.

There are two types of ROLs: primary ROLs and supplementary ROLs. On the primary ROL, you can list categorical, preliminary and/or advanced programs. If you rank an advanced (PGY-2 level) program on your primary ROL, you can also submit supplemental ROLS of preliminary programs that are linked to that advanced program.

Considerations When Creating Your Primary ROL

The NRMP allows candidates to list 20 different programs on the primary ROL and 20 different programs on each supplemental ROL. After that, you have to pay a fee. However, it is important to note that most foreign medical graduates interview with far fewer schools, so you probably do not have to worry about exceeding the limit.

That being said, foreign medical graduates who have ranked a larger number of programs within their preferred specialty have a higher likelihood of getting matched. According to data from the 2016 residency match, the average number of contiguous ranks for matched candidates was 6.3, as compared to 2.5 for those who were not matched.

When creating your primary ROL, you should also consider the competitiveness of the programs to which you are applying. The NRMP recommends that foreign medical graduates apply to a range of programs that vary in their levels of competitiveness.

Another opportunity you may want to consider is ranking programs as a couple with another applicant. If your partner or close friend is also applying to residency programs in the United States, you can link your ROL with that person in order to increase the odds that you will be matched to programs that are in the same geographic area. Whether your partner is another foreign medical graduate or a graduate of a US medical school, ranking programs as a couple can be a great way to ensure that your Match outcome fits with both your career goals and your personal priorities.

Beyond the Primary ROL: Creating a Supplemental ROL

If you included an advanced (PGY-2 level) program on your primary ROL, you need to include a supplemental ROL with a list of preliminary (PGY-1 level) programs. Getting matched in this way would mean simultaneously securing both a preliminary and an advanced position at the same time. This can relieve stress for foreign medical graduates because it guarantees that you will have the opportunity to complete a “full course of training.”

In most cases, the preliminary programs on your supplemental ROL are tied to the geographical location of the advanced program, so your supplemental ROL may look significantly different from your primary ROL. However, you should note that the matching algorithm will only consider your supplemental ROL if you get matched to the advanced program on your primary ROL. If not, the information on your supplemental ROL will not be considered in the matching process.

Finalizing Your ROL(s): The Certification Step

Once you have finished an ROL (either a primary ROL or a supplemental ROL), it must be certified. That means you have to click the “Certify List” button in the R3 system, at which point you will be prompted to enter your username and password. This confirmation should not be taken lightly — when you certify an ROL, you make a binding commitment to enter any program at which you match.

Nevertheless, it is still possible to change an ROL after it has been certified — as long as the February 21 deadline has not yet passed. When you have made a change, you must re-certify the new ROL so that it can be properly processed by the Match algorithm.

Getting matched to a US medical residency program is a long and challenging process, but FMG Portal is here for you every step of the way. Contact us today to learn more about everything we offer!

Important Dates for the 2018 Residency Match

For foreign medical graduates who are looking to be matched to a US medical residency program in 2018, the winter months of waiting for Match Day can feel just as hard as the application process — but you need to remember that there are still a few key deadlines you need to meet. If you are participating in the National Residency Matching Program (NRMP) Main Residency Match in 2018, there are several important dates that you should keep in mind as you look ahead to the new year.

January 15, 2018 — Rank Order List Entry Opens

In less than a month from now, the rank order list entry opens at 12:00 pm Eastern Standard Time. Even though there is another month after that before the rank order list entry closes, it is important to start thinking about your rank order list in advance. That way, you will be able to dedicate enough time to the development of a strong rank order list, and you won’t end up feeling rushed as the deadline approaches.

When you participate in the Main Residency Match, you will submit a primary rank order list that may include a combination of categorical, preliminary, and advanced programs. Depending on your interests and career goals, you may also decide to submit a supplemental rank order list of preliminary programs that are linked to more advanced programs, which would enable you to lock down a PGY-1 and a PGY-2 position at the same time. It is important to take the time to explore these options before and during the period in which the rank order list entry is open.

As we discussed in an earlier post, the number of programs on your rank order list may also matter if you are a foreign medical graduate. According to data collected by the NRMP after the 2015 Main Residency Match, foreign medical graduates who ranked a larger number of programs within their preferred specialty area were more likely to be matched within that specialty area. Specifically, the average number of contiguous ranks for those who were matched was 6.3, as compared to only 2.5 for those who were not matched.

The NRMP also advises foreign medical graduates to include a combination of more-competitive and less-competitive programs on their rank order lists. Right now is a great time for you to start exploring the options and considering the competitiveness of your programs of interest, while also accounting for personal considerations, like institution locations. That way, by the time January 15 rolls around and the rank order list entry opens, you will already have a solid list of programs in hand.

February 21, 2018 – Three Major Deadlines

Five weeks after the rank order list entry opens on January 15, you need to have your list finalized. At 9:00 pm Eastern Standard Time on February 21, 2018, all rank order lists must be certified. Make sure yours is in by the deadline!

That same date — February 21, 2018 — is also the late registration for the 2018 Main Residency Match. The regular registration deadline was November 30, 2017, but if you missed it, you still have the opportunity to participate. Unfortunately, you have to a late fee of 50 dollars alongside the regular registration fee, but that is a relatively small price to pay if you are truly committed to pursuing a US medical residency in 2018.

This deadline also applies to Match withdrawals. If you elected to participate in the 2018 Main Residency Match but want to withdraw your application for any reason, you have to do so by February 21, 2018. Withdrawing your application from the Main Residency Match is a serious decision, considering all of the hard work you have already put into the residency application process, so you need to make sure you give yourself enough time to fully consider your options before the withdrawal deadline arrives.

Match Week: March 12 – March 16, 2018

Match Week starts on Monday, March 12, with the start of the Supplemental Offer and Acceptance (SOAP) program. At 11:00 am Eastern Daylight Time, you will find out whether you got matched. If not, you can participate in the SOAP until it concludes on Thursday, March 15.

Friday, March 16, 2018, is the day you’ve been looking ahead to for months — Match Day! At 1:00 pm Eastern Daylight time, Match results are sent to applicants by email and posted in the R3 system. On that day, you will find out if you made it into the program of your dreams and are on your way to a US medical residency program in July 2018.
If you’re a foreign medical graduate looking to make that dream a reality, FMG Portal is here to help you at every step of the process. Contact us today for more information about what we offer!

More Lessons from the 2016 Residency Match Data: Are Outside Experiences Important?

Last week on the blog, we discussed the NRMP report on the outcomes of foreign medical graduates in the 2016 Main Residency Match. To create this report, the NRMP tracked the rates of match success for foreign medical graduates based on a number of key measures, such as program ranking choices and test scores. As we mentioned in last week’s post, there are clear lessons that you can learn from the data on ranking choices and test scores as a foreign medical graduate preparing for a U.S. medical residency.

However, when it comes to the report’s information on foreign medical graduates’ outside experiences, the implications of the raw data are less clear. Read on for more about how you can understand the numbers and apply the information to maximize your chances of match success as a foreign medical graduate.

Statistics on the Outside Experience of Matched and Unmatched Foreign Medical Graduates

As a foreign medical graduate, you might find yourself asking the question of whether or not it is important for you to get outside research and/or work experience before you apply for a U.S. medical residency program. At the outset, the data in the NRMP report doesn’t seem to provide much help in answering that question. For all the different types of outside experiences that the NRMP measured, the average numbers for matched and unmatched foreign medical graduates was almost exactly the same. Consider the following statistics:

For foreign medical graduates who were matched in 2016, the mean number of research experiences was 2.2. For those who were unmatched, the mean number of research experiences was also 2.2.
For unmatched foreign medical graduates, the mean number of abstracts, presentations, and publications was 6.4 — slightly higher than the same statistic for matched candidates, which was 6.1.
The mean number of work experiences was 5.3 for matched foreign medical graduates and 5.5 for unmatched candidates.
For foreign medical graduates who were matched, the mean number of volunteer experiences was 3.5, as compared to 3.4 for candidates who were unmatched.

When you look deeper into the data and examine these same statistics broken down by specialty area, the numbers only get more confusing. For some specialty areas, the mean number of experiences reflects the overall average — about the same for matched and unmatched candidates. There are only a few where the average number for matched candidates significantly outweigh those for unmatched candidates. There are even some specialty areas where the average number of experiences is considerably higher for unmatched applicants.

What the Statistics Mean for You as a Future US Medical Residency Applicant

Considering these statistics can be daunting for foreign medical graduates. Based on the data, it just isn’t clear whether having more outside experiences — or any at all — can truly help you in the matching process.

One of the reasons why it is so hard to draw conclusions from the data is that averages are prone to skewing. Consider the data for abstracts, presentations, and publications. While the average for both matched and unmatched candidates was around 6, nearly 40 percent of the of the applicant pool of foreign medical graduates in 2016 had no publications at all. This indicates that certain applicants are skewing the data, so if you have less than 6 publications, it doesn’t mean you fall short of the “average” applicant.

Ultimately, the main takeaway from the NRMP data about outside experiences is that the number of outside experiences you have does not really matter. What matters is the quality of the outside experiences — and your ability to illustrate that quality on your application. An outside experience can be worthwhile if you can weave it into your personal statement — writing about how it has prepared you for your residency and how it has influenced your career goals — or if you can get a letter of recommendation from a supervisor or mentor who can speak to your excellent performance during the outside experience. Otherwise, if the outside experience is just a line item on your CV, it probably won’t make much of a difference for whether or not you end up getting matched.

Thus, one of the best options for an outside experience is a clinical externship in the United States. Completing a clinical externship in the United States is ideal because it shows residency programs that, as a foreign medical graduate, you are already comfortable working in a clinical setting in the United States. After completing a clinical externship, you may also be able to get a letter of recommendation from an attending physician in the United States, which is preferred (or even required) by many U.S. medical residency programs.

If you’re interested in completing a clinical externship before you apply for a U.S. medical residency program, FMG Portal offers 3-month and 6-month externship options in a wide range of specialty areas. Contact us today for more information!

Lessons for Foreign Medical Graduates from the 2016 Main Residency Match

During the 2016 residency matching process, the National Resident Matching Program (NRMP) monitored the outcomes for all graduates of foreign medical schools. Specifically, they kept track of match success, specialty preference, ranking information, and applicant characteristics. The data they collected provides valuable information for future applicants. If you are a foreign medical graduate looking to apply to a U.S. medical residency program in the future, there are several key lessons that you can take away from the NRMP report.

Program Ranking Choices: The More the Better

The NRMP report can be particularly helpful if you are a foreign medical graduate trying to figure out how to best to rank programs on your application. According to the NRMP, foreign medical graduates who were successful in matching to their preferred specialty were more likely to have ranked a larger number of programs within their preferred specialty. Specifically, the NRMP reports that, on average, foreign medical graduates who were matched had longer lists of contiguous ranks than those who were not — 6.3 continuous ranks for matched foreign medical graduates, as compared to only 2.5 for those who were not matched.

As a foreign medical graduate, you might be tempted to limit the number of programs you rank within your top-choice specialty area and add a greater number of programs in non-preferred specialty areas that you think will be easier to get into. While the NRMP does recommend applying to a mix of competitive and less-competitive programs, the data suggests that applying to more programs within your specialty area of interest could increase the odds that you will be matched at all. Instead of spending your time trying to locate the less-competitive programs, you should focus on polishing your application show that it demonstrates that you are truly passionate about the your top-choice specialty area.

At the same time, if you do plan to apply to a particularly competitive specialty, it can be helpful to identify an alternative specialty and rank your preferred programs within that specialty area, according to the NRMP. Based on the data, whether or not you choose to do this will probably not have a significant effect on your odds of getting matched. The mean number of distinct specialties ranked by foreign medical graduates who got matched in 2016 was 1.3, whereas the mean was 1.4 for those who were not matched — practically no difference at all. So you shouldn’t be worried that identifying an alternative specialty will reduce your odds of getting matched.

The Importance of Test Scores

Another key takeaway from the NRMP report is that there are two tests that can make a significant difference in determining whether or not you get matched: the USMLE Step 1 and the USMLE Step 2 CK. For both of these exams, the average score for foreign medical graduates who were matched was substantially higher than the average for those who were not matched. It is also important to note that, among the foreign medical graduates who were matched, those who matched to their preferred specialties had higher scores, on average, than those who matched to programs in non-preferred specialty areas.

On the USMLE Step 1, the mean score for foreign medical graduates was 233.8, with a standard deviation of 17.0. The NRMP notes that this is “well above” the minimum passing score in 2016, which was 192. Similarly, on the USMLE Step 2 CK, the mean score for foreign medical graduates was 238.8, with a standard deviation of 15.6. Again, this was considerably higher than the 2016 minimum passing score of 209.

Looking at this data, there are a few key lessons for foreign medical graduates. Most importantly, it makes sense to dedicate a lot of time and energy to studying for the USMLE Step 1 and USMLE Step 2 CK exams. However, if your scores aren’t as high as those reported above, don’t despair! The data are all based on averages, and there are lots of other places in your application where you can make up for a lower score and show that you are ready for success in a US medical residency program.

Also, even though the data shows that the USMLE Step 1 and Step 2 CK can significantly impact the matching process for foreign medical graduates, you should not forget the importance of the USMLE Step 2 CS. It may not play as large a role on your application, but it is still considered by application readers. Moreover, it is essential for ECFMG certification, so you need to make sure you are ready to pass when test day arrives. Similarly, if you make the choice to take the USMLE Step 3 before you begin your residency, you need to make sure that you are well-prepared so that your score reflects your knowledge and abilities in the field of medicine.

As 2017 comes to a close and the 2018 residency match draws near, FMG Portal is here to help! Contact us today to learn more about what we offer!

Medical Specialty Spotlight: Nephrology

Kidney disease is a growing problem around the world, but if you are looking to specialize in nephrology, one of the best countries to train in is the United States. According to the National Institutes of Health, about 14 percent of the American population has chronic kidney disease (CKD), as compared to only 10 percent of the world population as a whole. In total, about 661,000 American have kidney failure. About 468,000 of these patients are on kidney dialysis, and about 193,000 have a functioning kidney transplant. According to the American Journal of Kidney Diseases, the prevalence of CKD in the United States is expected to increase by 27 percent by 2030.

The two most common causes of CKD are high blood pressure and diabetes, with almost half of CKD patients reporting that they have been diagnosed with one or both of these conditions. That’s why CKD is so common in the United States — because of the high prevalence of cardiovascular disease and diabetes. However, its is important to note that changing lifestyles in developing countries are also raising the rates of these diseases worldwide, especially as the number of elderly individuals in countries like China and India grow. Therefore, in the future, there will probably be a high demand for nephrology specialists around the world.

If you are looking to become a nephrologist — that is, a physician specializing in the treatment of kidney disease — it just makes sense to complete your residency and fellowship in the United States, given the high rate of CKD in the country and the likelihood that it will rise in the future. Read on to learn more about the educational pathway to becoming a nephrologist.

Internal Medicine Residency: The First Step on the Path to Nephrology Career

Because nephrology is a specialization within the field of internal medicine, the first step to becoming nephrologist (after finishing medical school) is to complete an internal medicine residency program. These programs last for three years, and they are particularly popular among foreign medical graduates. Of all the foreign medical graduates who were matched to residency programs in the United States in 2015, 67.3 percent were matched to internal medicine programs, according to the National Residency Matching Program (NRMP).

In an internal medicine residency program, you can expect to gain a broad background education in the diagnosis, treatment, and management of disease and disorders that affect all of the internal body systems — including the renal and urinary systems. In addition to your clinical and didactic training, you may also have the opportunity to engage in research. If you are hoping to become a nephrologist, you may be able to conduct advanced research in nephrology, which can help you prepare for the specialization later on in your career.

Once you finish your internal medicine residency program, you will be prepared to take the American Board of Internal Medicine (ABIM) certification exam. After you pass the exam, you will be eligible to apply for a fellowship in nephrology in order to pursue your dream of becoming a specialist in the field.

Completing a Nephrology Fellowship Program

During a nephrology fellowship program, your studies will focus specifically on kidney-related diseases and disorders. As previously mentioned, CKD is the most common kidney disease in the United States and around the world, but as an aspiring nephrologist, you will also gain expertise in other kidney conditions, including:

Kidney stones
Polycystic kidney disease (PKD)
Acute renal failure
Glomerulonephritis
Pyelonephritis
Bartter syndrome
Dent disease
Nephronophthisis
Gitelman syndrome

Depending on your area of interest, a nephrology fellowship program can last anywhere from two to four years. If you choose to focus your fellowship on clinical training, it will typically last for two years. In addition to learning about the treatment of the conditions listed above, you may also have the chance to learn about cutting-edge clinical treatment options, such as home-suitable dialysis. You will also gain expertise in related areas of clinical care that you will likely encounter in your practice, such as geriatric care and palliative treatment.

Alternatively, you can choose to focus your fellowship on research — either clinical research, translational research, or basic science research. For aspiring researchers, a nephrology fellowship typically lasts three to four years. If you choose the clinical research pathway, you may be able to earn a master’s degree over the course of your training. As a nephrology research fellow, some of the topics you might study include:

Epidemiology of kidney disease
Public health strategies to improve access to CKD treatment in developing countries
Drug development for rare kidney disease
Cancer-related signaling pathways in kidney cells

After you finish the fellowship program, you can take the optional Nephrology Certification exam offered by the ABIM to demonstrate your expertise in the field. From there, you start your career as a nephrology-focused clinician, researcher, your researcher/practitioner.

If you are a foreign medical student or graduate, getting a job as a nephrologist might seem like a long way off, considering the years of preparation that are required, but it’s never too early to start preparing yourself! A clinical externship in nephrology can be a great way to get a feel for the field and establish connections with medical professionals in the United States before you apply for an internal medicine residency. Contact FMG Portal today to learn more about how this opportunity and the other ways we can help you get matched!

Choosing a Medical Residency: Regions of the United States

The United States is one of the largest and most diverse countries in the world. A few weeks ago, we talked about the differences between medical residency programs in urban and rural areas. However, it is important to note that even within the category of “urban” or “rural,” there are significant differences between different parts of the country. Within the geographic borders of the United States, you can find an example of almost every climate zone, and there are distinctive cultural differences between regions as well.

During your residency, the characteristics of the region in which you live can affect both your lifestyle and your work as a physician. This is especially true if you are pursuing a residency in one of the more general medical residency subjects — such as family medicine or pediatrics — since the types of cases you encounter can depend largely on the cultural circumstances of the region. Therefore, if you are a foreign medical graduate looking to get matched to a residency in the United States, it can be helpful to learn more about the different regions of the country so that you can apply to programs in places where you will feel comfortable living and where you will have the chance to work on cases that fit in with your medical interests and career goals.

The East Coast

The East Coast is one of the most densely populated areas of the country. As a result, you can find more medical residency programs in this region than any other, and you will find most of them in urban and suburban areas. The East Coast is home to some of the largest cities in the country, including New York City, Boston, Philadelphia, and Washington, DC — each of which has its own unique culture. However, they do share some general characteristics, such as highly diverse populations, good public transportation, and easy access to restaurants and grocery stores.

If you live on the East Coast, you can expect to experience four distinct seasons. Summers are hot, and winters can be very cold. In the northern areas, you might get a lot of snow in the winter, but further south, heavy rain is more common. Both spring and fall on the east coast are considered to be beautiful. In general, the culture on the East Coast tends to be more formal than in other areas of the country.

The Midwest

The Midwest, also known as the Great Plains, refers to the inland states between the east coast and the Rocky Mountains. Some of these states include Ohio, Iowa, Illinois, Michigan, and Minnesota. Although large portions of these states are rural, there are also a few major cities, such as Chicago and Detroit. Like the states on the east coast, you can expect cold winters and hot summers in the Midwest states. People in the Midwest are especially well-known for being friendly.

One of the most significant health issues that you will face if you work as a physician in the Midwest is the opioid abuse epidemic. The misuse of opioid medications (such as morphine, oxycodone and hydromorphone) is a growing problem in all parts of the United States, but it is especially concentrated in the Midwest. As a medical resident in the Midwest, you may treat overdose cases or individuals who are seeking treatment for addiction, so if you are interested in pharmacology, psychiatry, or any other drug-related area of medicine, a residency program in the Midwest may be of interest to you.

The South and Southwest

As in the Midwest, the South and Southwest regions are mostly rural, but with a few major cities, such as Atlanta (in the South) and Houston (in the Southwest). The climate in these states is much warmer and more humid in the summer, but Southerners also enjoy milder winters. The South is famous for its hospitality and its delicious comfort food.

Two medical issues that are more prominent in the South than in any other part of the country are obesity and smoking. Southern states like Mississippi, Louisiana, Alabama, Kentucky, and West Virginia have some of the highest numbers of people who meet the criteria for obesity and who say they smoke regularly. As a result, physicians are challenged to treat patients with many obesity-related medical conditions (such as type II diabetes and heart disease), as well as health problems caused by smoking (such as lung cancer).

The Mountain West and the West Coast

The Mountain West region includes the states that are between the Midwest and the West Coast. Some of the states in this region include Colorado, Utah, Idaho, and Montana. Because of the Rocky Mountains, much of this region is rural, although there are a few large cities, such as Denver. The Mountain West is known for its dry climate. In the winter, there is often snow, especially in the high country. In the summer, you can expect a daily temperature swing, with warm days and cool nights.

Outside of the East Coast, the West Coast is the most populous area of the country. Most people on the West Coast live in California, where the climate varies considerably. Southern California is warm and sunny, while Northern California is overcast and cool for most of the year.

The Mountain West and West Coast states are well-known for being among the healthiest in the United States, with low rates of smoking and obesity, and high rates of activity and exercise. However, the outdoor adventure opportunities in the states — like hiking, rock climbing, and skiing — can cause traumatic injuries. If you are interested in treating sports- and outdoors-related injuries — in either an emergency room or a rehabilitation setting — this region could be a great place to work. California is also particularly well-known for cutting-edge technological advances, so a residency in this area could be of interest if you are interested in medical technology research and development.

Choosing Between Regions of the United States

As an aspiring medical resident, it can be a challenge to figure out which region(s) of the country you would be comfortable living in. One way to experience life in the United States first hand is to complete a student elective or graduate externship before you apply. Not only can this give you a better idea of what it is like to live in a particular region of the United States, but it can also give your CV a boost and connect you with physicians who could possibly write letters of reference for your application.
FMG Portal offers student electives and graduate externships in a wide range of fields. Contact us today for more information!

Medical Subspecialty Spotlight: Bariatric Medicine

If you want to dedicate your career to the prevention and treatment of obesity, you may want to consider an educational track that leads you to subspecialize in bariatric medicine. Physicians who choose this subspecialty work with adults and/or children who are overweight or obese. As a bariatric medicine specialist, you would help your patients manage their weight and the associated complications, and you would devise prevention strategies for at-risk patients who want to avoid becoming obese.

Understanding Obesity

According to the World Health Organization (WHO), “Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health.” More formally, overweight is defined as having a Body Mass Index (BMI) of 25 or above, while obesity is defined as having a Body Mass Index (BMI) of 30 or above. Being overweight or obese puts patients at a higher risk for a wide range of other health problems, including:

Heart disease
Stroke
Type II diabetes
Cancer
High blood pressure
Osteoarthritis
Gallbladder disease
Sleep apnea
Asthma

Obesity is a growing problem around the world. The WHO estimates that the population of obese individuals has doubled since the 1980’s. In 2014, an estimated 1.9 billion adults were overweight, with 600 million of them meeting the criteria for obesity. In the same year, the WHO estimated that 41 million children under the age of 5 were either overweight or obese. Obesity is a particular problem in the United States. According to 2011-2014 data from the Centers for Disease Control and Prevention (CDC), 36.5% of adults in the United States were obese, and 17% of children between the ages of 2 and 19 were obese.

The Bariatric Medicine Subspecialty

Given the increasing severity of the obesity epidemic in the United States and around the world, many American medical schools have started offering fellowships in bariatric medicine. To get a bariatric medicine fellowship, you need to have previously completed an ACGME-accredited U.S. medical residency program in a relevant specialty area. Some of the residency specialty areas that schools accept include:

Internal Medicine
Family Medicine
Pediatrics

These three residency focus areas provide the general medical education that you need in order to succeed in a career as a bariatric medicine specialist. In each one of these programs, you learn about diagnosing and treating patients with a wide range of conditions, which is important bariatric medicine specialists work with overweight and obese patients who have highly diverse physical and mental health histories. Importantly, these three residency specialties were also the top three specialty areas in which foreign medical graduates got matched in 2015, according to data from National Resident Matching Program (NRMP).

What to Expect from a Fellowship Program in Bariatric Medicine

After completing your residency, you can apply to a one-year fellowship program that focuses on bariatric medicine. It is important to note that most fellowship programs that focus on bariatric medicine are officially titled Obesity Medicine and Nutrition Fellowship programs.

Because obesity is such a complex health condition, bariatric medicine fellowships tend to be highly interdisciplinary. You will likely study prevention and treatment strategies that involve nutritional programs, behavioral changes, pharmacological interventions, and bariatric surgery. Upon completion, you will be prepared for the board certification exam offered by the American Board of Obesity Medicine (ABOM).

Getting Into a Fellowship Program

So far, there are only a few Obesity Medicine and Nutrition Fellowship programs in the United States, so entrance is competitive. However, you can boost your chances by demonstrating your commitment to a career in the field. Here are a few things you can do as a medical graduate and as a medical resident:

Complete a graduate externship program in bariatric medicine before you apply for a U.S. medical residency. Not only can this boost your odds of getting matched to a residency program in the United States, but it can also indicate to future fellowship application readers that you know what you are getting into and and are ready to take on the challenge of a career in bariatric medicine.
Do bariatric-medicine related research while you are a resident. Many U.S. medical residency programs in internal medicine, family medicine, and pediatrics allow you to do conduct scientific research as part of the program. Whether you do lab research on pharmaceutical treatments for obesity, or population studies on obesity risks in certain demographic groups, having already done research on bariatric medicine may give you an edge over the other fellowship applicants.
Complete a fellowship in a related field. At some schools, in order to enter the Obesity Medicine and Nutrition Fellowship program, you need to have already completed another one-year fellowship in a related subspecialty area, such as endocrinology, gastroenterology, critical care medicine, or nutrition. Be sure to look into the requirements of the programs you are interested in before you apply.

If you want to pursue a career in bariatric medicine, FMG Portal is here to help. We offer graduate externships in the field and other services that can improve your chances of getting into a U.S. medical residency program. Contact us today for more information!

Choosing a Medical Residency Setting: Urban or Rural?

As a foreign medical graduate, there are many factors that you must consider when applying to medical residency programs in the United States. With so many different residency programs available at universities and medical centers, it can be hard to narrow down the list, even after you have identified your specialty area of interest. One of the factors that you should take into account is the setting of the residency program — that is, whether your choose a program in an urban area, a rural location, or a small city / suburban area. The setting that you choose can make a big difference for your residency experience, in terms of both your medical work and your life outside of the program. Read on to learn more about what you might expect from U.S. medical residency programs in urban and rural areas.

Choosing a Medical Residency in an Urban Area

U.S. medical residency programs in urban areas offer distinctive opportunities for foreign medical graduates. In cities, you can find lots of hospitals, outpatient care centers, and community health centers, so your clinical rotations may take place at many different sites around the city. This can give you a broader range of experiences than you might get from a residency program in a rural area or a suburban setting.

Many of the cities in the United States are also characterized by significant racial and socioeconomic diversity. Indeed, a 2015 study by the Brookings Institution found that the 50 largest cities in the United States had a significantly larger gap between the rich and the poor than smaller cities and rural areas. Therefore, if your residency is in an urban area, you might have the chance to work with patients from a wider range of cultural and economic backgrounds. Depending on your country of origin and the city in which you choose to work, you may have foreign language skills that can come in handy when working with the diverse populations of American cities.

Choosing a residency program in an American city will also significantly impact your lifestyle outside of the program. One of the benefits of living in a large city is that you will never need to worry about being bored — from restaurants to museums to concerts, there is no limit to the cultural experiences you can find in American cities! However, one of the drawbacks is that living accommodations are more expensive in American cities, so you may need to live with roommates. At the same time, public transportation systems are better in cities than in rural areas, so you may not need to own a car.

It is important to note that there is no “typical” American city, so if you are looking for a residency program in an urban area, you should do additional research about the cities you are considering. As of 2015, the 10 most populous metropolitan areas in the United States were:

New York City, New York
Los Angeles, California
Chicago, Illinois
Dallas – Forth Worth, Texas
Houston, Texas
Washington, DC
Philadelphia, Pennsylvania
Miami, Florida
Atlanta, Georgia
Boston, Massachusetts

Choosing a Medical Residency in a Rural Area

The opportunities that you would get as a medical resident in a program in a rural area are different from those that you would get in an urban area, but they can be just as educational and fulfilling. According to the Centers for Disease Control and Prevention (CDC), health risks for Americans in rural areas are significantly greater than for those living in rural areas, so as a medical resident, you may have the opportunity to gain experience with more serious cases. Here are a few statistics from the CDC about health disparities in rural areas that can provide insight into some of the challenges that medical residents in rural areas face:

Compared to Americans in urban areas, rural residents are more likely to die from heart disease, cancer, chronic lower respiratory disease, and stroke.
Death from unintentional injury is 50% higher in rural areas than in urban areas — primarily due to motor vehicle crashes and opioid overdoses.
Children living in rural areas are more likely to have mental, behavioral, and developmental disorders than those living in urban areas.

Because there are fewer physicians in rural areas, residency programs in rural areas are more commonly available in the broader specialty areas of family medicine, pediatrics, and internal medicine. That’s good news for foreign medical graduates, since the NRMP reports that these were the top three areas in which foreign medical graduates got matched in 2015.

The rural areas in the United States are located primarily in the Midwest, the South, and the West, each of which offers different cultural opportunities and lifestyle options. For example, in many rural areas in the West, there is easy access to outdoor activities like hiking, rock climbing, and rafting. On the other hand, the South is famous for comfort foods like fried chicken and pecan pie. Rural Midwesterners are known for being particularly friendly. On a more practical note, if you are living in a rural area, your housing will probably be less expensive, but you may also need to own a car in order to get around.

Clinical Externships in Rural and Urban Areas

Researching rural and urban areas in the United States can be helpful as you decide where to apply for a U.S. medical residency program, but there is no substitute for real-world experience. A great way to learn what life is really like in one of these settings is to complete a clinical externship. FMG offers clinical externships in many areas around the country, including rural and urban settings, as well as small cities and suburban areas. Contact us today to learn more about all of the resources we offer for foreign medical students and graduates!

Residency Specialty Spotlight: Pediatrics

If you want to dedicate your medical career to working with kids, a residency program in pediatrics may be the right option for you. According to 2015 data from the National Resident Matching Program (NRMP), pediatrics was the third-most popular residency specialty area for foreign medical graduates, behind only internal medicine and family medicine.

As a pediatrician, you could work with infants, children, and adolescents, ranging in age from birth to 21 years. Pediatricians are trained to provide preventive care and treat a wide range of conditions, including hereditary diseases, infectious illnesses, and traumatic injuries. You may choose to work in a primary care setting as a general pediatrician, or you may specialize your practice on a certain area of the field. It all starts with a pediatrics residency.

Pediatrics Residency Programs in the United States

US medical residency programs in pediatrics last for three years and provide general training in the wellness of infants, children, and adolescents. However, because pediatrics is such a broad specialty area, the programs can vary widely between schools. That means that when you are searching for residency programs, you should pay careful attention to what makes each one unique.

For example, programs may differ in the relative amount of time dedicated to clinical work in ambulatory and primary care settings. The location of a school often plays a role in this, since some schools are located in large cities where you may end up working at multiple hospitals and outpatient centers, while programs in rural areas allow you to gain extensive experience working at one or two locations. There are also programs that allow you to focus your studies by pursuing a certificate in an area of interest, such as global health, community health, medical education, or academic research.

In general, though, you’ll usually spend the first year of a pediatrics residency building a broad base of knowledge and developing basic skills in pediatric care, through a combination of clinical and didactic work. In the second year, you will have the chance to take on greater responsibility in clinical decision-making. You’ll probably also have the chance to pursue particular areas of interest through electives. Finally, the third year of a residency program will give you the chance to step into a leadership role in the clinic and prepare for your future as a pediatrician, whether you choose to focus on a specific subspecialty or practice as a generalist in the field.

Post-Residency Fellowship Options

Once you finish your residency in pediatrics, you can start your career as a general pediatrician or you can apply to a fellowship program. Almost all pediatrics fellowships in the US require an additional two or three years of study, although there are a few one-year fellowships available as well. Although this is not a comprehensive list, here are some of the options you could consider:

Adolescent medicine (3 years)
Allergy and immunology (2 years)
Pediatric cardiology (3 years)
Pediatric endocrinology (3 years)
Neonatal medicine (3 years)
Pediatric infectious disease (3 years)
Pediatric emergency medicine (2 years)
Pediatric sports medicine (1 year)

Getting Matched to a US Program

If you are interested in a US medical residency program in pediatrics, you might want to complete a graduate externship or student elective in the field. Not only can these experiences help you decide if pediatrics is the right specialty area for you, but they also look great on your CV. Many residency programs also require foreign applicants to submit a letter of reference from a US physician, and an externship program is a great way to make connections in the States.

FMG Portal offers student electives and graduate externships in many different specialty areas, including pediatrics. Contact us today for more information!

U.S. Residences have Additional Requirements for FMGs

Unlike U.S. allopathic medical school seniors, foreign medical graduates (FMGs) must meet additional requirements to be considered for U.S. medical residencies. These additional requirements may be one reason that FMGs are not placed in the NRMP Match Program at as high of rate as U.S. allopathic seniors. To be fully prepared for the NRMP process, foreign medical graduates can educate themselves on typical U.S. medical residency requirements. The University of Washington’s internal medicine application site provides an example of the additional requirements that FMGs face when trying to match with a U.S. residency.

If applying to the University of Washington medical program, FMGs have to meet these requirements (in addition to the typical personal statement, transcripts and letters of recommendation).

Must be a permanent resident of selected states OR sponsored by faculty

Because most foreign medical graduates are not permanent residents of Washington, Montana, Wyoming, Alaska or Idaho, most applicants will have to meet the second requirement, faculty sponsorship. The faculty member must write a letter explaining how he or she knows the foreign medical graduate and what qualifications the FMG possesses. Foreign medical school graduates may be able to find a link to a University of Washington faculty member through their medical school. Another option for FMGs is to try to obtain a clinical clerkship or internship with a University of Washington faculty member. This can be a difficult requirement to meet and it is only the first of three.

Must have 2 weeks of clinical clerkship at an LCME-accredited medical school OR four months of residency at an ACGME-accredited program

The University of Washington also specifies that these clerkships and residencies must be at a Puerto Rican, Canadian or U.S. location. Foreign medical graduates that have only worked in their native countries will not meet this requirement. To be able to apply for residency at the University of Washington, FMGs will need to obtain one of these clerkships or residencies. For the LCME clerkship option, there are 155 qualifying schools. For the ACGME residency option, FMGs can select from schools listed on the ACGME list.

Must apply through the ECFMG ERAS Program

The online ERAS application program certifies that FMGs meet the same clinical standards as U.S. allopathic seniors. There are three exams that FMGs must pass in order to apply through this program. It is likely that foreign medical graduates will have to visit the U.S. for at least one of these exams. Therefore, it is imperative to have enough time to meet these requirements before the application and interviewing process for NRMP begins.

Many U.S. medical residencies, including the University of Washington, have additional requirements for foreign medical graduates. FMGs should examine what requirements are needed long before the fall application and interview process. Some requirements, like a 4 month residency or 2 week clerkship, require travel and take weeks or months to complete. By researching these additional requirements early, FMGs can be prepared for the NRMP matching process.

NRMP Matches 52.4% of Foreign Medical Students to U.S. Residencies in 2017

The National Resident Matching Program, or NRMP, announced the largest number of medical residency applicants and placements in 2017. The program places medical school students and graduates in residencies using a Nobel-prize winning algorithm. To be included in the program, medical school students submit applications and interview with programs starting in the fall and continuing through early winter. The program directors and applicants then rank their order of preference. The algorithm matches applicants to residency programs. This successful program continued in 2017 with over 35,000 medical school student and graduate applicants.

In 2017, these medical school students and graduates competed for over 31,000 positions. 94% of U.S. allopathic seniors were successfully matched. This is a consistent number from year to year. However, the placement rate for non-U.S. citizen international medical school graduates and students (also known as FMGs) is much lower, only 52.4%. Over 7,000 FMGs applied in 2017 and less than 4,000 were placed. NRMP notes that this is the highest match rate since 2005, so 52.4% is better than average.

The lower match rate of international medical students suggests that these students may need additional support to successfully match with U.S. residency programs. Comparing the experiences of U.S. seniors and foreign medical students might illuminate some difference that account for the lower match rate. U.S. allopathic seniors follow a standard process for medical residency matching. They know when to take their USMLE (United States Medical Licensing Examination). In many cases, their medical school can support and guide them through the process. For foreign medical students, their medical school might not be able to provide the support and guidance needed to obtain a residency in the United States. The medical school’s process might be set up for medical residency in the local area.

U.S. students might also have an advantage during interviews. Resumes are written and interviews are conducted in their native language. Additionally, many U.S. school provide workshops on resume writing and interviewing. Foreign medical students may not have access to this support.

Hand-on clinical experience might also help U.S. students rise through the ranks. Many medical schools including clinical experience as part of the curriculum. These schools partner with U.S. hospitals and clinics for training. Foreign medical students may have clinical training in their native country. However, interviewing residencies may be more comfortable accepting students with training at known U.S. institutions.

It seems as though foreign medical students are at a disadvantage when it comes to medical residency placement. However, additional support can enable international medical students and graduates to be successfully matched to a U.S. residency. Hands-on clinical experience in the U.S., resume advice, and interview preparation are likely to increase the chances that a FMG will be matched with his or her preferred medical residency.