Choosing a specialty for the match

This video is different from the article written below, however it is in Arabic.




Choosing a specialty to apply for in the match may seem like a silly topic to most of you, but in fact it's very important and should be decided upon almost a year before the match, but for those of you that didn't think about this topic you still have a chance.

When it comes to choosing a specialty to apply for, candidates could be divided into the following groups (according to how i see it) :

Group 1. Fresh medical graduates, with no specific preference

Group 2. Fresh medical graduates, with a specific preference to less competitive residencies (Pediatrics, IM, FM, Med-Peds, Psychiatry,........)

Group 3.Fresh medical graduates, with a specific preference to competitive residencies ( Ob/Gyn, Neurology, Surgery, Orthopedics, ENT, Radiology, Ophthalmology, Anesthesia .......)

Group 4.Graduates that did residency in Egypt, with no specific preference

Group 5. Graduates that did residency in Egypt, with a specific preference to less competitive residencies (Pediatrics, IM, FM, Med-Peds, Psychiatry,........)

Group 6.Graduates that did residency in Egypt, with a specific preference to competitive residencies ( Ob/Gyn, Neurology, Surgery, Orthopedics, ENT, Radiology, Ophthalmology, Anesthesia .......)


As we can see the decision for what to apply for in the match for Groups 1,2 ,4 and 5 is straight forward and easy.As they all can apply to the less competitive residencies available to IMGs.

The problem is in Groups 3 and 6.

For Group 6 their original specialty in Egypt is the same competitive one they are trying to pursue in the US, and they feel that they have been already 3 or more years in that specialty and can't be anything else . The advantage this group has is that they are eligible to apply for pre-residency fellowships , and in that scenario they will continue in their specialty and have a better chance of matching after a year or 2 of fellowship in the competitive residency they want.The problem is when there are no pre-residency fellowships available for their specialty or they are too competitive.Sometimes a year or more of Research (which is usually unpaid) is necessary before being accepted in a clinical fellowship or competitive residency.

Another problem Group 6 faces is that they are already older in age (average age is 30 years ) and the residencies they want are usually 4-5 years , plus they would want to pursue another accredited fellowship after that, and they might have to do a year or 2 of research before getting the fellowship in the first place. The other problem is that most of this group is married and have children, and need to be financially independent as soon as possible.

So for Group 6 : Try to apply for your desired competitive residency, but as a back up apply for fellowships and/or research. Research is easier in most competitive specialties but is usually unpaid, that's why a clinical fellowship which is always paid, is better if available. Always try to find someone who has supported previous applicants get into residency programs in the past (it's not easy to find out about this , since research positions are hard to begin with). If you try to do some international publications back in Egypt your CV might be competitve ebough to find paid research positions, but if you have no experience then you probably will not find a paid position easily.

Some people apply for a different less competitive residency (as a paid alternative ) and then apply for their more competitive specialty after being board certified. The best alternative in my opinion is to apply to a clinical fellowship (if possible), then apply for residency after that.

The idea of switching specialties (applying for a new specialty other than the one you did in Egypt) is also a valid one, and i've seen many people here in the US do that and lead normal happy lives. Three years of training in Egypt should not control the 30 years to come in your life (if you live that long). Some people say " But i was born to be a Surgeon, i can't be anything else " and that is just illogical , because no one was born to be a Surgeon.

You have the right to dream and fight for your dream , but be practical; if your dream is Surgery ,Ophthalmology ,Orthopedics , Neurosurgery , Radiology or other competitive specialties and you can't let go then search for it everywhere and not just the United States. Do everything you can to reach that dream, but don't get carried away and waste your life after false hopes. Remember you have a family relying on you and parents growing older everyday and will need you sooner or later.


For Group 3 , the candidates are usually younger (average age 26) and many of them are not married and don't have to support families. Since they did not do a previous residency in Egypt they can't apply for clinical fellowships, and their only option is to do a Research fellowship in these competitive specialties and apply for the residency directly after a year or 2 of research. They can also apply for an entirely different less competitive residency, then after being board certified apply for the more competitive one they want.

The advantage here is that they are younger ,can wait longer ,and can spend longer periods being unpaid or paid by grants only , than if they had families to support. The problem is that Research is a longer way to competitive residencies ( I know a fresh graduate who wanted ophthalmology and did Research for 7 years before he matched).

Like i mentioned before, i meet fresh graduates that tell me that they were born to be Ob/Gyns or Orso (Orthopedics bel masry), yet they did not do residency or get any training in that specialty.Wanting a competitive specialty as an IMG is not something bad, but it means that you have to work for it.

When i meet a candidate with 250+ scores , and has been doing Research in Orthopedics for 2 years and has multiple publications and very strong LORs and he tells me i want Orthopedics, i tell him , Go for it !! But when i meet someone with low scores , and no Research or publications or anything and they tell me they won't accept anything other than surgery, i'm not so optimistic. Being a fresh graduate should make you a bit more flexible than old graduates that did Residency in Egypt.

So for Group 3: You need to apply for Research in the specialty that you want as soon as you can , preferably with someone that is known for publications , so that you can get your name on a few papers, posters and do some presentations in conferences. Also try to work with someone that has been known in the past to support applicants get into residency programs in that specialty. You also need to do "Hands on training" in the form of externships if possible.There is also the option of applying for a less competitive residency then after finishing applying for your specialty of choice .


General guidelines :

I was once talking to one of my close friends and he wanted Surgery real bad, so i told him if you want Surgery then apply everywhere; apply in the US (residency and fellowship), apply in Canada (fellowship), apply in the UK (he did his MRCS) and apply in New Zealand. But if you want to practice in the US, then be a little more flexible and apply to back up specialties other than surgery.

Unlike mathematics where the shortest distance between two points is a straight line ,in real life the shortest distance between two points is being flexible. Flexibility doesn't mean accepting the status quo and getting the least competitive residency , but it means that you can reach your goal by setting several intermediate goals which are more available to you.


Now whether it's group 3 or 6, other factors should be put into consideration :

1. USMLE scores: with very good scores , you have better chances (notice the word "very" before good, usually means 240 or more)

2.Letters of Recommendation/Good connections : Probably more important than scores in some specialties, and in this case the person recommending these candidates actually sits down and makes phone calls to get them interviews, then sits down again before the rank order list to remind the program directors about these exceptional candidates that worked with him/her for quite a while.A connection here means that you have worked with someone for a while in the US or Egypt (like residency, research or observership) and they know you welll and like you and want to help you (that is the correct definition of a connection). Some people like to think of a connection as someone that doesn't know you and is recommending you just because you are an Egyptian or a friend's friend, but these type of connections are useless and not so effective. Try to work with someone that has helped IMGs get residency positions before in your desired specialty.


3. Publications: specially first author ones, also includes posters, book chapters, presentations and the like. I know egyptian residents in Egypt who had abstracts and posters accepted in medical organizations in the US, who when applied for research got paid positions and many interviews.

4. Previous US clinical experience (USCE): this is where clinical fellowship comes in favor for Group 6, although electives (during medical school) and externships are possible ways for Group 3 and 6, to get USCE. You can always apply for a prelim year in IM or Surgery, or a transitional year, and that would give you a better chance. The only problem is that these prelim years are competitive themselves, and more appropriate for people applying for Surgery (as in prelim surgery) and for candidates that do not have a visa problem (US citizens, Green card holders, EAD ....)

5.Post-graduate degrees: as Masters Degree and PhDs specially from a University in the US or other well known Universities (that doesn't include Universities in Egypt lel asaf). If you want to learn more here are some videos about Postgraduate degrees. www.youtube.com/playlist?list=PL34BA9D0E7F5F897D&feature=plcp

6. The amount of time and money a candidate can spend: American medical graduates that are competing with Group 3 and 6 paid on average $250,000 to finish Pre-med and Medical school and get the chance to apply for these specialties in their own country, so don't think you'll come from Egypt and not invest a dollar and get the same residency that these American graduates are fighting for. You have to invest in yourself as much as you can timewise and financially (according to your own resources). You have to do Observerships, Externships, Fellowships, Research, apply to more programs, score higher and many more things that Americans don't have to do , to get the competitive residency you want.This is a presentation about how to consider your medical education as an investment.

 

7. Most importantly of course is God's will, which can waive the need for many of the above mentioned requirements.
 

Mohamed Soliman