Road map to U.S. Residency

A seminar on tackling the match.

Dr. Muhammad Ali KhanDr. Faraz Khan Luni

Dr. Isra’a KhanDr. Muhammad Faraz Masood

Excited to carry a pager

Muhammad Ali KhanDow Medical College

Batch of 2008

Definitions

• ECFMG: Education Commission for Foreign

Medical Graduates.

• ERAS: Electronic Residency Application

Service

• NRMP: National Residency Matching

Program

• FSMB: Federal State Medical Board

What is a Match?

MatchProcess of getting into a US residency

program.Handled by NRMP

ROL (Rank Order List)Ranking of programs by candidates.Deadline: End of February.Residency programs submit their ranking of

candidates. Finally the MATCH is declared on Monday of 3rd

week of March.

What is a Pre-match?What is a Post-match?

• Pre-match

– Signing up of residency contract before the

match is announced.

• Post-match

– Unmatched candidates are provided a list of

programs having vacancies. They can then

apply there to get residency.

Pre-match vs Match

Pre-match Match

• Can start the visa processing before hand.

• Most University programs do not offer pre-matches.

• Visa processing begins by mid to late April.

• All programs enter the match.

Pre-match vs Match

Pre-match Match

• Peace of mind that you have got the job

• Small programs do not usually lead to competitive fellowships.

• You May or May Not match.

• University programs lead to all sorts of fellowships (especially if you are on J-1)

Post-match Scramble

• Starts on Tuesday and ends on Thursday of the

match week.

• One should ideally be in the U.S. to participate in it.

• Realistic for people who have contacts in that

particular program, have green cards or are

citizens of United States.

Components of a successful Match

•USMLE Scores - filters• Certification• U.S. Clinical Experience & LORs• Networking in the U.S.• Research experience (University calls)• Personal Statement• Time since graduation• Interview – Communication skills• Step 3• Medical school transcripts

1st & 2nd Years

• Concentrate on your basic sciences and academic achievements.

• Extracurriculars like volunteer organizations.

• Learn research methodology: use step 1 BS, attend workshops

• Make a professional CV and email address

• Identify mentors• Start on a research project

3rd & 4th Years

• Concentrate on clinical knowledge, Hx and PE

skills.

• Utilize elective slots to do more research projects

& clinical electives (local or international)

• Start applying to US universities for electives

which you will do in 4th and final years.

3rd & 4th Years

• Start building a contact/alumni list

• Present research at seminars

• Step 1 if possible

• Towards end of 4th year at least have

an idea of what you probably want to

specialize in.

Final year• Concentrate on Medicine and Surgery rotations

• Best time to take Step 2 CS is during the period

of clinical electives in US

• Should have some published research by now.

• By the end of final year should have done at

least two U.S. electives (the more the better)

• If not then do electives immediately after you

graduate.

After graduation

• Concentrate on Steps

• Aim for certification

• Keep in touch with LOR attendings

• Pakistani citizens should do house job.

• Prepare documents for the match.

• Clinical observerships

U.s. clinical electives• Best time to do them?• Should know how to present using

SOAP format• How to search for them?

– US news– https://www.aamc.org/students/medstud

ents/vsas/– Seniors/Alumni/Faculty– Google is your best friend

• Step 1 requirement

U.s. clinical electives

• Cost estimate for 2 months - $2000-

4000

• Apply at least 6 months in advance.

• Common errors: inappropriate email

address, informal writing style,

informal CV

• Alumni can be a big help

How to get good lors

• Plan to spend enough time with two attendings

• Show enthusiasm and interest – be inquisitive

but not excessively

• Cover at least 2 patients daily and read about

their conditions

• Be a team player

• Volunteer to give RELEVANT presentations/talks

how to get good lors

• Be friendly and make small talk too

• Don’t call everyone SIR!!

• Show independence in assessing

patients

• Don’t try to answer too many

questions and make other

students/residents look bad

How to get good lors• Ask for feedback at the end of your interaction

with attending.

• After feedback, explain to them your goals of

post-grad training. Request LOR

• Supply them with CV for LOR.

• Waived vs Un-waived

• Make good friends with the secretaries of the

attendings!

• Stay in touch

Local letters

• Ideally

- U.S. trained physician

- Personalized LOR from any senior

consultant.

• No Generic letters!!

- Useless

• IM applicants need one letter from Chief of

Medicine & four in total.

Research opportunities

• Local opportunities:

– Identify faculty at AKU, SIUT, Dow

– Initiate your own project

– JPMA , CPSP & Ayub Medical College Journals.

• International opportunities:

- mostly unpaid.

- best for people who have green cards or are citizens.

- if you get an opportunity GRAB IT, it might not knock

again

Student conferences

• Oral presentations are better.

• Matter need not have been

published.

• Try to participate in conferences

which are related to your specialty.

Personal statement

• Big opportunity to emphasize your

strengths!

• Why did you choose this specialty?

• Your personality, your strengths.

• Your experience in the US

• Should be one page: font Arial, size 12

Personal statement

• Get at least 6 reviews done on

PS

• Will go through at least 6 drafts,

so start working early

• Common errors: making it your

CV, spelling/grammatical errors

• DO NOT COPY, you will get

caught for PLAGIARISM.

Usmle Step 3

• Essential for H1b visa.

• Best time to take it as soon as you reach

US for interviews.

• Best prep is giving it soon after Step 2 CK

• Format: 2 day test – MCQs and CCS

• Can influence match favorably if used

properly

Official Timeline• July 1, 2010

- MyERAS  Web site opens to applicants to begin working on their applications.- ERAS Support Services at ECFMG will begin generating and distributing tokens to IMGs.

• September 1, 2010- Applicants may begin applying to ACGME accredited programs.- ACGME accredited programs may begin contacting the ERAS PostOffice to download application files

• November 1, 2010- MSPEs are released to ACGME accredited program.

• March 2011- Scramble.- NRMP Match  results will be available.

My timeline

• June – Start working on your personal

statement.– Start searching programs.– Get to work on your LORs, you need 4 at

least.• July

– Buy the online token of ERAS. The window opens from July 1.

– Start sending your LORs to ECFMG for uploading them on ERAS

My timeline

• August– Your LORs should have been uploaded at

your ERAS office.– Should ideally be certified by August 31.

• September– Apply to programs on September 1.

• October to January– Interview season.

MY TIMELINE

• February– Submit your Rank Order List.

• March– Match declared on Monday of third week

of March.– Post match scramble for three days after

the match.

Program types• Internal Medicine

– Categorical– Prelim

• General Surgery– Categorical – Prelim

• Family Medicine– Categorical

• Pediatrics– Categorical

• Neurology– Categorical: 3 years neurology + 1 year prelim IM

included– Advanced: 3 years neurology

Choosing programs

• One of the most important step of your application.

• First have a budget in mind.

• ERAS fee– Number of Programs per Specialty

– Up to 10: $7511-20: $8 each21-30: $15 each31 or more: $25 each

Choosing programs

– Example 1: A candidate applies to 30 IM programs and 30 Pediatrics programs. Total cost would be $305 for IM and $305 for Peds i.e. $610.

– Example 2: A candidate applies to 60 IM programs. Total cost would be as follows. The first 30 costing him $305 and after

that every program costs $25 i.e. his cost for the last 30 programs is $750 and total is $1055.

Choosing programs

• Dowites usually apply to 70+ programs, AKU people apply to 40 programs.

• Make a spectrum of programs when you apply– _____% University.– _____% University affiliated Community.– _____ % Community.

• Do not follow anyone blindly. Do your research before you apply to programs.

Choosing programs

• What to look for in a program?– Description (university, community or

combo)– Residents in the program (any dowite)– Faculty (any dowite)– Visa offered (J1, H1 or only green cards)– Fellowship offered & success rate of

fellowship placements among its graduates.

– Some programs will take AKU grads only from Pakistan (so be prepared for this bias)

Choosing programs

• My suggestions– Work as a team. Researching programs

can be very tiring at times.– Decide your budget.– Apply very well, it is an investment.– Start calling up programs by end

October & November.– Thank you cards.

Visas

• J 1 Visa (Exchange Visitor Visa)

– All programs which take IMGs sponsor it.

– All university programs.

– Fellowships are easier to find.

– Stamped for 1 year & status valid for 7

years.

– After 7 years, return to home country for

two years.

Visas

• J1 Visa continuation– Only during the first year you can return

to Pakistan.– After that you cannot exit US or else you

need to get it re-stamped.– Does not get converted to a Green card.– Need to do a waiver for three years to

convert it into H1b visa.– If you do not want to do a waiver

job……..get the hardship waiver, costs around $5000-7000.

Visas• H1 b visa (Temporary worker’s visa)

– Stamped for 1 or 3 years & status valid for 6

years.

– If you get a 3 year stamp you can enter & exit

US during the 3 year period.

– Gets converted to a Green card.

– If you have had problems with visa clearance

you may get your B1 visa converted to H1

status while living in the US

Visas

• H1b visa continuation

– Can be an expensive visa but is totally

worth it.

– Premium processing fee $1225 +

(lawyer fee $2000-3000 if University

does not pay)

– Few University programs sponsor H1b.

– More Community Programs sponsor it.

– Fellowships are harder to find.

Total expense

• Electives ………………………… $2500• USMLE STEP 1…………………. $ 920• USMLE STEP 2CK …………….. $ 935• USMLE STEP 2CS …………….. $1355• Application ……………………….

$1200-2800• Interview season………………..

$3000-5000• Two tickets to the US ………… $2200• Total $12,110/-

My Pearls• The 3 P’s for this whole process.• P: Party hard• P: Practice harder• P: Pray the hardest

• Why I chose this background?• You should always aim as high as the

sky.• Your efforts should be comparable to the

vastness of an ocean.• In the end it is your dream, your efforts

will pay off.

All the bestThank you !