Friday, October 5, 2018

Passport renewal in the USA for Indian citizens

Most residency and fellowship programs give only 1-2 weeks of vacation at a time. This makes it difficult to renew one's passport back home in India. Hence, it is easier to do the renewal in the States while you are working and don't really have a pressing need for the same.

I would recommend/it is recommended to renew your passport in the States at least 1-2 months prior to the expiration of your current passport. Generally would be recommended to do at 2- 3 months prior to future travel plans and the visa renewal, but would talk to the attorney processing your legal paperwork (like H1B or J1 renewals)

To be frank, the renewal process is pretty straightforward. Go to this website and follow instructions as is https://passport.in.ckgs.us/howtoapply. But just in case, I found a really helpful link to someone's personal experience on renewing their own passport. https://www.am22tech.com/renew-indian-passport-usa/

My personal timeline with the renewal process
  • Sept 18th- Submitted my passport application
  • Sept 19th- Under process with the consulate 
  • October 3rd- Returned from the consulate
  • October 4th- Shipped back to me
  • October 5th- Received my new passport

A couple of tips 
  • There is generally a notary at the place where you work who will notarize your documents for free
  • Passport size photos are 2*2 in the States. The cheapest spot I found was in Costco, but people have used Walgreens Walmart CVS etc. They are pricey just FYI
  • Renewals can be done on the basis of a petition. One does not need an approval to apply for the passport

Sunday, June 10, 2018

Moving tips for residents

Now that I am moving given a job change just a couple of tips for those who will be doing the same next year. Broken it down into phases

Looking for a new place
Apps that kind of help you scope out the places and average rent. Generally, 1-2 months is ideal timing since old tenants move out and you would be moving in.

  • Trulia- https://www.trulia.com/-  It gives you a sense of security, given you know the crimes that have taken place in the area and the average rent in the same region. Please note there might be a LOT of brokers in this place so you may have to pay a broker fee, WHICH IS A LOT! 
  • Apartments.com- https://www.apartments.com/ - This was a lifesaver for me in my hunt, since I was expected to shell out a LOT for an apartment. And the ones I saw were pretty expensive compared to the size. In my head, apartment complexes were nonexistent in the place I was moving to. However, on this site, you can see the different complexes and the average rent that it might be, which was super helpful and extremely relieving. 
  • Apartment List- https://www.apartmentlist.com/- This site helps you in shortlisting apartments based on your preferences of distance and budget.


Utilities/Mail
- Do note that you will have to end your electric/water accounts at your old place and start one's at your new place
- USPS has an amazing service whereby you can change your current address to your new one at this place and not worry about losing mail
- This is a website which helps in managing your electric utility bill. You get $25 off your electric bill via this referral link. The big reason I like it is that you can use your credit card when paying bills which helps in earning points. Review on Arcadia can be found here.

Bank accounts
- I would look for check whether your current banks have good coverage in the place you are going to move to. Eg- Chase is great in Ohio, but BoA is better on the East coast. Similarly, KeyBank is a major player in Ohio, not so much on the East coast.
- So either close or keep your current accounts depending on what suits your requirements.
- Update your mailing address with the accounts so as to not have issues when you make transactions.

Credit Cards
- This would be a good time to open a new credit card had you not already done so last year. Link to my credit card recommendations is here and flying tips with Amex referral is here


Selling your old things
Apps like LetGo and OfferUp work well, or you can sell your furniture to your juniors/colleagues if you do not like transactions with unknown people.

If you have more tips please post below, or send me an email with your comments and I will update the same.

Thursday, May 17, 2018

Step 3 preparation by Puneet Baweja

Hi all the following post is by Puneet in regards to preparation for Step 3.

Preparation Materials: Master The Boards Step 3, Step 2 CK UWorld notes, Uworld qbank and CCS. 

Preparation: Go through MTB properly once before starting qbank. I added in ccs portion about halfway through the qbank. I had about nine days between the two parts, therefore, the week before each exam I concentrated only on the relevant material. 

Day 1 - Foundations of Independent Practice (FIP): This is basically CK along with basic science correlations. Concentrate on your uworld CK notes and all the basic science in MTB. As for Biostats, go over all the cases in uworld once a couple of days before and create your cheat sheet for the equations. In the real exam, Biostats use up a lot of time therefore if it seems like it could take a while just click something and move on… come back to it if you get time at the end of the block. 

Day 2 - Advanced Clinical Medicine (ACM): This is all about managing comorbidities, risk and prognostic factors. Go over your step 3 uworld notes for this. So make sure you know which risk factor matters more in each patient and know where to pick treatment over investigations. Don’t even bother looking at biostats or basics anymore. Your notes for CCS will help here as well since it’s all management, therefore, don’t wait too long to start CCS. 

CCS: This again requires work if you’re not a resident. Familiarize yourself with the software, it’s all about practice. Approach this like CS- Have a plan of what to do and which differential diagnosis to suspect depending on patient history. Know how to order each investigation in the most convenient way, as in type in oxy to select oxygen therapy as well as pulse ox at the same time. Also, the week before day 2, as I went through MTB, go over all the diseases a general physician should be able to treat in CCS manner. This way you won’t forget the specific investigation and treatment in the real exam. Also, don’t forget to go over the ccs software on USMLE's website since it’s a bit different than uworld.

Best of luck!

Puneet
drpbaweja@gmail.com

Wednesday, February 28, 2018

A million moving parts

The following post is by one of my colleagues at work. An amazingly inspiring story to keep persisting when all the odds are against us!

"It is a gamble. There are a million moving parts to matching to Residency and despite everything we do, there are powers beyond us that determine how those million parts fall together. But fall they will, and you will have an answer on the 15th of March. That is the best thing about this whole journey. Closure. I was lucky. Very lucky. I had a lot going against me. I applied for residency at the age of 28, 4 years after I'd graduated from an obscure medical school in China. I had lower end scores, no step 3 and I needed a visa. I matched in my first attempt.

 Here is my story.

It was 2014 and my boyfriend of 5 years and I would spend hours discussing ways of avoiding the inevitable course our futures held, had we stayed in India with our social limitations on just being us. I wanted out. Soon after graduating, I worked with the organization of my dreams-Doctors without borders. 3  years with them allowed me the privilege to serve in the poorest and most dysfunctional parts of India. South Chattisgarh, Eastern Nagaland by the border with Myanmar, Mumbai. I did my time and worked hard. In my last project in Mumbai just as I joined the project, I had 2 colleagues leaving to begin their Residency. This serendipitous moment planted the seed in me to think of the USMLE's. I had never really thought about it prior to that.

30 days later, I quit my job, convinced my parents and boyfriend that this our future and started the journey. I had no idea the rollercoaster ride I had just thrown myself into.  This was the biggest risk I had ever taken. I started off by deciding on a timeline to get things done. My biggest struggle was getting Clinical experience opportunities. Every hospital that offered observerships required step scores or personal recommendations. I got lucky early when I applied to observe under an ID doctor at a  hospital in Florida that accepted me simply based on my personal statement and my past ID experience with MSF.  A lesson for all of you is try to tie your past life experiences into your application. It really helps. My ID observership was a huge success. I was diligent during the month, came in earlier than the residents, left after, attended lectures, helped out the team, reached out to other faculty and got myself on board 6 publications that help me to this day! Another tip for all of you is to try to network with other faculties in the hospital you are doing an observership in. You won't believe the doors that will open  with a simple email to a professor in the hospital(I introduced myself as an observer in the hospital which I was--gave my email a lot more relevance)

My second observership was a disaster. I made a cardinal mistake of doing my observership in a specialty I had no interest in.  I struggled with showing interest in contrast to my previous observership. Lesson number 3- Might be obvious but please do electives in subjects you are interested in - Your passions drive a lot of your juju and people can easily spot when you don't have your heart in it. It's funny because I was in cardiology.  My third observership was at a community hospital in Cleveland that was fortuitous in that it put me on a path that would eventually lead me to Residency. I again used my rule number 1  which is getting in touch with other physicians while I was on this rotation, except that this time I started emailing attendings and contacts outside the hospital. I noticed I had a colleague from my MSF years doing his residency in Cleveland and reached out to him and he connected me to a physician at the Family Medicine clinic of the program I eventually matched into.

This opened a lot of doors. I was able to learn more about the program in an area of medicine I was passionate about and it showed. At the end of the rotation, I got a stellar recommendation and the program very likely factored that in when they ranked me. I interviewed at a couple of other places but my heart had already been set on this program. On March the journey came full circle when I opened the email. I had matched!

In hindsight, I would give the following advice
-Networking matters! Help is found in the most unlikeliest of places. Reach out to other doctors at the hospital to possibly extend rotations
-Do observerships/rotations in a field of medicine you are interested in
-Figure out what your life story is and if you feel it is not extraordinary --make it! There are a million NGO's looking for volunteers, it will give you a nice context to weave your narrative


I wish you all the best and ask you to be hopeful! I matched in the face of a million odds. It is possible. The other side is beautiful.

What if you don't match
-try again a second time. Do rotations that are in programs with residencies
-Think about alternate medical careers-Not the best option if you want to do clinical but Clinical Informatics is a great option-there is an increasing demand for FMG's with a medical background to get involved. Another option is the pharmacy industry. There are always options available if you look closely. You will probably have to do a few months of unpaid work before you get your foot in the system.

Rahul Shenoy

Tuesday, January 23, 2018

Fellowship application timeline

This is regarding my fellowship application for Pediatric intensive care application. This is based on my personal journey. I had a LOT of help during the same and I am ever thankful for my mentors, seniors and colleagues for guiding me through the way.

First off, once you have decided you want to pursue a fellowship I would start working on building contacts in the field. I spoke to my seniors and mentor and asked what I could do to make myself more marketable.

Couple of things that I did/things that were recommended
  • Away electives- If your program lets you do so. Generally, helps in building rapport with attendings at other programs and thereby your network.
  • Research in the field of your interest/application
  • Presentations: Try presenting at a National conference if possible in your 2nd /3rd year of residency prior to applying for a fellowship if possible.
  • Work on your personal statement during your down-time in 2nd year. Since this is generally the bane of existence for most residents

For Pediatric fellowship the time line is a bit as follows
Somewhere in the middle to end of June
Apply for a token to create an ERAS account
End of June to 2nd week of July
- Work on the ERAS application.
- Get LOR’s (take into consideration that your attendings are busy and have a life of their own! They will take at least 2-3 weeks to write you a STRONG LOR. Do consider that it takes 5 business days to upload the same to ERAS. The Program Director LOR has to be one of the 3-4LOR’s that you send to programs) P.S.- You should be dropping hints to them in the end of May that you are expecting them to write LOR’s for you in case I missed mentioning that.
2nd week of July
You can technically apply if your application is ready to the programs. P.S- The programs CANNOT see your application yet
July 15th
Moment of truth. This is when the real application begins, and programs call for interviews
July 15th till the mid November
Interviews take place here. So, a lot of post call travelling and leave requests and what not. Finances/travelling tips for fellowship interview in another post that you can find here
Mid October to end of November
Work on your ROL. Trust me a month seems like a LONG time
End of November to Mid December
The MAGICAL match process takes place in NRMP. Start praying for good news.
Mid December
Cheers! You have matched at your desired program! 

If not take part in SOAP (post-match scramble in residency)

Please note: NRMP token opens somewhere in between. I do not remember the exact date unfortunately.
Tips on looking up programs
  •  Talk to seniors, attendings on the places you are applying to PRIOR to applying.
  • Visa is another criterion that some of us used prior to applying. Unless you do not have such restrictions
  • FRIEDA is a good place to read on programs as well
  • Lastly email the coordinator for places that you have no information on. They will generally get back to you within 2-3 days.

 Hopefully this helps all individuals who will be applying the following year for fellowship! Best of luck and fingers crossed

Sunday, December 10, 2017

The road to residency: how I got into a competitive specialty with low Step 1 score, no research and no electives

The following post is from one of my colleagues and good friends from residency. I know a lot of great medical students give up on their dreams should they not match in the first attempt. This post is for such individuals to tell you that there is light at the end of the tunnel! Dream big and you will make it!

"I first decided to study for the USMLE when I read questions from First Aid to USMLE that was sitting on my friend’s shelf (Thanks Nishchit). After reading that book, I was convinced that the training I would get in the United States would be the kind of training that would suit my personality and allow me to grow. I was right. I am a fourth-year Med-Peds resident at Case Western Reserve University- MetroHealth Medical Center, Cleveland, about to enter a fellowship in Critical Care Medicine at University of Pittsburgh Medical Center (UPMC), Pittsburgh. I am living my dream.

It wasn’t easy getting here though. In addition to being an IMG from India and needing a visa, I had a low Step 1 score, a good Step 2 score, passed CS and Step 3 in first attempts, and had no elective experience. I had only one month of observership when I first applied for Internal Medicine. I had no research or volunteer experience. Oh, and did I mention that I was three years out from my graduation? Needless to say, I didn’t match the first time. It was hard. It was crushing. After almost two years of studying, spending money to go the United States and having the right intention of simply wanting to learn, I didn’t match. I sat on the curb of a busy street in Bandra and cried my heart out. My partner who was sitting next to me cried with me.

I woke up the next morning, opened my laptop and looked at my resume. I looked at all the things my profile was lacking. I needed more US clinical experience and I needed to do volunteer work. At that time was working in an ICU in Mumbai. My work was shift based and it wasn’t hard for me to find another job. I found an LGBT clinic in Mumbai and started working as the staff physician. The clinic was located within the office of a large non-profit which had connections to the United States. (I did not know that at the time) I worked hard and made connections with two US physicians. One I reached out to myself- a Med-Peds physician running an LGBT clinic in Ohio and the other a Family Medicine physician who had come to the Mumbai clinic for a conference. The Med-Peds physician decided to take me on as an observer. The Family Medicine physician got me interviews at his program. I worked hard during my observership with the Med-Peds physician and got into the residency program there. 

It all seems smooth now, as I recount the steps I took to get a residency in the United States. It wasn’t easy though and often I wondered what I would do if I failed.

My path is unique and can hardly be replicated. But I have found that the common thread between my story and other success stories is ‘persistence’.

USMLE scores are extremely important, but they’re not all that matter. If your scores are not good, make sure the recruiters see your other qualities that will make you a good resident. My profile wasn’t very good on paper, so I set out to correct that. I also knew that I was a hard worker and people liked my work, so my goal was to demonstrate to my future boss that I would make a good resident. It worked. I got into a highly sought after residency program.

The road to a residency in the United States is a long and hard, but in the end, it is fair and I assure you that you will grow as a physician. However, before you embark on this journey, make a commitment to yourself that you will get into a residency program in the United States.


You WILL fail if you give up! But you WILL succeed if work hard and persevere! Failures that come along the way are only to make you stronger, to make you a better professional. So take that in your stride and work on making yourself a more attractive candidate. The rest is, as they say, up to what some call God, some luck and some providence. 

Varun Shetty
varunshetty@protonmail.ch"

His story continues here http://neilnf.blogspot.com/2017/12/the-road-to-fellowship-aiming-for-stars.html

The road to fellowship: aiming for the stars

This post is by my colleague who I had to hound to write this post once I knew where he matched. The reason I wanted him to write this was to prove that IMG’s do have what it takes to get into prestigious institutions and to not listen to the disbelievers!

"I was ecstatic when I got into the Med-Peds program. It was the perfect program for someone with a global health interest like mine. Also, after having worked in Mumbai in non-academic settings for a year, I was hungry to learn. Medicine became my life and I enjoyed every day at work. Finding my way into residency also gave me confidence.

I then made a decision. All my life I was aiming low, telling myself that I would never be good enough to go to AIIMS, Harvard or any of the Ivy league programs. I told myself that this time I will try. I will work hard to find myself in the best program in the specialty of my choice.

So, from the beginning of my residency, in addition to focusing on my clinical growth, which I must add is extremely important and indispensable, I starting thinking about what fellowship I wanted and how I was going to get there.

My interest is in the practice of critical care in a global health setting. I decided that I wanted to do Infectious Diseases and Critical Care- an unusual choice but an upcoming specialty in medicine. With my program director’s help, I found a mentor and worked on an ID research project. I completed it within the year and submitted it to IDWeek, an international ID conference. I presented there the year after. I also worked on workshops, papers and other teaching projects.

I realized in the course of applying to residency, that being on a visa is big negative for programs. H1B visa narrowed my fellowship prospects further. So I had to be the best candidate possible.

Somewhere in my third year, I realized that Med-Peds being a four-year program, left me with just two years for fellowship as the limit on H1B is 6 years, after which we have to have applied for a green card or leave the country for a year. I had to then make a choice. ID or Critical Care. I couldn’t do both, at least not initially. This was really hard. I knew I loved both but I couldn’t decide. Also, my profile was better suited for an ID program than a critical care program. After weeks of thinking about what I wanted, discussion with visa lawyers to get the specifics of visa and green card right, I decided to apply to both ID and critical care. My philosophy was that what I really wanted was to be in academics practicing global health medicine. It was important for me to land in a program that supported my career interests and helped me grow. And as I found out through the fellowship interview process, it is predominantly about finding a mentor.

I looked at ID programs and realized that I could not even apply to some Ivy league programs because they wouldn’t sponsor an H1B visa. I looked at 30-something critical care programs and found that only about 15 programs sponsor an H1B visa. I was indignant, but thankfully I had put in all the work to become a good candidate.

I heard from some really strong ID programs and I was drawn to all of them! Amongst the critical care programs, UPMC, Pittsburgh seemed most interesting. It is probably the oldest critical care program in the country and arguably one of the best. When I interviewed at UPMC I found out that they have a global health track. I also found a physician there who I knew would be the perfect mentor for me. My interview went well. I was well prepared (make sure you prepare for some behavioral questions) and my enthusiasm for my future career interest and the program was apparent. I got a pre-match offer for critical care (most critical care medicine programs are not part of the match) and I was thrilled to accept it.

I look back and see how far I have come. How many years it took me and how hard it was. But when I was inside it all, I never dreamed I would come this far. But I did not doubt my love for medicine, my enthusiasm or my stamina to do what it takes. My only motivation was, and is, to become the best physician I could become!

I won’t oversimplify the process of getting into residency and fellowship by saying that all that is needed is motivation and love for the field, because I know that unearned privilege like having money to stay in the US to do rotations, luck, meeting the right people and bunch of other factors all make a difference. But I can tell you that you will absolutely need hard work, motivation and perseverance to make your dream come true. It is possible to become that successful physician you want to be.

Dream big. It will happen.

Signing out

Varun Shetty
(varunshetty@protonmail.ch)"

Tuesday, November 14, 2017

Travel experiences from a newbie on the fellowship interview trail

It seems like just the other day I got done with the residency interview trail and now I am going for the fellowship interviews! Please note the following is for fellowship interviews. If you are a medical student applying for residency I would use my earlier post.

Couple of differences that I noticed between residency and fellowship interviews is as follows

  1. Given you are earning in dollars now, the pinch of money is NOT too much but still palpable
  2. Most hospitals generally provide accommodation. The really fancy ones even pay for the airfare!
  3. The fellowship programs are trying to sell themselves to you instead of vice-versa (at least that is what I felt)

One goes for interviews generally in the 3rd year of residency OR 4th year if you are Med-Peds/Chief in your program. So if you are in residency you generally travel on post-call days, eat pre-interview dinner and sleep at night in the hotel accommodation the program provides. Therefore as mentioned in point 1, you want the fastest yet cheapest option. This is generally flights unless the distance is not too far in which case people do drive.

Couple of tips that I felt that a candidate can do to make the experience easier (at least in my case; please note that different people have different options. This is my experience)
I highly recommend getting the Amex Platinum credit card since it gives you HUGE perks. My referral link is this. To list a few
  • 60,000 membership reward points for spending 4k. You will definitely hit this depending on the number of places you interview at
  • $200 airline credit- It works with only single airline
  • $200 Uber credit ($15 per month)- One uses this feature A LOT on your interview trail. 
  • $100 credit for TSA pre-check which is something US citizens can do but for IMG's only if you are one of the global entry countries can you do the same
  • Access to a LOT of lounges during flights. I feel this is another BIG perk for residents who are interviewing and frequently flying
  • You get complimentary gold access to Hilton, Marriot and Starwood preferred. (The hotels treat you like royalty)- As mentioned in point 2 on the top, the programs pay for the stay. So you can give your account number at check-in and you get rewarded for the stay.
The annual fee though high ($595), I feel the above perks are worth it.

Please note- 
- In case the program does not pay for accommodation, you can check Airbnb for a place to stay at a cheap rate and maybe rent a car to the interview/uber it.
- One can also apply for the Chase sapphire reserve since that has travel deals as well.

I flew the following airlines. Highlighted the perks and features which I liked. All the airlines generally give you pretzels/cookie with a drink (coke, Pepsi etc). You can spend money on hard drinks should you want to indulge in the same.

JetBlue- Loved this airline since there is free wi-fi with amazon prime video streaming. The food is amazing as well. The leg space is GREAT! Given I am a tall person, I love when I can stretch my legs without feeling like I am cramped in my seat.








Southwest- There is NO predetermined seating. Your seat is dependent on WHEN you check in. You get a boarding group number and at the time of boarding, you are broken into groups based on the same. You board the plane and call dibs on the seats. The biggest perk is the 2 checked bags for free, which you can use if you are changing your base-camp. You get wifi to watch cable channels to kill time. You have to pay for internet though.




Delta- The service was great. Loved the food. But depending on when you book your tickets you may get a good deal.










American Airlines- Cheap low cost but no special perks that I would run wild for. Had a couple of bad experiences but the flight crew made up for the same.










Just to get myself organized, I used the following apps. They are available for Android, Apple and windows.
Tripit Pro version- It is $49 for a year subscription which is okay per me for the interviews. It gives you notifications on when you can check in and gives you the shortest route to take to the next gate, which helps when your layover is just half hour and you have to run to the next gate. You can even store your hotel reservation, so you know your itinerary is not missing anything.







Awardwallet pro/free version- Helps you track your miles and know when miles are expiring. It also has a feature of letting you know when to check-in. My referral link is this 

Tuesday, March 21, 2017

Medical training license for Ohio residents

The application for training license for new residents is pretty straightforward and self-explanatory. But here is the simplest explanation for filling out the form.

State of Ohio Training Application Medical Training Certificate applications are available online at the State Medical Board of Ohio website: http://med.ohio.gov/DNN/PDF-Folders/Applicant/TrainingCertificateApplication.pdf

It is a 27-page document. The following page numbers are to be co-related with the same.

Page 8-
- Choose MD
- If you do not have SSN leave it blank
- For physician address- you can use your home country address if you do not have a US one at the moment

Page 9-
Leave ECFMG certificate expiry date blank

Page 11
Put the dates you stayed in USA and state traveling for interviews

Page 19-
You can use your home country's notary for the Affidavit but let them know it is a legal document and then do some fancy stuff and charge you the same

Page 24
Leave the expiration date blank

If you are an IMG you do not have to fill pages- 23, 25  

Once the form is done contact your program on how to go about after the same.

Saturday, March 18, 2017

J1 Visa process by Zeeshan Mansuri

J1 PROCESS (for INDIA)
1. Match day – YAYYYYYY! Match day done and dusted. Now, what’s the next step?
2. Wait for the email from your program coordinator. They will send it by next week.
3. You will receive a packet of your residency contract plus 100s of other forms from your program, which includes the same info to be filled in a gazillion times.
4. For J1, browse the MOH (Ministry of Health) website. Download the Statement Of Need (SON) application (attached with the post) and complete the bond papers and get it signed by 2 people, your father/mother and a gazetted officer (Check the application form for details). The bond basically states that IF you fail to return to India to complete the waiver, you/your Dad/Mom will pay 5 lakh rupees to the Government of India and IF you/your Dad/Mom fail to do so, the gazetted officer who signed the form will be liable to pay. Also, the gazette officer should have more than 7 years left in his/her service and CANNOT be a blood relative. Also, you will also require a sign from the gazetted officer’s boss to confirm that the gazetted officer is speaking the truth and has furnished the correct information.
5. Make sure to sign each and every page of the SON application at the bottom. Make sure to fill all the different annexure forms in the application as applicable.
6. Please plan to travel to New Delhi once they start issuing. They usually will give you a token number and will process only 25 a day (This varies from year to year). If you or your friend can go (your friend will need an authorization letter signed by you, authorizing him to get the SON in your place).
7. No bribing in the MOH office last year. It may change this year. (You get the point!!!)
8. ONCE YOU RECEIVE THE SON, MAKE SURE DATES OF YOUR RESIDENCY, YOUR NAME, SPECIALTY ARE ENTERED CORRECTLY. Remember it’s a Government office and they will be casual and make spelling mistakes.
9. Pay your SEVIS fee early. Your application will be processed by ECFMG by the order u paid your SEVIS fee. Make sure that all required documents are uploaded properly.
10. Send the NOC to the program. They will upload it to OASIS on the ECFMG website. ECFMG will take approximately 1 -3 weeks to send your DS 2019 form. Once you receive in your hand, you can schedule your visa interview after paying the appropriate fee.
11. The interview is very chilled out consisting of 3-5 questions. The visa officer will sign your ds 2019 and give it back to you (if he/she forgets, ask for it and keep it safe).
12. Passport in 3-5 days - bingo!!
13. Book your flight tickets by April 15th. Anytime later than that will hurt your dad's wallet by extra 150-200$. I would suggest going back ASAP.
14. In between, your program coordinator will be sending your more documents to sign and return.
15. All J1 applicants can start from India 30 days before the official start date of your program. (H1B people can start only 10 days before start date).
16. Visit all places you want to go and meet everyone you want to meet. Once you start residency, you will start missing all of that. These next 100 days are going to be THE golden period of your lifetime. THE last big vacation. Enjoy every minute of it!! Feel free to add info, correct anything or ask questions. Cheers! Good luck :) God bless :)
Best,
Zeeshan Mansuri

Saturday, December 3, 2016

Internship

This is regarding internship aka 1st year of residency in my program

General rules
Most programs make each module lasting 4 weeks, and they generally start on a Monday in internship. There are a TOTAL of 13 modules for the academic year, with a month for vacation

The first month was more of getting used to the EMR system in the hospital while figuring out how to get from home to hospital and back! Another part of starting new in a place is figuring out transportation. Should you be in New York, the public system is well connected. However, in Cleveland, the same is not true! You will need a vehicle if you intend to survive internship, at least that is what I think! Let me give you the following example- If I take the bus daily, I will take an hour to reach work, but if I have a car I will reach the SAME place in 20 mins, which translates to 40 more minutes of sleep! Who says no to that! 

Lastly, it takes every resident, in my opinion, a good number of days to learn how to function in a new unit. But, I feel as long as you have good seniors, you will thrive, no matter where you are! 

EMR (Electronic Medical record)
Things that I would recommend future applicants to look for is definitely the EMR (electronic medical record) system which a hospital uses. For example, my program uses EPIC, which is PRETTY powerful. We do NOT have written documents and thanks to a tie up with different hospitals within the EPIC ecosystem we are able to access patient records in other hospitals as well. 

As an intern trying to learn the ins and outs of Epic, took me a GOOD amount of time ~a month, and that too I only knew the basics. Till date I keep finding out new things about epic, both from my current interns as well as the attendings I work with, to say the least.

Things the EMR is used for - writing daily progress notes, results for labs that were sent and at times to mail another physician via the patient workspace about patient information. When I started my residency, my PD and chief, realizing that we as IMG's have a lot to learn placed us in electives, which helped us learn how to function in epic without getting too overwhelmed. For my good fortune, I had a co-resident, with who I powered through learning EPIC.

Modules
Wise wisdom from a senior of mine- 'Internship is not about learning, it is more about surviving! You are in a new place, with new colleagues, learning new etiquettes and to top it you have a NEW EMR to figure out, the best you can do in this year is to survive! You will start learning in your junior and senior year; so make mistakes and don't be shy to ask questions, as you are here to learn!' And now that I am in the 2nd year of residency I cannot but express how true those words are! Internship is more about getting to work and getting your responsibilities done in time i.e. time management.

Most programs have the same set of modules, but just different names. Our program has a good mix of general floors, subspeciality floors, outpatient experience, ED, electives, NICU and vacation in internship. 

I started off with electives, which for me was perfect, I used to have a good amount of teaching, and given we had to get certified in BLS, NRP and PALS, my attending used to let us off for the needed amount of time! I loved the attendings who I worked with and I imbibed some of their signature moves, so to say, because they were so good! 

For the next rotation I went into NICU, this for many of the pediatric residents, seems to be the bane of their existence. For this, I went in with advice from a senior, who said 'You either hate the NICU or you love it, there is nothing in between!'  I had amazing seniors in the NICU, who helped me out, not only by helping me write progress notes, but by also doing some of them on my first day when they realized I was freaking out and sweating buckets!! Here knowing dot phrases (things we use in epic to auto populate results) plays a major role!

And then finally I went into the floors! Again I had amazing seniors! I still won't forget the first day I did my pre-rounds, I was a mess. My seniors, to whom I am ever thankful for, took me aside and pointed out what was wrong and ways that I could improve, and after that floors were a piece of cake. Towards the end of the rotation I even was told that compared to what I did on day 1, I was a much better resident at the end! The work times for floors as an intern is hard! You have to reach early in the morning, so as to finish pre-rounding, which includes knowing the overnight events, labs that were sent if any and a focused physical examination. Here I feel in addition to talking to the overnight resident, the nurses play a major role, as they know minute by minute play of what happened with each patient. Learning to admit and discharge patients along with discharge summaries, is a MAJOR role done by interns. Towards the end of internship you realize what labs to focus on and how to present cases better, things like lab trends make more sense that just reporting numbers! In floors, you depend on your co-residents to help you out with work like admission and discharges, seniors for tips and tricks with EMR and nurses and finally the attending on how to interact with patients!

In the States there is something called as a resident team clinic (continuity clinic)- This is a place where you get to see every week on a particular day, a set of kids for well child visits. You become a child's pediatrician, something that I am sure most of you want to do! You get to see a child grow up in front of you which is a wonderful experience.! In this team clinic, you are generally with a preceptor who helps in molding your general pediatrician skills. There are so many things you can learn from you preceptors if you only let them teach you! The urgent care clinic is considered the outpatient experience. You get to see a wide variety of illness from colds to rashes to asthmatics to what not! You learn to figure out which is a sick vs, not sick kid!

Lastly, we also have a rotation in the newborn nursery which I must say was really amazing for multiple reasons! One since you have cute babies there and 2 because my attending was amazing and 3 because my colleagues were hilarious! 


As your residency progresses, you will learn that your co-residents play a MAJOR part in how you like your program. Even seniors, since if you don't know anything they are the people who can guide you to the correct answer. In my program at least, my batchmates are really amazing! Everyone steps up if the work is too much for one to handle! Lastly, we throw random functions for no good reason! 

Fellows, though people say are not good, I feel if you use them in the right way they are the best people to have. For example, you are interested in a particular sub-speciality, fellows help in telling you what things you should look for in a program and they are also more approachable compared to attendings given they are younger as well as they know what a resident is going through! 

Now at the end of my internship, the only thing I look back and think, if I had to do it over again I would not change anything! The entire year was one roller coaster ride, but it was worth it!

If there is any grammatical error, please excuse it! Just wrote this in an hour for people who are going to come over for residency!

Saturday, August 6, 2016

Credit Cards and Terms made easy

I am not sure how far it is true. But referral links seem to help some people get credit cards quicker than if they try to apply for the card themselves.

Just as an FYI, some people wonder what it is to have a credit card and what does it entitle you to 
  • Credit line- This is your spending limit
  • Cash access- When you use your credit card to withdraw money like a debit card
  • FICO score/credit score- It measures your credit worthiness to credit card companies. It is a BIG deal in the States, at least if you planning to buy a house or take a huge loan. A good number is anywhere >700 I believe and an ideal number is >750. This site is useful for people interested in knowing more about credit scores. Factors that impact the score

    1. Payment history (35%) Timely payments on all your accounts can help you get a higher score. The score is lowered for late payments, delinquent or over limit accounts, bankruptcies, and liens.
    2. Total amount you owe (30%) This is the ratio of what you owe to the amount of your available credit or your debt-to-credit ratio. A high credit card balance can lower your credit score as it may reflect difficulty affording your monthly payments. However, if you have a high credit limit and you keep your balances low, your debt-to-credit ratio will be low, so a higher credit limit can help you protect your good credit score. But this is only the case if you continue to keep your balances low.
    3. Length of credit history (15%) This shows how long you've been using credit and how well (or poorly) you've managed your finances in the past.
    4. New credit accounts and inquiries (10%) This includes accounts you've opened recently and recent inquiries from companies you've applied to for credit. Be aware that applying for too much credit can lower your score.
    5. Types of credit in use (10%) This includes all your credit accounts—credit cards, installment loans, mortgages and other types of credit.
  • You can also use credit score checking sites like Credit Karma or Credit Sesame which helps to keep track off credit checks on your account


Example for the use of a credit card-

I want to buy a 4K item but I have only 2k in my BANK account. For people from my country where debit is the mode of payment, one would have to wait till you have the money to buy things and only then can you buy it. This is where a credit card comes into play, it gives you the power to pay for stuff that you DO NOT have money for at the moment. So say I have a credit line of 5k, now I can definitely buy this item since it WITHIN my spending capacity, in other words, I have an invisible amount of 5k which can be used to buy it. Now the only trick is that you HAVE to pay off this balance before the set due date on your credit card. So you have to link your bank account to this credit card and pay off the amount you spend on it. PLEASE NOTE YOU HAVE A DEADLINE for payments, so if you are sure you WON'T have the ACTUAL money to pay off the credit card DO NOT, I repeat DO NOT BUY the item.

People do say that one should not MAX out a credit card. It means, if I am not mistaken, DO NOT over spend. So say the item was 6k and your credit card limit is 5k, then sorry to say my friend YOU CANNOT buy the item ONLY on the credit card. However, you can pay 4.99k from the credit card and the rest from the 2k that you have in your bank account. Once again a reminder YOU HAVE to pay off the credit card before the due date for the card.

Now coming to the actual credit cards for people, the following are some credit cards that I have which I feel are useful

This was my first credit card. I got it when I had no history and I guess the referral from my friend made the difference, since I know of people who did not use a referral and were rejected. So in case you want a referral this is my referral link
Pros
-         I feel the cash back bonus in different categories is extremely useful. Details can be found here
-         Also, link this card to your Amazon account and see the rewards building.
-         There is a promo that at the end of your first year, they will double your reward points which is pretty good
-         You can also get referral bonus of 50 bucks which is a pretty sweet deal to be frank
-         You get your FICO score for free on a monthly basis (when you have at least 6 months of history if you are an IMG like me)
Cons
-         International transactions are charged an extra of 3%
-         It at times is NOT accepted everywhere

This is one of the steady cards that I know off. I heard rumors of this card shutting down since there is Freedom Unlimited, but I highly doubt it. This is a card one must get once your Discover card starts showing you a FICO score. So in case you want a referral this is my referral link
Pros
-         The card is by Chase, which is a big name in the banking sector
-         Rotating 5% reward categories like Discover, calendar can be found here
-         You earn a $150 Bonus after you spend $500 on purchases in your first 3 months from account opening
-         Unlimited 1% cash back on all other purchases - it's automatic
Cons
-         You don’t get a FICO score like Discover

A sleek metal card design which was my BIGGEST reason to get the card. So in case you want a referral this is my referral link
Pros
-         You earn 50,000 bonus points when you spend $4,000 on purchases in the first 3 months from account opening. That's $625 in travel when you redeem through Chase Ultimate Rewards®. (I now it is a A HUGE AMOUNT, but guess offering to spend for others helps here)  
-         For those who travel and eat A LOT, you get 2X points on travel and dining at restaurants & 1 point per dollar spent on all other purchases
-         Earn 5,000 bonus points after you add the first authorized user and make a purchase in the first 3 months from account opening- You can add random person and once they swipe destroy the card
-         $0 foreign transaction fees- This is another awesome feature when traveling outside the States
-         1:1 point transfer to leading frequent travel programs at full value - that means 1,000 Chase Ultimate Rewards points equal 1,000 partner miles/points- I have NOT used this feature but it is really enticing
-         Travel confidently with premium Travel Protection Benefits, including Trip Cancellation/Trip Interruption Insurance, Auto Rental Collision Damage Waiver, Trip Delay Reimbursement and more
Cons
-         Annual fee after the first year $95, which though is high I feel is worth the cash back
-         You don’t get a FICO score like Discover

That's all folks for now!

Friday, June 3, 2016

“I regret saying that I am denying you visa to the US”

“I regret saying that I am denying you visa to the US”

“Why?” asked me!
“Because your scores are very low and I do not feel that you will be able to do anything with these there”, said a slightly surprised visa counselor.
“Who are you to judge my scores? You are not qualified to do so. I know my scores are not good. But I have done my background research before deciding to commit so much of time, money and effort to this. It is tough but it is not impossible! When there is hope, why should I give up on my dreams?”
There was a whole minute silence. The shock on the counselor’s face was screaming that no visa candidate had ever argued with him like this. But for my pounding heart, it was a do or die moment!
“Ok, you will get one chance and only one to prove what you can do”
And so I got my first EVER international visa stamp, that too into the US and thus my journey to the States began!
Hi all, I was reading Neil's blogs and thought to share my experiences in the USMLE journey so that others who are in similar situations like mine are motivated to see through it until the END!
That being said let me start at the beginning.
In 2013, I was one amongst the thousand's of US residency aspirants and by no means a lucky one! I literally had every hurdle imaginable to an IMG.
Citizenship: I am from a third world country and NEVER visited any foreign country.
Exam scores:  My USMLE step 1 score was below the 90thcentile and step 2 in low 90s.
Graduation: I had been working for 2 – 2.5 years after medical school and so I wasn’t a fresh graduate. 
Past 'Research' experience: I did do some clinical research work after graduation, but nothing too fancy.
US experience: I had a very short (2 week) observership in one of the University hospital's (from where I was lucky to get a good letter)
Interview call: of the 70 odd pediatric programs that I applied to, I received only 1 interview call.
Match day! – of course, to no surprise for all, I did not match :( 
However, I feel God must have heard my prayers, because on the day after 'Match' day – I received a call from the program coordinator of the hospital I interviewed at stating “One of our matched candidates is not able to make it to the residency program. Are you still interested in joining us?” 
And I was SHOUTING in utter disbelief! “Yes, I am.” J
Finally, when I did go to get my H1B visa stamped, the visa officer who denied my visa in the first place, saw me and looking at me came out, smiled and said: “Well Done!” Oh, the joy of proving someone wrong, Incredible!
So here I am, almost at the end of my pediatric residency and still living a dream! The sole purpose of writing my path to USMLE  is to  encourage you to keep trying! Don’t give up on your dreams, no matter how crazy people think you are! You never know what life might have in store for you. I faced hurdles, extra hurdles, in every step! Every person I knew looked at me as if I am crazy to pursue USMLE further. But I knew what I wanted and I was determined to do all that I can! So saying I end with this  
I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.
The Road Not Taken – Robert Frost