How tough is medical residency

Most of the people ask me about postgraduate residency programs in United States and a majority of these people are Nizhnians. There are also a few from Volgograd. I’ve already written about postgraduate studies in Australia, Malaysia, New Zealand, UK and other countries and I might as well write about United States. Please keep it in your mind that what I write can be wrong. So, you can verify everything on your own for further assurance.


1. Some people think that clearing the qualifying medical tests are enough for start practicing medicine in United States or that Medical Licensing Examination (USMLE) is enough for getting a residency. Even though, USMLE plays a pivotal role for residency in US, but just passing it’s Step 1, Step 2 CK (Clinical Knowledge) and Step 2 CS (Clinical Skills) are not enough for getting you a residency in US. The application involves med school insignia - literally a pain – and Step 3, which is mostly taken during or before the start of residency.

2. Exams accessories – they are of extreme importance. You have to select exceptional review books for revising USMLE. There are some brilliant USLME revision programs that include Kaplan and question banks (Kaplan, NMBE, USMLERX, USMLE World), which are really helpful for your practice. Make sure you don’t miss any of them, as they have been helpful to many people. People have been found spending big amounts on these, which range from $800 to 5000.

3. USCE or United States Clinical Experience is highly regarded in residency programs for interviewing residency candidates. And most of the candidates are required to have at least 2 Letters of Recommendation from US physicians. For getting a Letter of Recommendation, a candidate is required to take externship / subinternship/ observership programs, which eventually take a notable time. On the other hand, some scientific / clinical researches pay more attention to International Medical Graduates (IMGs).

4. Getting into United States – this is certainly tough as it is handled by bureaucrats and US embassy / consulate. IMGs need to have traveled to US for at least thrice before they could start their residency. They have to come to US for Step 2 CS, USCE, and finally for residency interview. Performing all these steps costs a lot of money and you are really going to hate it. But what you would hate more are Visas. Some people might get visitors’ visa, which is later declined most of the times. For residency Visa, you have to choose H1B or J1. H1B is for 6 years of employment and J1 is for a 7 years education. You need to be extremely good for employment in US and you must also possess letters from Ministry of Health for your J1 Visa. In most of the cases, people prefer J1, as it is much easier than H1B.

5. Application process to a residency program – this is a pretty painful process, which I haven’t yet been able to understand completely. It includes all those things which you might hate the most - pre-match, scrambles, NRMP, ERAS, interview processes, final applications, ECFMG certifications and several others.
6. Interviews – Mostly, IMGs apply for a small number of programs for interview, which ranges from 10 to 20. And a simple profile of an IMG has is 4-5 years post graduation, 2 USCEs at least along with a few LORs, 80th percentile and above for USMLE Step 1 and Step 2 CK scores, passed Step 2 CS on first try.
7. Specialties – some specialties are absolutely useless for IMGs, which include radiology, ophthalmology, anesthesiology and dermatology. Majority of IMGs opts for Internal Medicine and Family Medicine because American Medical Graduates (AMGs) choose an easier field with higher pays to be able to manage their medical school debts. Internal Medicine and Family Medicine residency usually lasts for 3 years. Many IMGs pursue their fellowship programs for their subspecialties, as the J1 visa is only valid for 7 years. Therefore, 3 years of residency along with 2-4 years of fellowship is good enough for an IMG to be called specialist.

8. Competition – It’s extremely competitive and there are some programs that can only be picked by those with 90th percentile or above for residency interviews. Moreover, some specialties including neurology, neurosurgery and surgery are even more complicated and tough for average people. You have to be extra smart and very intelligent to have completed all these courses with distinction. If someone’s is the most acknowledged surgeon in a foreign country, he might end up becoming family medicine physician in United States.

Okay, I guess it was the shortest possible summary that I could give you about residency in US. My knowledge is not even 10 percent as compared to the knowledge of several other IMGs, but I just tried my best to share with you all that I could after witnessing so many people discussing this topic on several online forums.

So, if you too are inspired to work in United States after watching all that charisma and brilliance in TV serials like Grey’s Anatomy and Dr. House, you should think about it again. Because it is very tough and takes a lot of hard work before you finally start living a perfect life of your dreams. Besides, it is a bad idea to look for fame, respect and money, as it won’t really be possible for majority of people. The work hours would be long and tiring, plus there would always be someone on yelling on your back as your supervisor. You will have to sacrifice a lot of friends; and you will also be away from your family and friends. So, if it takes all that, one should better become a nurse.


And for those who are inspired by fame, respect and money; you definitely won’t get any of that! What you get is probably long-hours of strenuous working with yelling supervisors, sacrificing your time and being very far from your family and friends, changing who you are and many other negative stuffs.

medical education

Residency matching tips

Hello everyone,
This should catch the Residency Match 2010 and maybe it will be of some help to those preparing for the same. It might even come in handy for the later generations of aspiring US residencies.
This is just what I did:
1. I sent in my applications for a total of some 150 Medicine programs – It is getting more and more competitive as each year passes, especially for the IMG programs. They say that the IMG-friendly programs got some 3,000 applications this year and this has been growing over the years. Probably because each applicant applies for more than 100 programs. That’s what I thought also and so I applied for 150 programs. I also intend to apply for Family Medicine if I don’t get enough interviews for Internal Medicine. Good thing I don’t have to apply for FM also. No point in applying for programs that you aren’t eligible for. Their software itself will probably filter the ineligible ones. Applying for more programs isn’t going to get you any more interviews. Apply only for those you’re eligible for.
2. J1 Programs – I’d wanted to apply only for the H1b programs, but as they say beggars can’t be choosers, and so best keep your options open and apply for both eH1b and J1 programs.
3. Credentials – Most programs use the USMLE scores as a selection criteria. Get a good score by working hard. You want to know what a good score is? Well, that’s pretty tough. For IM a score of 90 would be good, but then there are a good number of double 99s running around. Try and get the maximum scores for Step 1 and Step 2ck. Understand that Step 3 scores are not that important, but I’m not sure. I got 86 and one of the program directors mentioned that that was a pretty good score.
They say that a double 99 is a must for a good program. Don’t think that’s true. I got 95 and 99 and the 95 didn’t do me bad. Scores are just to filter applicants. Once the grain is separated from the chaff, the whole application is given a go through. So don’t give up because of low scores. Don’t lose heart. Some with even a score of 79 have got through. Try to pass at the first attempt. Suppose you fail. So what? That’s not the end of it. There are still some guys who got in after multiple USMLEs. There’s a light at the end of the tunnel, always.
Year Of Graduation – They say that most programs have a preference for freshers, but there were quite a lot of fellows who’d finished their PGs in their home countries. I think that programs prefer guys who’d completed their residency in their home countries. But that doesn’t necessarily mean that you should complete your PG to improve your credentials. No point in wasting time doing stuff that isn’t going to be recognized here in the United States of America. Quite a lot of fellows have got into residency straight off from under-graduation.
ECFMG and Step 3 – I’d got my ECFMG certification and had finished Step 3 when I applied for residency programs. Step 3 scores just might come in handy to get a few extra interview calls. Specifically if your Step 1 and 2ck scores are low. I’m not asking you to wait till you get your Step 3 scores before applying.
Research – There is difference between University and Community programs, University programs expect some sort of research activity on your CV, or publications. Publications in the US are more preferable, carry more weight. Update – I didn’t do any research anywhere, just participated in the ones in the hospital where I did my USCE.
USCE (Clinical Experience) – Clinical experience is something they look for in your CV. This is used as a filtering criteria by many PDs. Some do and some don’t consider just observership as US clinical experience. But don’t bother. Getting a observership is just as competitive and difficult at present. Apply for both observership and externship. Expensive but worth it. More the clinical experience the better.
Sep. 1 – Important! No compromise allowed! Get your LOR and MSPE documents ready and have them sent to ERAS by August. Also get your CV and your Personal Statement ready and out by Sep. 1 (00:00 AM EST). Go through your exams and be ready by Sep 1. Have at least your ECFMG ready by then. You’ll get a good number of interviews with just your Step 1 scores. Don’t take any risks. Better apply with all you scores by Sep 1.
The Mercy Of God – A short testimony. As far as I am concerned, the most important factor. It wasn’t my credentials but solely the mercy of God that I got all the interviews that I got. This is not an idle statement. I’ve experienced a lot of miracles and have surmounted some obstacles over the last two years on my way to a US residency. It is purely on God’s mercy that I’m even writing this blog, because until recently, I was nothing but a symbol of failure.
You wouldn’t believe it but I got my US visa only on my fifth attempt (rejected four consecutive times). I’ll soon enough blog on my US visa experiences. I now believe that it was God’s plan for me. Suppose that I’d got my visa the very first time I applied? I’d probably gone over my head, sitting on my own capabilities. Actually I’m only an average student and it is because of God that I am where I now am. This has only strengthened and will strengthen more my faith in God. Obstacles and problems take us closer to God.
I’ll now confess. All my research and USCE opportunities were nothing but the miracles of God. If not, I’d not have got even the 10 of the 26 that I did get.