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


Thursday, May 12, 2016

Taxes in the US

This time, I thought would just write about tax paying in the US for my fellow residents or new residents starting this year. First off the basics, a tax year is counted from January 1 to December 31, and you are required to file federal income tax returns by April 15.

There are multiple ways to pay taxes

  • Online - Turbo tax etc which are really simple and free, at least the basic outline
  • Through an agent for a fee
I personally did mine through an agent since I am new to the States and I did not have much free time as an intern. In the first year of residency, you get a decent amount of money back and hence I recommend going with an agent. So, as usual, I asked my senior on who to contact and he gave me the contact details of his tax agent and she kinda ran me through the entire process. There were some colleagues and seniors of mine who have stated that one can get the same amount of refund via online software's (Turbo-tax), but I personally did not have much time or luck to go through the same.

To file taxes you need the following documents 
  1. W2 from your employer
  2. 1099-INT if you had any miscellaneous incomes (see below for more details)
  3. Moving expenses (a rough estimate)
Once you get those details you send the same to your tax agent who gives you an estimate of how much refund you get and then you are set.

Note
If I am not mistaken there are 3 taxes in total
- Federal (USA)
- State (Ohio)
- City - The general consensus is that one does not owe city tax if you live and work in the same city. 
Elaborating on some terms

Form W4
When you join a company, your employer will ask you to fill Form W4. That form gives information to the employer regarding how many deductions an employee can make. For every deduction claimed, the employee is able to deduct a certain amount of income from the income tax. The number of deductions claimed in the W4 form is just an estimate regarding how much tax you may owe. 

1099
There are several types of 1099 forms:
  • 1099INT: For interest paid by a bank.
  • 1099DIV: For dividends and distributions paid by financial institutions.
  • 1099R:Distributions from Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
  • If you paid interest on a mortgage or real estate taxes, you will receive 1098 with that information.

Thursday, November 5, 2015

Building a HISTORY in the States

These tips and tricks are entirely based on the advice of a VERY wise senior. When you first come to the States for residency, you will need a couple of things to setup.

SIM CARD
Firstly a mobile number. Given that a good number of residents come from outside the States, having a network which gives you free calling to your home country is a BONUS. That's where UltraMobile comes into place. I know in my previous post I said H2O is good, but trust me when I say that UltraMobile is the real deal. For 30$ per month, you get unlimited calls to India with 1GB of 4G data, which is PRETTY IMPRESSIVE! It also has an option of getting nano sim, so in case you decide to upgrade your phone, which many of you will do, it has got your back covered! :) You can get the initial sim on Ebay for 10 bucks which gives you the first month for FREE!
It is totally up to you on how risky you want to be. If you want to buy it directly from UltraMobile, here is your link

BANK ACCOUNT
Next is for earning cash back when you open a bank account. Generally find the bank which your institute has a tie up with. Go to their site and check for any promos that they are running. They might have an offer that should you open an account with their bank you will get a bonus of $ XYZ for signing up!!! which is PRETTY AWESOME!
P.S.- I used Keybank and got 1/3 of a $1000 :P

CREDIT CARD
The last trick that again, my senior taught me, was regarding getting a credit card. Most of the USA banks DO NOT give you a credit card UNLESS you have a credit history. However, Discover does give you one with no credit history with a credit line of $1500 which is PRETTY COOL! So in case you are still hunting around for a credit card do head out to Discover and check it out. You can shoot me an email @ neilnf@gmail.com if you want a referral, following which you and I get a referral bonus for $50 each.

That's it, folks!

UPDATE: Just FYI for the bank you need a direct deposit to get the bonus. For both SSN is needed. For the credit card you need address proof as well.


If you do have any other tricks, please do let me know. After all we are here to help each other! :)

Sunday, August 30, 2015

Personal Statement Tips

Firstly, ignore the grammatical errors in the post, was a bit tired! :P

Now to begin, a good number of individuals have asked for tips on how to write a Personal Statement for the Match. There are a million results that pop up when you google search personal statement & your specialty.  

Tips for writing PS

It is hard to create one, that is for sure, but you must attempt to make one at least. Firstly just read a couple to know what a personal statement should have. Keep reading online PS's till you get that one which strikes you that your life was shaped like that one. 

Once you have created your personal statement, keep reading and re-reading it. Send it to your OLDER siblings or friends to proof-read it. Once this phase is done and ALL GRAMMATICAL ERRORS are corrected send it to your seniors to check if they are impressed by it. For heaven's sake DO NOT THINK THAT THEY ARE JOBLESSLY sitting around just to read your PS. They have a lot of other commitments. If they do give you a feedback well and good, if not still thank them for going through, since they have taken time from their busy schedule to actually read it.

Lastly, before FINALLY uploading it on ERAS, do check it for Plagiarism. You really do not want to use a completely copied PS from the web. It there is NO originality in the PS, you can be rest assured it will be discarded by the PD. Try to have 80 or higher original content

These are a few sites that help you in the plagiarism area

Finally, this is how I structured my PS
  1. An opening line by one of my profs or an online quote which hit me hard and caused me to think.
  2. An event which caused me to like the field (in my case pediatrics)
  3. Why this field, I mean to say what is so special about it and what I have done to show my interest in the field
  4. Steps I have taken to be prepared for residency in the States
  5. My strengths and why the program should choose me
  6. Summary- Which has the HIGHLIGHTS of the PS

Sunday, July 19, 2015

Drivers License in the states PART 2

Read the previous test for documents needed for the knowledge (written) test.

Once you pass the driving test you will have to produce the following documents to get your driving license

  1. Utility bill or something that has your name and address on it (Lease agreement might not work from what I got by the look of the guy)
  2. Passport
  3. i94
  4. Letter from employer
  5. Indian license
  6. SSN card
  7. The paper which your examiner gives you stating that you have passed
  8. A USA CHEQUE to pay the money for the license. CARDS ARE NOT ACCEPTED!!
  9. And do dress nicely since you ll be taking a picture which will be on your license :P
That's all folks :)

P.S: The sad part is that the license is for the duration of your visa. So most of us will have to renew it yearly :(

Saturday, July 18, 2015

Guide by Dr Vikas Reddy

An exhaustive guide to the USMLE by Dr Vikas Reddy :)

Saturday, July 11, 2015

Driver's License in the States

The Driver's license test generally has 2 parts. 

Knowledge and the ACTUAL driving test

If you have an Indian license, take the same along with the following documents
  1. Passport
  2. I-94 printout
  3. Letter from employer stating that you work there
  4. SSN- Details on how to get one is in the previous post.
For the knowledge test, you can practise online by doing practise one's according to your respective States. You can get few here (http://driving-tests.org/) In Ohio, the test has 40 questions and you just have to get 75% of the questions to clear the exam and then schedule your DRIVING test.

Best of luck!

P.S.- I read the manual and did the above questions. Most of the questions just need plain common sense answers :) So it really won't take too much time.

Tuesday, June 30, 2015

SSN for H-1B individuals (Medical residents)

You can get an SSN as soon as you land.

Steps are as follows
  1. Open this LINK
  2. Fill in the last page with the correct details
  3. Take your passport and the current I94 
  4. Go to the nearest SSN office near you by checking HERE.
  5. Once in the office they will take your forms and fill in the details and that's it!
  6. In a week or 2 you should get your SSN in the mail!
P.S.- I do not think that the rumor that you have to wait for 2 weeks is true since I have done it 3 days post landing.

Friday, June 19, 2015

Few sites that I felt were useful for the USMLE

This is most likely going to be among my last few posts regarding the Match process.

Do go through the following sites as they are useful in varied ways. Not only in interview tips but also in general :)

An amazing blog by Kaplan. Gives you good insight into many things :)
http://www.residencysecrets.com/

http://www.imgresidencytips.com/index.php - Has almost everything from the beginning to the end.

http://rookiedoctor.com/ - Written by a guy who has gone through the process and gives advice where deemed necessary

This is the closest to the best thing with which you can prepared for the residency interview questions :)
http://exams.emedicinelive.net/index.php/usmle/2/52-residency-interviews--real-interview-questions-with-answers
http://exams.emedicinelive.net/index.php

This is for the Tell Me about Yourself question for which most of us panic
http://career-advice.monster.com/job-interview/interview-questions/intreview-tell-me-about-yourself/article.aspx
http://www.theladders.com/career-advice/how-to-answer-tell-me-about-yourself-interview-question
http://www.theladders.com/career-advice/10-good-ways-to-tell-me-about-yourself

The following blogs are written by guys  like me
Dr Benji Ho (a Caribbean grad) -  http://www.caribbeanmedstudent.com/
Dr Jagjit - https://iamjagjit.wordpress.com/
Dr Karthik - https://helpingmedicalhands.wordpress.com/


On another note if you want to try your clinical solving you can try the following app Daily Clinical Case rounds

Hoping they help you guys in your journey. I'll keep updating it as and when I come across anything interesting :)

Best of luck!

Tuesday, June 16, 2015

Steps to H1B for new medical residents

  1. Apply for the medical license to your respective state board- From Receipt to Acknowledgement around a week; from there to the actual license around 2 weeks. So, a total of 3 weeks.
  2. Get yourself an attorney from the list that your program sends you/ ask your colleagues where they are doing theirs from
  3. Talk to the attorney regarding fees and stuff (generally program pays for all except the premium processing fees) Fees find below
  4. Depending on your attorney’s liking, apply for a visa based on an acknowledgment letter/Training license certificate
  5. He then sends the application to the USCIS who then will issue you a petition number
  6. Based on that you CAN complete the next 2 forms i.e. [you need the petitioner’s name and dates approved for, and your point of contact in the States which generally is your PC]
    1. DS 160 - Tips for filling the forms can be found HERE (thanks to Dr. Vikas)        
    2. US travel docs form 
  7. OR  
  8. You can wait for the approval and use the exact dates the petition got approved for and the Petitioner
  9. Get an appointment- Pay the visa fees according to the exchange rate.
  10. Go for the interview with the documents the Attorney sends and ta-da you have your visa.
OFC DAY
Take the following for the appointment
  1. DS 160 confirmation page
  2. Appointment confirmation
  3. Passport
Stand in line, get your fingerprints and photo clicked and you are done for day 1. If you have already done for visitor visa(B1/B2), this should be a cake-walk since you know what to doJ
P.S. Please take a photo according to the instructions on the consulate website since there have been problems with the IT aspect for quite a number of my colleagues and me. {2*2 inches and stuff}
INTERVIEW DAY
Take the above and supporting documents which HAS to include (I-797B i.e. H-1B petition approval notice)
Please note- Some people also say that you have to take the other forms like i129 (Petition application for H-1B), I-797C (Receipt for the premium processing). But frankly speaking, they are not needed, if you have it, then well and good but, the I-797 B is a MUST.
Questions asked
  • Where will you be working? – In a Hospital
  • Oh, so you are a doctor? – Yes
  • *He was delighted by that* May I know your salary? $ XXX
  • Good, your visa is approved.
And I walked out a happy man J
For Chennai, passport collection is from the OFC. Please refer to the consulate site for documents to be taken while collecting the Passport.

Fee  Type
Fee
Who Pays for it ? Why ?
Base filing fee
$325
Program
It is employer’s business expense
Fraud prevent & detection fee
$500
Program
It is employer’s business expense. Just like above, it is mandated by law.
Fee based on attorney charges
$1000-$2000
Program.
It is employer’s business expense.
Premium processing fee (Optional)
$1,225
Generally we pay for it ourselves, but you never know if the program will be good enough to pay for you J Please read the note at the end of the post
Visa fee (fee involved in getting H1B visa at US consulate)
varies by country
Your expense. All the costs involved in obtaining visa, including cost involved in translation of your credentials, etc. It will NOT be an employer’s expense. The employer will only send you the documents required for visa stamping.


NOTE THE FOLLOWING:
  • Even if you are approved well in advance of your start date at your program, you cannot enter the US in H-1B until 10 days before the start date of your Residency i.e. June 20 considering your start date is July 1st
  • The Attorney generally requests for the full 3 years of H-1B, however, there is no guarantee that the immigration Service will give all 3 years. According to their regulations, they should give 1 year (even if we request 3 years) since the Training license is for 1 year (license issued by the State of OH). Some examiners will give 3 years (depends on your luck as to which examiner gets your case). So if you get 3 years, count yourself lucky. If you are approved for 1 year, there is no problem renewing the H-1B status again next year in the US.
  • You will need someone, who has a bank account with a US bank to send a cheque for the $1225 premium processing fee. At least that is what my attorney insisted on, but guess this part varies from attorney to attorney.