Tips for FMG/IMG Matching in Otolaryngology-Head and Neck Surgery

Oswaldo A. Henriquez, MD

oswaldojr@hotmail.com

Resident Physician

Otolaryngology-Head and Neck Surgery

Emory University School of Medicine

MD, Luis Razetti Medical School

Universidad Central de Venezuela

Caracas, Venezuela

It’s no secret that being a foreign medical graduate (FMG; also known as international medical graduate or IMG) and pursuing a match in a surgical specialty such as otolaryngology-head and neck surgery can be quite a challenge. Just look at the numbers reported by the National Residency Matching Program (NRMP) in their last annual report. In the last two matches (2006 and 2007) only 16 FMG applicants matched in otolaryngology. In 2007, only 9 of the 270 positions (3%) offered on the match were filled by FMGs—and these numbers did not even differentiate between US FMGs (who are US citizens with foreign MD degrees, hence no visa issues) and non-US FMGs. (If anyone does know the number of true FMG stats during those years, please let me know). It is a well known fact that FMGs are more prone to apply to “FMG friendly” specialties such as internal medicine or family medicine. So for all of you against these odds, still hold the course for this quest! Here are my two cents as one of those lucky 9 that made it in 2007.

First of all, congratulations: a lot of people drop out of the race before it even begins (and I do not blame them). But if you truly feel that this specialty is what you want, there is no reason why you should not give it your best shot. As a disclaimer, the advice that I am about to give you comes from personal experience and those of close friends. It is for sure not the only way to do things. So here it is:

1. The sooner the better

This means, basically, the sooner you realize in med school that you want to come to the US for training, the best you can prepare yourself to be a competitive candidate.

2. Work starts at home

Doing well in scores at your med school is the first step to becoming a competitive candidate. Try to be on the top 10% of your class. But if it is too late for this, no worries. One of the beauties of this process is that if you were not a rock star at your med school, you have a second chance: doing well on the USMLE steps scores. This is actually going to be the real measuring stick that reviewers will go by. Nevertheless, it helps to have good scores in your clinical rotations at home, which will also make the USMLE easier.

3. Doing an away rotation, or at least an observership in a US program

Another good reason to start working on your goal early. Go to the program websites, where you can find info about how to apply for an away rotation just like a US med student will do. Have in mind that some programs won’t accept foreign medical students. You will probably have to pay some fees like a malpractice insurance fee among others and fill out some paperwork. If your med school is like mine, you won’t have an official block during your curriculum for these rotations, so you may have to sacrifice 4 or more weeks of your vacation time for this. One of the reasons why this is so important is that as a visiting med student on an away rotation you will have the complete experience, seeing patients at the clinics, scrubbing in the OR, and helping the residents, the whole deal. This in contrast with an observership, which is what you get to do once you are already an MD, where you cannot have any direct patient contact. If you are at this point of your career, email the programs directly to try to set up an observership. Although not as good as an actual student rotation, it is the second best thing to do. The observership will give you a general idea about the environment and structure of a residency in the US and will also help you get a couple of letters of recommendations (LORs) from the chairman and/or program director. During your time there be sure to schedule a sit down with the program director and/or chairman of the department. It is good to get some advice from them and ask any questions that you may have. Since you are going to need at least 3 LORs for your applications, it would be ideal to actually set up 2 or 3 of these meetings/rotations if you can.

4. Ace the Boards

The mean USMLE step 1 and step 2 CK scores for US seniors who matched in otolaryngology in 2007 were 238 and 241, respectively. That means you also have to ace those exams. One difference is that most US applicants apply only with the USMLE step 1 score; they will usually take USMLE step 2 CK and CS after or during the interview period. While this works for them it won't necessarily for you for these two reasons: First, programs prefer (some even request) that by the time you apply you will already have (or will soon have) your ECFMG certificate. That means having passed USMLE steps 1 and both steps 2 CK and CS. This gives them peace of mind that if you were to match in their program you are already ECFMG certified and good to start your training on day one of your residency. Second, if by any chance you did not ace your USMLE step 1 score, getting a high score on USMLE step 2 CK helps a lot, since most programs will take into account the best of the two scores. So be ready to hit those books.

5. Research, research, research

...research, research. If you have the opportunity to take part in a meaningful research project during your med school years, take it. It does not matter if it is otolaryngology related or not, or if it is clinical or basic science (although the latter is generally preferable). Continuing with my trend of giving you stats, according to the NRMP the mean number of abstract, presentations, or publications by US seniors who matched in otolaryngology in 2007 was four. For better or worse, research has more weight if presented at US meetings compared to national meetings in your country or if published in a US journal. Consider investing one year after med school doing a research fellowship in an otolaryngology program at the US (this is what I did). I consider this a must, not only for the educational experience that this represents, but also because it gives you a chance to get yourself known, get some abstracts at some national meetings, or even produce some publications to improve your CV. One way to find these research spots is by emailing programs and asking if they have any positions available. A warning to keep in mind is that most of these positions come with small or no salary, but it is definitely going to boost your chances. In my case I e-mailed about 60 people and ultimately received one reply back with an offer. So don’t be discouraged: be persistent. Suffice to say if you get a research spot, work extremely hard on your project from day one. But don't stop there: this is a great opportunity to get yourself known by the program. One way you can do this is by going to grand rounds every week, journal clubs, or any other departmental activity. Besides being a great learning experience you will get to know the residents and faculty, and they will get to know you. Also make sure that one of your letters of recommendation comes from the principal investigator in your project.

6. Getting your application ready

Programs receive hundreds of applications every year and they only give around 10 or so interviews per spot. Once they are done choosing those lucky few, they close the gate. So send in your applications as early as possible. This means no more than 1 or 2 weeks after the initial application date starts. Another thing, and again this is my personal view: I know most of you would like to train in a "cosmopolitan" cities such as New York, Chicago, Miami, or San Francisco, or in the so-called "top tier" programs. In order to increase your chances I would highly recommend applying everywhere you can. I know it is a big expense, but if you made it this far, don’t take chances, think of it as an investment. Rest assured that standards of training are so high in surgical specialties such as otolaryngology that there really are no bad programs out there. You are going to get a solid training nearly anywhere you go.

7. Interview time

All the work you have put in over the past few years has been for this, the dreaded interviews. If you are like me, it is a scaring feeling knowing that your first ever job interview is going to be in a foreign language. The key is to prepare yourself. One way to do this is to set up some mock interviews with your US mentor or research principal investigator (if you have one). This will make you feel more confident. As an FMG there are a couple of questions that are going to come up frequently during the interview trail. The most common one is about your plans after residency and if you want to eventually go back to your country or stay here in the US. Another common topic is questions about your med school and if there are otolaryngology residency programs in your country and why you don’t want to do your training there. So be ready to answer these types of questions since there are sure to come up at any point during an interview. Also keep in mind that this is your moment to shine. As an FMG, you have a unique background that may help you stand out from the rest. For example, you may have had to work as a general medicine doctor in the middle of the jungle for one year. So make sure to find a way to bring out these unique backgrounds in the interview.

8. Know the visa paperwork

Remember that otolaryngology programs are not used to dealing with visas and all the associated paperwork. They may ask you what your visa situations/options are. Be ready to explain this in a straightforward and simple manner. They may have the idea that is a complicated process but in reality it is not.

9. And last but not least

As with everything in life, luck plays a big part of all this. For example, being in the right place at the right time. Since this is something that you can’t control, I will just wish you… Good Luck!