IMG Friendly Residency Programs

Aside from preparing for the Steps the most tedious and puzzling part of the residency process is making a list of IMG friendly residency programs to apply to. Obviously being an IMG you should only apply to IMG friendly residency programs whose program criteria you meet. As you know its very important to be selective in where you apply as there are thousands of programs and application fees can amount to thousands of dollars.

To narrow down to a couple hundred of programs from thousands was a process of determining the intersection of where my individual profile overlapped with program criteria. Do not use the generic “IMG Friendly” Residency Program Lists floating around the internet. You want to tailor the list to your unique profile based on several other factors such as scores, visa status, type of IMG, years since graduation, USCE experience – one size does not fit all.

residency program list

There are a few tools online that generate a list of matching programs claiming to also reveal the percentage of residents that are IMGs, but this statistic was irrelevant to me. Because there absolutely needs to be a distinction between Caribbean vs non-Caribbean IMGs since many programs heavily favor one IMG type over the other. An example of this is Family Medicine where programs are statistically twice as Caribbean IMG friendly vs Non-Caribbean IMG friendly.

So I started off creating an Excel spreadsheet with separate tabs for each specialty I wanted to apply to such as “Internal Medicine”, “Family Medicine” etc. I then went to Freida and searched for programs with a filter on the Specialty and location. I only wanted to apply to certain states where there was potential for my spouse to get job opportunities. Being in the IT field we restricted ourselves to CA, AZ, NV, TX, NY, NJ, FL, DC, PA, MD etc.

img friendly residency programs

Creating an Excel spreadsheet with separate tabs for each specialty and enter the program details

I copied and pasted the search results from Freida one by one to the Excel Spreadsheet into the respective Specialty tab along with contact name, email, city, states, phone, etc. I then visited the website of each and every program (which was very tedious to say the least!) I tried to look for each programs application criteria whenever it was specified. I removed or kept the program in my Excel spreadsheet based on whether I met the criteria or not.

The final filter and most important one was to remove or keep programs from my lists based on non-Caribbean IMG friendly programs, this involved going through the Current Residents page of each site counting the number of non-Caribbean IMGs and dividing them by the total number of residents. I entered this percentage in my spreadsheet – as absurd as this may sound but it is the best indicator of whether a program is TRULY IMG Friendly or not. You will come across several programs that explicitly claim on their websites that they welcome IMGs to their program but a quick look at their current residents will suggest otherwise.

Many programs do not have detailed information on their websites, so I contacted those programs. The IMG percentages on Freida do not distinguish Caribbean IMGs from non-Caribbean IMGs. I finally picked the top 200+ programs based on reputation and percentage of non-Caribbean IMGs and applied there.

current-residents

Visit the Current Residents page of each program counting the number of non-Caribbean IMGs and dividing them by the total number of residents and log it in your spreadsheet

It was relatively quick to detail this process for you but mind you it took several weeks to complete my application list and even then I kept altering it till applications opened up in September. You should only apply to those program whose application criteria is met, otherwise its very easy to get carried away, applications = money – so apply smart!

If you don’t want to spend several weeks preparing your list we built
MyResidencyList.com so you can generate a list of IMG friendly residency programs to apply to – Custom-Tailored to your profile.
Your custom-tailored list is based on your USMLE scores, clinical experience, years since graduation and factor in whether you are a AMG, Caribbean IMG or Non-Caribbean IMG.

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Behavioral Science notes for USMLE Step 1

Autonomy

  • Patient has rights to make decisions regarding his/her treatment
  • The wishes have to be carried out even in the event that he/she loses consciousness
  • Out of beneficence (doing what is good) & autonomy, autonomy is more important
  • Confidentiality is violated only if patient has TB, HIV, STD, or other conditions which can harm innocent third-party

Consent

  • Consent needs to be taken for providing all kinds of medical care
  • Consent required from parents if patient is a minor (<18)
  • But in life-threatening situations, blood transfuions & surgery can be done (implied consent)

Partial Emancipation

  • In areas of STD, contraception, prenatal care, substance abuse consent from parents is not needed if patient is above 15 years of age (mature minor)

Emancipated Minor

  • A small number of minors at age of 16 or 17 (varies from state to state), who are married, self-supporting, living independently, or themselves have a child that they support or in the military do not need parental consent but legal permission maybe required for serious medical conditions or surgery (such as organ donation)
  • Parents can’t refuse any treatment for their children on religious beliefs in life-threatening conditions (for example blood transfusions), even if the child is severely brain-damaged or developmentally disabled
  • Parents can refuse treatment only if child’s disease is incompatible with life
  • A patient with mental illness, mental retardation, autism (even with mental age of 8) that might be considered incompetent for other areas of life still has the right to refuse for medical procedures (power of autonomy over beneficence)

Informed Consent

  • For each & every procedure
  • No procedure or surgery to be extended even if it is in patients favor (autonomy)
  • Decisions (oral or written) made when patient was competent and conscious are valid even when patient loses capacity later on to make decisions
  • Oral consent valid for all procedures (even heart transplant) but difficult to prove if need arises
  • Consent is implied in emergency
  • Consent over telephone is valid but you need a witness and make sure you take consent from right person
  • Information about the patient cannot be released if the patient does not sign the release form
  • If court of law enforcement agency wants any such information it can only be disclosed if they have a valid court order and a search warrant

End of Life Issues

Advanced Directive

  • Is a method by which a parents communicates his/her wishes for healthcare in advance before becoming unable to make decisions for his/herself
  • Advanced directives could be a living will or healthcare proxy
  • Living will is a document in which a patient expresses his/her wishes in written form
  • Healthcare proxy (medical power of attorney) is a patient assigned person who speaks on behalf of the patient
  • In case their is no living will or healthcare proxy and the patient does not have the capacity to make decisions first we ask the spouse of the patient regarding what the patient would have wished for him/herself. The next assigned proxy are the parents or children of the patient.
  • In case the family members disagree about the treatment decisions you should take the following steps in sequence
    1. Encourage consensus and request discussion among family members to reach a decision
    2. Refer to hospital ethics committee
    3. Refer to court or seek judicial intervention

Terminally-ill Patients

  • Physician assisted suicide and euthanasia are unacceptable and unethical
  • Law of double effect is when the treatment offered to relieve discomfort can shorten the life of the patient, then the prime duty is to relieve pain even if it shortens the patients life. For example opiods can be given to a patient with known COPD who is terminally-ill and is in excruciating pain

Futile Care

  • Physician is not under obligation to give treatment that will not benefit the patient even if the patient or family is demanding it
  • Brain-dead means the patient is dead even if the heart is beating. You can take off ventilatorly support (need no permission) but before turning off the ventilator its advisable to explain to the family members the meaning of brain-dead and obtain consensus.

Organ Donation

  • Organs can be removed even when the heart is beating, in fact it is better because the organs are well perfused
  • Physicians should never obtain consent for donation, only the organ donor network should obtain the consent
  • Even if the patient has an organ donor card family consent is still necessary

Ethical Dilemmas

  • Informed refusal is as important as informed consent
  • A psychiatrist and his/her patient can never have a sexual relationship even if the physician-patient relationship is terminated.
  • Child-abuse reporting is mandatory
  • Impaired driver (history of seizures or vision loss) should report him/herself to DMV first. If on persistent counseling he/she does not report by him/herself you may have to report to DMV.
  • Spousal abuse cannot be reported without consent
  • Do not disclose genetic information to the employer unless the patient wants that
  • Risk-management is the term applied to the portion of hospital administration that evaluates potential legal liability to the institution

 

 

 

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Am I at a Disadvantage for requiring Visa Sponsorship?

Applicants requiring visa sponsorship may have considered whether they are at a disadvantage for not being a US Citizen or Green Card holder. And likewise those with US Citizenship or Green Cards may wonder if they have an advantage over those without one.

us

At the time of application I was a green card holder and too wondered whether I would be given preference over those requiring visa sponsorship. As you may have noticed I like to provide data and charts in my blog posts to justify my opinions, however I do not have any hard evidence for this topic.

But I can share my opinion based on analyzing the profiles of hundreds of applicants (with varying immigration status, scores, USCE, etc) during my match year it seems like there is no apparent advantage amongst IMGs.

The number of interviews an applicant was offered seemed to be more or less the same for any two similar applicants regardless of status. So in conclusion I would say there definitely is no harm in being a US Citizen or Green Card holder but no significant advantage either as it pertains to yielding interviews.

Whether immigration status affects your ranking order as an applicant is another topic altogether and would nearly be impossible to know, atleast in a general sense.

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IMG Friendly States for Pediatrics

In this post we will be sharing some insightful data on IMG friendly States for Pediatrics. The list of IMG friendly states for Pediatrics Medicine by IMG type (Caribbean IMG vs Non-Caribbean IMG) can be found below. This data was provided by MyResidencyList.com

 

chartThis chart goes into more detail showing the most Non-Caribbean IMG friendly states. Again, for my purposes I defined IMG friendly as any program which IMGs made up 10% or more of their total residents in the past 3 years. The numbers denote the percentage of programs in the particular state which were Non-Caribbean IMG friendly.

  1. Pennsylvania (63%)
  2. Georgia (60%)
  3. Michigan (60%)
  4. New York (57%)
  5. New Jersey (56%)
  6. Ohio (56%)
  7. Texas (54%)

 Caribbean IMG Friendly States for Pediatrics

  1. Louisiana (100%)
  2. New York (80%)
  3. Florida (73%)
  4. New Jersey (67%)
  5. Ohio (67%)
  6. Georgia (60%)
  7. Pennsylvania (50%)
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Residency in the US vs India/Pakistan

Being an IMG in a US residency program for me has been different in some aspects compared to my residency experience in my home country. The differences maybe challenging to get accustomed to especially when you are expected to hit the floor running right from day 1. In this post I will share a few differences from my personal experience.

The biggest one I experienced was dealing with the social aspect of patient care, the degree to which this applies may vary based on whether you work in a public hospital vs a private hospital. Taking a detailed social history of patients was new to me – such as the kind of health services the patient has at home, whether they reside in a nursing home, rehab center, etc. Getting this information upon admission is important for the purposes of informing the social worker so that the patient discharge process appropriately suits the needs of the patient

Getting accustomed to the Electronic Medical Records (EMR) system – more specifically how to navigate and utilize can take some getting used to. In my home country all our processes were paper-based and we did not have EMR systems. After working in 2 different hospitals here in the states I realized the type of EMR systems vary from place to place. They can be very easy and user-friendly or difficult and counter-intuitive depending on the system.

Lastly, many hospitals do not have around the clock phlebotomists therefore as an intern you maybe responsible for drawing blood samples – it is a bonus if you are good at phlebotomy.  It is advisable before starting residency to become well-versed with the types of tubes for collecting different samples. (i.e. lavender tube for CBC, yellow or red topped tube for BMP, etc) so that you are not wasting time drawing samples in the wrong tubes and having to redo it

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How Many Residency Programs Should I Apply To?

The answer to this posts title widely varies based on several factors. The most important factor is whether you are an American Medical Graduate (AMG) or International Medical Graduate (IMG). Other important profile factors include USMLE Step scores, US clinical experience, visa sponsorship needed, years since graduation, etc. Asides the aforementioned factors, your budget for application fees may also be a limiting factor

Its no secret that as an AMG the median number of programs you need to apply to is far less than the number IMGs need to apply to in order to be offered the same number of interviews to ultimately match. The number of AMGs that match every year ranges between 92-95%, whereas for IMGs it is 50%, according to NRMP Match Data.

In order to make an informed decision on the number of programs you should apply to we will look at some data trends across various specialties based on the 2015 NRMP Applicant Survey

Family Medicine

AMG-Applicant-Data-for-Family-Medicine
A resounding 75% of programs offered an interview invite to AMGs that applied to Family Medicine (those who matched)

IMG-DO-Applicant-Data-for-Family-Medicine
In comparison, only 15% of programs offered an interview invite to IMG/DOs that applied to Family Medicine (those who matched)

Internal Medicine

AMG-Applicant-Data-for-Internal-Medicine
52% of programs offered an interview invite to AMGs that applied to Internal Medicine (those who matched)

IMG-DO-Applicant-Data-for-Internal-Medicine
In comparison, only 8% of programs offered an interview invite to IMG/DOs that applied to Internal Medicine (those who matched)

Pediatrics

AMG-Applicant-Data-for-Pediatrics
60% of programs offered an interview invite to AMGs that applied to Pediatrics (those who matched)

IMG-DO-Applicant-Data-for-Pediatrics
In comparison, only 19% of programs offered an interview invite to IMGs that applied to Pediatrics (those who matched)

Neurology

AMG-Applicant-Data-for-Neurology71% of programs offered an interview invite to AMGs that applied to Neurology (those who matched)

IMG-DO-Applicant-Data-for-Neurology
In comparison, only 15% of programs offered an interview invite to IMGs that applied to Neurology (those who matched)

On average, across these 5 specialties 65% of programs will offer an interview invite to AMGs that have applied. In contrast, on average only 14% will offer an interview invite to IMG/DOs. This means IMG/DOs will need to apply to significantly more programs in order to yield the same number of interviews.

Based on my own experience I think you should aim for 10 interviews in order to maximize your chances of matching. In theory all you may need is one interview invite and for that program to rank you high in order to match. But in reality the more interviews you are offered and attend the higher your chances of matching.

In light of this data from NRMP and my personal experience in the match, Non-Caribbean IMGs should should apply to a MINIMUM of 100 programs to be safe. My stats were IMG/Step1: 250s/Step 2: 260s/No Visa needed and I applied to over 200 programs and received about 20 interviews (10%). With over 400 Internal Medicine, over 500 Family Medicine, over 200 Pediatrics, over 200 Psychiatry, and almost 150 Neurology programs, it is very important to be selective in where you apply. You should only apply to programs whose criteria you meet.

MyResidencyList.com will generate a list of programs matching your unique profile including your scores, whether you are an American Medical Graduate, Caribbean IMG, Non-Caribbean IMG, clinical experience, years since graduation, etc. Their database is based on information collected from various sources including phone calls to the programs, program websites, prior match results and more.

 

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IMG Friendly States for Family Medicine

In this post we will be sharing some insightful data on IMG friendly States for Family Medicine. The list of IMG friendly states for Family Medicine by IMG type (Caribbean IMG vs Non-Caribbean IMG) can be found below. This data was provided by MyResidencyList.com

MyResidencyList.com will generate a list of programs matching your unique profile including your scores, whether you are an American Medical Graduate, Caribbean IMG, Non-Caribbean IMG, clinical experience, years since graduation, etc. Their database is based on information collected from various sources including phone calls to the programs, program websites, prior match results and more.

 

Non-Caribbean IMG Friendly States for FM
This chart goes into more detail showing the most Non-Caribbean IMG friendly states. Again, for my purposes I defined IMG friendly as any program which IMGs made up 10% or more of their total residents in the past 3 years. The numbers denote the percentage of programs in the particular state which were Non-Caribbean IMG friendly.

  1. Virginia (67%)
  2. Texas (44%)
  3. New York (37%)
  4. Michigan (32%)
  5. Ohio (32%)
  6. California (30%)

 

Caribbean-Friendly-States-FM

  1. Louisiana (100% – not many total programs)
  2. Michigan (91%)
  3. Virginia (90%)
  4. Georgia (89%)
  5. New Jersey (82%)
  6. New York (79%)
  7. Pennsylvania (71%)
  8. Illinois (65%)

 

IMG Friendly FM
This is a chart depicting the percentage of IMG friendly programs based on IMG type. For my own purpose I defined “friendly” as any program where IMGs made up 10% or more of the total residents in the past 3 years. The most surprising and revealing fact was that more than twice as many programs are Caribbean friendly as are Non-Caribbean friendly. Furthermore only 15% of the total Family Medicine programs sponsored any form of Visa while being Non-Caribbean IMG friendly (as per my aforementioned definition of the term)

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IMG Friendly States for Internal Medicine

In this post we will be sharing some insightful data on IMG friendly States for Internal Medicine. The list of IMG friendly states for Internal Medicine by IMG type (Caribbean IMG vs Non-Caribbean IMG) can be found below. This data was provided by MyResidencyList.com

MyResidencyList.com will generate a list of programs matching your unique profile including your scores, whether you are an American Medical Graduate, Caribbean IMG, Non-Caribbean IMG, clinical experience, years since graduation, etc. Their database is based on information collected from various sources including phone calls to the programs, program websites, prior match results and more.

 

Non-Caribbean-IMG-Friendly-States-for-Internal-Medicine
This chart goes into more detail showing the most Non-Caribbean IMG friendly states. Again, for my purposes I defined IMG friendly as any program which IMGs made up 10% or more of their total residents in the past 3 years. The numbers denote the percentage of programs in the particular state which were Non-Caribbean IMG friendly.

  1. Michigan (88%)
  2. New Jersey (86%)
  3. Florida (85%)
  4. Maryland (80%)
  5. Connecticut (73%)
  6. New York (73%)

 

Caribbean-IMG-Friendly-States-for-Internal-Medicine

  1. Georgia (75%)
  2. New Jersey (74%)
  3. New York (72%)
  4. Michigan (64%)
  5. Florida (62%)
  6. Ohio (62%)

 

IMG-Friendly-Internal-Medicine-Programs
This is a chart depicting the percentage of IMG friendly programs based on IMG type. For my own purpose I defined “friendly” as any program where IMGs made up 10% or more of the total residents in the past 3 years. The percentage of Non-Caribbean IMG Friendly programs vs Caribbean IMG Friendly programs is nearly identical – which is much more assuring than the data trends for family medicine.

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What To Do After Applying to Residency Programs?

Let me tell you, you will be on what seems like the longest emotional roller coaster of your life after you Apply. Constantly checking the forums for news from others and manically refreshing your inbox. I remember constantly checking my email between the hours of 6 am – 3pm PST hoping to hear from programs. I impatiently wished the day would end after 3pm so that I can magically wake up the next morning to some good news!

The best thing to do is nothing, you should take a vacation or spend some time with friends and family, after all you should be proud of yourself for making it this far. I remember being anxious when someone on the forums would report receiving an interview invite, especially when it was from a program I also applied to. Not all programs send out invites once or at the same time. Just because you know of someone who received an invite from a particular program and you did not, doesn’t necessarily mean you will not in the future.

Constantly phoning or emailing a program is not going to help. Program coordinators are flooded with message and emails and its not feasible to reach out to each of the thousands of applicants reaching out to them. From my experience of sending out several hundred emails requesting a status update on my application resulted in either a generic response or in most cases none at all. Just because you are not receiving invites as early as October or November does not necessarily mean your chances of getting interview invites in the future are bleak. I received some invites as late as January to some very reputable programs (I assume as a result of cancellations)

Just sit back and try to relax, watch a movie, goto the beach, take a vacation, prepare for your Step 3 if you want! But most importantly be ready to interview as the opportunity can come anytime and you want to make sure you are well-prepared for it

 

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Interview Opportunities at Newly Accredited Programs

Another topic not often discussed is the opportunity to interview at newly accredited residency programs. During my match year the Residency Match registration opened up September 15, after registration opened up several new residency programs became accredited! I assume part of the reason why applicants don’t discuss these newly accredited programs is that there is a competitive advantage in keeping quiet about them.

Many applicants finalize their list of residency programs that they would like to apply to before registration opens. When registration opens up they apply to their desired programs and subsequently sit back and wait to hear from programs. Often what happens is that there are residency programs which receive their accreditation after registration opens and as a result not many applicants know about these programs! One great resource to track such programs is https://apps.acgme.org/ads/Public/Reports/Report/8

I personally came to know of a few newly accredited programs through friends of mine that were kind enough to share that information with me. I applied to some of these programs and they resulted in interview invites. For these new programs it might be difficult to receive a desired number of applicants since not many applicants may know about their program in the first place.

Standing out in a pool of fewer candidates coupled with the fact they might need a year or two to figure out who their ideal candidate is may help you gain an interview invite. Furthermore in my experience the Program Directors for these programs were highly ambitious in wanting to make their program successful.

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5 Essentials I Packed for Residency Interview Season

During interview season you maybe on the road alot depending on the number of interview invites you receive. I personally received 20+ and ended up attending most of them and it was very useful having a checklist of things every time I packed my bag and was off to another city. The following were a few of the most useful items on my checklist

travel-ess

  • Electric Kettle: This has to be at the top of my list! I cannot function without Chai in the morning just like most people cannot function without coffee. Coffee is much more accessible on the road almost every motel/hotel has a coffee maker along with the necessary ingredients like coffee powder, sugar, and creamer. I bought a cheap electric kettle from Target to make Chai in. I always brought my own tea bags along, sugar was always available in the motel/hotels, and I bought milk from nearby gas stations.
  • Umbrella: An umbrella is a must especially since interview season falls between October and February. Most places around the country its either raining or snowing during this time.
  • Medicine: I always carried Advil and NyQuil Cold & Flu with me wherever I traveled. Although this can be purchased anywhere it is good to have on your person. On a couple of occasions this came in very handy when I felt I was coming down with the flu, the NyQuil really helped.
  • Laptop + TV Shows/Movies: There were times where I was in the same city for several days due to a gap between interviews. After you have a few interviews under your belt you are more confident and prepared for future interviews. Having several days of free time in between interviews can be boring sitting in a motel/hotel. I always had my laptop with me and would watch TV shows or movies on it – it was also good for relaxing my mind.
  • Non-Perishable Foods: We were once stuck in snowstorm Jonas which lasted several days and pretty much forced to stay indoors at the hotel. All the local businesses were closed and getting in and out of the hotel was near impossible. We were lucky to have a bag full of non-perishable food which got us through this difficult time.

 

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Illegal Questions during Residency Interviews

There are a set of rules governing your interaction with programs pre/during/post residency interviews. These rules apply to both the applicant and the programs and they are known as the Match Communication Code of Conduct. I have known of these rules being violated often during and post residency interview. The rules are as follows along with some examples of scenarios

  • Respecting an applicant’s right to privacy and confidentiality: This means program directors (PD) and interviewers are not allowed to ask you which other programs you have applied to including information on the specialty, location, etc
  • Refraining from asking illegal or coercive questions: This means PDs and interviewers focus on the applicants “goodness of fit within their program”. The conversation should not focus on the age, gender, sexuality, or religion of an applicant. An example of an illegal question would be “do you plan on having children anytime soon?”
  • Declining to require second visits or visiting rotations: This means PDs and interviewers should understand that requiring applicants to visit a second time may place logistical and financial hardships on the applicant. If the applicant is unable to visit a second time it should not affect their ranking.
  • Discouraging unnecessary post-interview communication: This means both parties should not have any post-interview communication which may influence the rank order list. An example of this would be communication from a program stating “If you rank us high, we will rank you high as well”

I personally am not sure what the appropriate course of action would be if you were to encounter such a situation. It is understandable that an applicant maybe reluctant to point out a violation when it occurs as to not jeopardize their chances with a program. If you have suggestion on how to deal with this situation please leave it in the comments below

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How Much do Residents Make?

In this post we share information on how much do residents make and in addition to salary the typical benefits. Below is some information on the salary and benefits offered by the programs I ranked.

Note these figures may vary from year to year

  • Salary: Ranged between $49k to $60k, with the average being about $52-$53k
  • Health Benefits: All programs offer Medical, Dental, and Vision, for you and your family. Basic plans are often free, the ones with better coverage will cost you. Going through the various plans here would be impossible!
  • Meal allowance: Most programs offer this and it averages $10/day going as high as $25/day (although not typical)
  • Relocation allowance: Only a couple of programs offered this (probably due to most my interviews being from community programs) and it ranged between $1000-$2000, most did not provide this
  • Educational allowance: Most programs offer this and it ranges between $500-$1000/year which is intended to cover education material cost of attending conferences, etc
  • Raise: Residents are offered a year to year raise and it ranges between 2.5%-3%
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Travel Tips for Residency Interview Season

I wish this topic existed when I was going through interview season! I am going to share some tip and tricks on how to get through the hectic interview season as cheaply and conveniently as you can. I love to plan every little detail when I travel and pride myself on doing it as economically as possible. I had 20+ interview and attended most of them and here was my experience!

I had already spent nearly $5000 on applications and with 20+ interviews I thought boy it’ll  certainly cost more than that on travel alone! But I managed to attend these interviews for much much less than I thought.

travel

Interview Clothes

I bought 2 suits for the interview season, you don’t need to overhaul your entire wardrobe. In most cases you are only attending each program once, they don’t know what you wore at your last interview or for that matter what you will be wearing at your next as long as your clothes are clean, respectable, and you look presentable. I bought two suits from Ann Taylor for about $300, signing up for their membership allowed me to knock off something like 15-20%. The takeaway here is that a couple of suits are enough and preferably buy them from the same place if they offer some sort of new member discount

Local is cheap

My favorite interviews were the in-state ones since you don’t have to break the bank to attend them and also you wont get homesick! All of my local interviews were within a 3 hour drive so transportation was cheap (having a hybrid helps!) and being day trips we didn’t need to book hotels. I paid around $100 in total for gas for all in-state interviews.

Food

I don’t consider this a cost to consider since food is a fixed cost regardless of where you are, obviously its cheaper to eat at home but with the hectic schedule who has time to cook anyways!

Flights

For our first out of state interview we traveled by road with a relative who happened to be going there at the same time as our interview and it cost us nothing. Our next set of interviews were on the east coast, my spouse and I both flew round trip from the west coast to New York twice for free! Most of our out of state interviews were in NY or neighboring states to which we traveled in a rented car. The only flight we paid for was from NY to FL and it was for a total of $266 for 2 tickets.

Now you must be wondering how I got those free flights, the secret is credit card signup bonuses. When you signup for most credit cards in the US they give you signup bonus miles. There is one small caveat – you only get those miles after you have spent a minimum amount of money on the card – in most cases it was $3000 per card.

I signed up for 3-4 credit cards and spent that amount fairly quickly thanks to residency application fees! I also used the cards for all my personal purchases as well rather than using cash or debit. If you plan on using this trick the key is to signup for the credit cards well in advance of interview season preferably before applying so that you can rack them up with application fees

Hotels

Hotels can get expensive although we tried to save as much money on them as we could. During my first trip to the east coast a relative of mine worked for a large hotel chain and one of the perks he had was the ability to get us discounted hotel rates, he hooked us up with hotels for cheap as $35/night. However on our second trip to the east coast he had moved on from the company and that was bye-bye to our discounts. So we booked our hotels at regular price, the prices across hotel search engines don’t vary more than a few dollars. We resorted to AirBnB whenever we had to stay in NY since hotels can easily exceed $200-300/night there

The optimal piece of advise would be to crash with friends and relatives wherever you can, although we had friends and family in many of the cities where we stayed we preferred to get our own places. You can also offset your costs by renting out your place on AirBnB we did this for a few days and earned a decent amount of money.

Total Costs by Category
Hotels: $1498 = $1,748 – $250 (earned by renting out our place on AirBnB)
Car Rental/Gas/Uber: $1,128
Flights: $266, we saved about $1500+ on flights using credit card signup bonuses!
Clothing: $300
Total: $3,192
Per Interview Average: $177

An average cost of $177 interview is not shabby at all! That includes getting there, putting a roof over your head, interview clothes, etc. We used the extra money we saved to travel in New York and Florida: we visited Epcot, the Everglades, Florida Keys, Times Square, Statue of Liberty.

So the takeaway in summary is use those credit card signup bonuses, stay with family and friends (great opportunity to spend quality time aswell!), don’t go overboard with cloth shopping

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How To Make Your Rank Order List

One of the most difficult things to do during the residency match process is making a rank order list. A rank order list as most of you probably know is simply ranking all the programs you interviewed at from 1 through n. 1 being your top choice. Programs rank candidates the same way and these two inputs determine where you match. You can read more about this at https://en.wikipedia.org/wiki/National_Resident_Matching_Program#Matching_algorithm

After the interview season had come to an end on the USMLE forums I often saw candidates asking others for advice on how to make their rank order lists. In my opinion no one knows better on how to make your rank order list than you. Different people have different factors of varying priorities in their lives. You need to decide what your factors are and which are the most important to you – no one can make that determination for you!

For me personally job opportunities for my spouse, potential for fellowships after residency, salary to cost of living ratio were the most important to us. Firstly we organized our list based on preference of specialty. We further organized the programs within each specialty based on fellowship opportunities – we ranked the university based programs higher than community based programs. University based programs will obviously give you a higher chance at in-house and fellowship opportunities at other programs than community based programs.

We then arranged our list based on the salary to cost of living ratio. Salaries for the various programs ranged from $50k to $60k and the cost of living (primarily rent) varied a lot across cities. We researched the average rent for a 1 bedroom apartment by looking at Craigslist listing for the various cities. We logged all this information in an Excel spreadsheet. Aside from rent we also took into account whether we would need a second vehicle based on the available public transportation in each city. We used Google Maps to determine public transportation availability.

Each candidates priorities can range widely based on whether they are single, married, have kids, financial situation, or other obligations in their personal lives. So my best piece of advice on rank order lists is to write down a list of factors and their priority for you and based on your unique set of circumstance make your own rank order list!

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Why Connections Don’t Matter (much)

Many applicants have friends or family that have already matched and are currently working as residents or others that are in the medical profession. Some of these applicants will reach out to their friends or relatives to put in a good word with the program coordinator or program director in an attempt to help their application.

References are a legitimate way for managers in corporate America to identify good candidates for open positions. An employee vouching for a colleague from a past job or from a personality standpoint is helpful to managers. In the context of the residency application process a candidate may receive an interview invite on the basis of a reference however I believe only in certain cases will that matter much.

If a program director or a selection committee does not send out an invite to an applicant its probably based on particular criteria they have set which the applicant does not meet – in this case enlisting the help of a friend or relative to gain an interview might not mean much in the long run. On the other hand being acquainted with a faculty member or program director that is aware of your credentials/character might be more beneficial.

In cases where the candidate may have an exceptional personal story which would not otherwise be apparent on an application it might help. It might help during the ranking process when it comes down to ranking two identical applicants, having someone personally vouch for one of them might provide an edge.

Remember your ultimate goal should not be to rack up interview invites but rather to be ranked high by the programs where you interview. In my opinion interviews gained based on merit or strength of an applicants profile have much stronger legs to stand on

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The Most Underrated Residency Application Factor – Location

You’ve heard the infamous phrase “location is key” well it certainly seemed to hold true in my experience applying for residency. During the application process most people discuss scores, AMG vs IMG, visa status, or year of graduation but rarely does anyone discuss location.

After I applied I kept a spreadsheet which I would religiously update everyday which tracked interview invites to applicants (from programs where I applied) along with those applicants stats as they reported them in the forums. Surprisingly the data revealed that location was a huge factor. I noticed applicants were receiving a significant number of interview invites from their resident states vs other out-of-state applicants with nearly identical (and in many cases stronger) profiles not receiving invites.

Of the 20+ interview invites I received a significant percentage were from IMG friendly programs in the state where I lived. There were many out of state programs where I did not receive invites from that were sending invites to local candidates with significantly lower scores or those requiring a visa.

And this makes sense as well, at many of the places I interviewed the program directors seemed very keen on having potential residents settle down in the area after residency – especially those programs located in more rural settings or under-served communities. Program directors may feel that a local candidate has a stronger connection to the particular community and the likely-hood of them staying around after residency being much more significant than an out of state applicant.

Another factor (which I had no insight into) might be the fact the applicant may have done an observership or externship at the particular hospital being local to it and may have left a positive impression. The obvious takeaway should be to definitely apply in your resident state as it could be a huge factor in receiving interview invites.

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How I Scored 229 on USMLE Step 3

In this post I will share my USMLE Step 3 preparation process. I wanted to pass Step 3 before starting my residency therefore I was not able to devote as much time for preparation. Since it had been more than 1 year since I took Step 2CK I decided to start with Master the Boards Step 3 to brush up on my knowledge. But I didn’t spend much time reading the book and after 10 days I started doing UWorld questions.

Once I had gone through 50% of the UWorld questions I started doing CCS cases from UWorld since it takes some time and practice to become familiar with the software for the CCS cases. Simultaneously I watched a few of the Archer videos. I particularly liked the introductory video in which he tells about the various tips to order tests quickly and also when to change the location of the patient.

I did all 51 CCS cases from UWorld twice and read the other 41 cases once. After finishing UWorld (both questions and CCS cases) I took UWSA and scored 239.

Then I took my exam and I took a gap of 3 days between day 1 and day 2 because I wanted to go through the CCS cases at least once again since they constituted 50% of the Day 2 exam and also had a great bearing on the final score.

Preparation Time: 1.5 months

Study Material:
Master the Boards Step 3
UWorld

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How I Passed USMLE Step 2CS on First Attempt

This post is intended to help those who are preparing for Step 2CS. In this post I will be sharing my USMLE Step 2 CS preparation process and how you can also pass it on the first attempt. If you would like to see my overall profile you can visit My Residency Stats

The part of the residency match process that made me the most nervous was undoubtedly the Step 2CS. In my opinion one of the biggest flags on an application is not passing Step 2CS on the first attempt and that made me worry.

Step 1 and Step 2CK are only a representation of your theoretical skills but Step 2CS is the only thing on your application which are an indicator of your clinical skills. Sure externship experience or letters of recommendation may be an indicator but they can be attained through personal contacts and as a result may not be given much weightage unless a program director knows the person writing them.

Practicing Tips:

You should have a partner to practice with regardless of whether they are in the medical field or not. I practiced with my spouse and other students preparing for Step 2CS over Skype video. This helps overcome your anxiety of interviewing a patient and also you can practice doing physical examination and how to perform different maneuvers. Try to learn and explain your findings to the standardized patient using simple words and not complex medical terms.(You are evaluated for that!)

Practice with someone with good English-speaking skills and is preferably from the United States because some of us being IMGs may have difficulty understanding an American accent and on the day of the exam the fear of not being able to understand your patient’s accent can make you nervous.

Typing Skills:

Make sure your typing speed is good because your interactions with patients are timed during the exam.10 minutes might sounds like enough but I felt the time crunch – I was glad I practiced typing  before the exam. Try to get to a typing speed of atleast 35 wpm. There are several free websites online to help improve your typing speed.

Preparation time:

I took 1 month. Some people say there is no need for preparation,
but I feel it is important to give yourself atleast a month to prepare as passing this exam in the first attempt is as important as getting scoring well on Step1 and Step 2 CK.

Study Material Used:

  • First Aid for USMLE Step 2CS: I read all 44 cases from the book twice, not only reading them but also practicing them with someone.
  • CSE Videos: Felt like they were based on the First Aid book but did not feel like they affected my outcome much. If you are not confident in performing certain examinations/maneuvers you can find many videos on Youtube.
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How I Scored 259 on USMLE Step 1

This post is intended to help those who are preparing for Step 1. I would like to share some information on my USMLE Step 1 preparation process which resulted in a score of 259. If you would like to see my overall profile you can visit My Residency Stats

Preparation Time: 4 months

Study Material Used:

  • Kaplan Step 1 Lecture Notes (7 books): I started with Kaplan Step 1 Lecture Notes to brush up my concepts because it had been a while since I had studied the basic sciences. These books were great for this purpose. You should spend no more than 3 months on this.
  • BRS Physiology: Explains the concepts in a simple manner and it is a must read book
  • Goljan Audio Lectures (Pathology): I used to listen to these lectures when I did not feel like “studying”. It was a great way to refresh my mind and helped me grasp the concepts which are otherwise hard. Goljan’s method of teaching is amazing and it made the concepts easy to understand. Around 40% of the questions on Step 1 (in my case) were based on pathophysiology of disease process – so if you are good in pathology it may help you in the real exam.
  • First Aid for Step 1: This book is written in a really clear and concise manner, I read it word by word and line by line three times.
  • UWorld: UWorld or other question banks will strengthen your understanding of the fundamentals in the context of the real-world. After 1 month of preparation I began doing UWorld’s random timed questions and I made notes from the UWorld with the purpose of last minute revision.UWorld is a good indicator of where you stand, however in the beginning I did not give the scores much weight and rather used it as a tool to strengthen my knowledge. I tried to go through the explanations carefully which helps to answer other related questions. I took me 2 months to get through the first time. I did 2 blocks (40 questions per block) on average per day. It took me 4-5 hours per block
  • Conrad Fischers 100 ethical cases: I noticed I was not strong in Behavioral Sciences based on my NBME results therefore I read this book. Its an easy read (took me 3 days) and it helps you in choosing the correct answers for tricky questions.

Assessment Scores:

  • NBME 13 (Offline): 244
  • NBME 15 (Offline): 248, I did this test whilst I was halfway going through UWorld for the second time
  • UWorld Self-Assessment: After going through UWorld a second time I did UWSA1 and UWSA2 with a 5 day gap and score 262 both times

Some of my notes

Real Deal: 259

 

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