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)"

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 

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.

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

zeeshanmansuri@gmail.com

SON