Mar 24, 2014

The Match, The SOAP, & the reality of being an IMG

This past week was Match week, which for those of you readers unfamiliar with this term, it is the means by which MD graduates get "matched" into a residency placement.  For many people, Match week is the highlight of your 4 years of medical school, when you finally have a job post graduation and the reality that all of your hard work has in fact, paid off.

However, what many people don't understand is that there are far more MD candidates trying to "match" then there are spots in residencies.  Every year, there are thousands of applicants, many of them international medical graduates (IMG's) who don't receive a spot in a residency.  Therefore leaving them with the degree of MD but unable to be licensed and practice due to the inability to obtain a residency position.

The Facts:

  • Josh is finished with all of the requirements to graduate from medical school at SGU and will receive his diploma in June.
  • Josh passed all of his board exams, Step 1, Step 2 CS, and Step 2 CK with scores above the average for both IMG's and AMG's (American Medical Graduates)
  • He had strong letters of recommendation
  • He is in the 1st quartile (top 25%) of his graduating class academically for both the basic science years (first 2 years) and currently
  • He applied to 100+ categorical surgery residency programs both community based and university based across the entire US
  • Josh only received a few interviews to residency programs
  • We found out Monday that Josh did NOT Match

While not Matching did not necessarily come as a complete shock because of so few interviews, we were still very disappointed.  It is extremely scary to know that you not only don't have a job after 4 years of medical school, but you also have no job with $200,000.00 worth of educational debt that will have to start paying back after you graduate.

The SOAP (Supplemental Offer and Acceptance Program):

  • When you don't Match into a residency, you can enter the SOAP, a process by which you send out up to 45 more applications to residency programs that did not, for whatever reason, fill their positions during the Match.
  • On Monday afternoon, Josh sent out the full 45 applications to programs for Surgery (both categorical and preliminary), Family Medicine, Emergency Medicine, and Internal Medicine.  At this point he was willing to do anything.  We thought FOR SURE he could SOAP into something based on his grades and Step scores.
  • From Monday through Thursday, applications are reviewed by programs, phone interviews may happen, and every few hours, offers to those programs are made.
  • There were approximately 900 positions in the SOAP.  There were over 1100 AMG's unmatched and over 8000 IMG's unmatched trying to obtain these spots.
  • Josh got ZERO phone calls or emails the entire week.  NOT. EVEN. ONE.
  • It is our belief that international graduates, regardless of citizenship were filtered out from the start, that Josh's application was not even looked at all week.
Our interpretation of the SOAP from an IMG standpoint was that it was like being stabbed with a knife and then having it twisted around inside of you in order to kill you slowly and painfully.....a slow, painful death.  There is nothing like sitting around all day for a week, waiting for a phone call, and one never coming.  The stress level in our apartment was sky high and yet we knew there was nothing to do but wait and hope and pray that something would work out.  Josh was a part of message boards online for people in the same position and we know that AMG's with significantly lower Step scores were getting multiple phone interviews as well as offers.  Never has the stigma of being an international graduate felt more damning.  Both Josh and I were so discouraged.

Post SOAP:
  • On Thursday at 5:00pm EST, the SOAP ends, and unmatched applicants are then allowed to contact programs by phone or email that still have openings.
  •  At this point, there were less than 50 spots across all specialties left after the SOAP and programs are not required to fill their positions.
  • Josh began sending out what I call hail Mary emails to programs with unfilled spots hoping that someone might throw him a bone and at the very least email him back.
  • He received many automated response emails saying either the positions had been filled or that they had decided not to fill their positions this year.
  • By Friday morning, Josh was beginning to look into alternative options for the next year.  These included doing an MPH (Masters of Public Health), unpaid medical research, delaying graduation in order to do more hospital rotations, and jumping off a bridge....joking...kind of.
On Friday around noon, Josh received a call from the program director at the University of Massachusetts, one of the programs he had emailed the night before.  He conducted a 10 minute Face Time interview and offered Josh a general surgery residency position for this year on the spot.  Within minutes of getting off the phone, an email with the offer came through, Josh signed it, and that was that.  Relief immediately followed.

What we learned/Our advice:
  • Apply on time.  Do not wait even a day to send out your applications. Being the first to get them in is likely key to getting multiple interviews.
  • If you can, have all of your Step scores IN before applications are due.  You are best off if you have a COMPLETE application at the time of submitting it.
  • Have realistic expectations.  If you are an international grad, it will likely hurt you.  Most IMG's go in to primary care (FM, Peds, IM, Psych).  If you do not want to go into one of these, consider apply to some anyway as a back up choice.
  • Avoid the SOAP at all costs!  It is NOT set up to be in the interest of the applicant, especially IMG's.
  • It is better to have a residency of any kind than not.  Trust me.
We feel very lucky.  Not only did Josh end up in his residency of choice, surgery, but amazingly he is also going to be at a university program at one of the top surgery programs in the United States.  It is nothing short of a miracle and we are definitely counting our blessings.


****EDIT: Here is a link to the follow up post regarding our match process.  Josh did, in fact, match into categorical surgery in the 2015 Match.  Read about it HERE.


114 comments:

  1. This is so well written and I really admire your strength and courage through all of this. You both certainly deserve that residency spot! It is such a shame the stigma of being an IMG has, it is like this in the Canadian system as well. It's so hard for us as wives to see our husbands who we know are amazing doctors being shoved aside simply because of the school they went to.

    Good luck to you, Josh, and baby Ryan! You guys will only be 5 and a half hours from where we are living :) I hope after all this craziness that your move and everything else goes smoothly!

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  2. I am happy that things worked out for your husband, and you have spelled out the downfalls of going to an offshore medical school.

    I have worked with plenty of American IMG's, and clinically I can't tell the difference between them and AMG's. Some of them are quite successful. However, at present less than half of them get into US residencies, and the numbers will get worse with the recent expansion of American MD and DO schools.

    I have also been on med school residency committees, and the hierarchy is always American (including Canadian) MD , DO, non-American IMG, American IMG. In fact, we had sometimes elected to leave unfilled spots rather than take American IMG's . That's just the reality.

    Of course, once you are in the system, you are golden. But, most IMG's just wasted 4 years and 6 figures. Offshore schools are a gigantic scam.

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    1. A scam? I don't know where you got that from, but a lot of the schools in Asia provide a FAR superior clinical experience compared to ANY US medical school. It's simple really...you only are as good as the amount of cases that you see, and that's really the case with a lot of the IMGs...whether they be American or non-American. They are just better prepared clinically and are able to cope up with a challenge simply because of the hectic patient loads that they are used to seeing in their home country. I can only talk about the Asian schools here being a graduate of one myself. Not so sure about the Caribbean schools.

      Secondly, I'm sick of hearing this nonsense of "wasting 4 years and 6 figures", as if the AMGs got to go to medical school for free? ALL of us, IMG and AMG, are in educational debt. Add up what the AMGs spent at med school...it most probably comes up to...you got it...six figures. Its quite trashy to talk about how someone just "wasted" 4 years when you don't even know what obstacles they had to face nor the reason why they made the decision to study at an offshore school in the first place. Please take your negativity out of the equation.

      To my fellow IMGs, please don't give up, and please keep working hard. Don't let anyone stop you from your dream.

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    2. Thanks for your kind words. We don't feel that our experience at a foreign school was a scam at all. There are obstacles to overcome, but we would do it again. I talked a little about that in a subsequent post linked here. http://thescurlockscene.blogspot.com/2014/04/international-medical-graduate-would-we.html
      Regardless of the the Match outcome, we don't see Josh's 4 years of school or 6 figures of debt as a waste. My point in this post was to show the reality of the situation and allow others to be a bit more informed of some of the hurdles that medical school student and specifically an IMG has. Thanks for reading.

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    3. Scam? With all due respect: You are shallow beyond imagination.

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  3. Congratulations. Your husband is fortunate. You are correct that any clinical position is a far better option than any of the alternatives.

    What percentage of Josh's classmates did not end up with residency positions?

    Would you advise other American students to avoid offshore medical schools? What about your classmates without jobs? What would they advise?

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    1. Hi there, I don't know the exact percentage of SGU grads that receive residency positions as a PGY-1 but I want to say it is close to 80%. SGU actually matches more grads than many International schools out there, however most are in primary care (IM, FM, Peds, and Psych) and it is definitely way more challenging to get any type of advanced specialty. I suppose my/our advice for American students attending offshore med schools would be to do it as a last resort. Josh didn't get in to American med schools. If he had, we obviously would have chosen that route, but if he hadn't gone to SGU, he would not be a doctor now. SGU isn't perfect by any means, but it did provide the pathway for him to become a doctor. It's hard to say what the future holds for IMG's because like the anonymous poster stated, it's likely only going to get harder to match with new American MD and DO programs opening up. I think if you are going to go the route of an IMG, then you need to prepare yourself to go into primary care and be happy with that. Here is the SGU residency match list for 2014 but also for previous years. It is easy to see that SGU is matching lots of students, some into really great, competitive positions, time will tell if these spots continue to be attainable for IMG's in the future. http://postgrad.sgu.edu/ResidencyAppointmentDirectory.aspx?year=2014

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    2. There is no chance that 80% of SGU students matched PGY1. That is very misleading

      It's more like 60 percent according to the NRMP manual.

      It took an act of God for your husband to find residency. Even though he was a bright and successful student.

      I'd never go to the Carribean.

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    3. Anon, I don't know where in the NRMP manual you are finding specific statistics for SGU. I only see stats regarding US IMG's vs Non US IMG's. It is true that the match rate for IMG's in general is somewhere in the 50% range however I assure you that SGU does not have 40% of their students not matching every year. It is most definitely somewhere in the 80% range for those that actually enter the match. Now the percentage of those that graduate and match from the initial class size as first years, that is a different story and while I don't know the percentage for that either, I would guess that would be less.

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  4. To Anon at 9:33 pm,
    I'm curious how American IMGs are "after" non-American IMGs, when they don't have the Visa hurdles?

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  5. @I cortez,

    Foreign IMG's who apply to the US programs are often the top students from their countries. For example, it is tougher to get into medicine at the Chinese University of Hong Kong than Harvard Med.

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  6. Was this a preliminary surgery (1 year) position, or a categorical position, that he obtained post-SOAP?

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    1. It is a preliminary surgery spot.

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    2. ^^^ There's the catch. Better than nothing, but prelim surgery is like being selected for the Hunger Games.

      May the odds be in your favor.

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  7. Well good luck to you for the match and soap next year!

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  8. Thank you so much for sharing your experience. I'm an SGU student and visit your blog from time to time. Just wanted to say that I appreciate you and your husband sharing the match experience and giving advice. Also just wanted to send a congratulations on getting placed. Best of luck you to guys on the next part of your journey!

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    1. You are so welcome! I'm glad that it's helpful to others....that was my intent. Good luck on the rest of your schooling!

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  9. Congrats on your husband's surgery placement. One quick point. When reading your story I felt that you could have made the logical point that if your husband did not get a surgery residency he could have very likely subsequently picked up a primary care post. Your paragraph below* describing Josh's situation sounded like he would have been stranded and financially bereft. In reality it's a common scenario for many IMG grads who initially apply for a specialty residency to end up in primary care, perfectly able to pay back their bills. You later mention that this does happen (nice), but this fact could have been presented earlier, making your husband's situation less dramatic and more factual. Just a suggestion.

    *It is extremely scary to know that you not only don't have a job after 4 years of medical school, but you also have no job with $200,000.00 worth of educational debt that will have to start paying back after you graduate.

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    1. Thanks for reading. While I understand your point, that paragraph you quoted was how we felt the during/after Match week. What also added to our panic was not SOAPing into a primary care position despite sending applications to almost all primary care open positions. Your suggestions are appreciated though.

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    2. I am a AMG. This will be my 4-5th season re-attempting the match. I previously matched with a very competitive specialty as categorical. It was malignant, big time. I finished my intern year, but the h*ll started after that. Went thru match last year, few interviews in another field, no match. No SOAP interests WHATSOEVER. I re-applied this last season, with more interviews. Everyone pray I match somewhere. I do have a medical license in a more progressive state than my home.
      Since recent health care reform, it appears there are few limited job ops for just being a general care "doc in the box". Without being board certified in IM, FM, whatever, you're kinda screwed.
      God help me that I match in 2015. I want to help mankind, not be on unemployment or drain my parent's retirement. Oh yeah, and my loans are up to ~350k. Thats with scholarships for undergrad, and even considerable MD school scholarships.
      Young ppl of today, please get education in match, physics, computer technology. Then YOU will be able to make the world a better place.

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  10. Reading your post made me tremble, again. I lived the nightmare of not matching as a US-IMG, even after 11 interviews for a competitive specialty. I was told "You will match, without a doubt" from multiple programs and was lead to believe I would perhaps.. be on their team. Not the case.

    Everything you wrote in your post was true. The SOAP is a nightmare for an IMG--basically impossible. I actually got two phone calls Monday. One phone call was from a program director that said " I WAS IN" and we had a face to face interview at the hospital the next day!! He claimed that in the next few days I would be getting phone calls all day. HAH, imagine how I felt when after the first round of SOAP I wasn't offered a spot at that program? As for the other program, they led me on, and still, nothing.

    When SOAP ended, I explored all other options just as your husband did. Research?? Medical mission trips? Volunteering? I've never been depressed before (save an unfortunate breakup) but this was the lowest I've ever felt. For that whole week I tried sleeping in as long as I could just so I wouldn't have to face the day knowing I failed at the only thing I was suppose to succeed in for the last 4 years. I felt broken.

    I signed up for resident swap, because it seemed like thats what people do in these situations. A few days later an alert was sent to me saying spots had opened. I sent in my information right away. I received a phone call later that week (the week after match week) I had been selected for a prelim surgery spot also in Massachusetts. I had been given another chance.

    I wouldn't wish my experience on anyone. It was terrible. But -- push through. Keep trying, and never give up. I hated hearing that from other people, especially when I felt so defeated. My job as a doctor now means more to me than ever. I'll be the happiest, hardest working surgery intern they ever saw.

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    1. Wow! Congrats on getting a spot. We definitely know what a relief that is and Josh feels the same exact way about getting his spot as you do. Not matching is a feeling I wouldn't wish on anyone. Where in MA will you be?

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    2. Great post and replies! I am in the same position - did not match and did not soap. How do you go about sending in documents on resident swap - LOR's in particular?

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  11. Wow! Congratulations to Josh! It's a really great opportunity for him to be granted such title. That is such a blessing to you guys. Being a doctor, he now has the chance to reach out and touch the lives of millions of people, and a chance to help your family too. Wishing you all the best! :D

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    1. Thank you Ravi for your kind words.

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  12. As a prior clinical preceptor at Ross University, I felt your pain.
    Essential to look at residency requirements, US experience etc), before applying. Also don't expect to get into Harvard to do neurosurgery. Keep trying, don't give up. Best of luck to you and your wife.

    Ron

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    1. Thanks Ron. Yes, I think the key thing for others to take from our experience is to have realistic expectations as an IMG . I wrote a follow up post to this one: http://thescurlockscene.blogspot.com/2014/04/international-medical-graduate-would-we.html
      Here I talked a little about our decision. Thanks for reading!

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  13. Wow, congratulations to Josh!!! So sad what you guys had to go thru. Your family picture is absolutely adorable.

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  14. umm... who says PSych is primary????

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    1. I'm sorry if that was offensive to you. I suppose psych is not primary care. The point in that portion of my post was that those four things are what most IMG's match in to.

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  16. This is going to sound like a random question in relation to your post....but does your husband regret going to a Caribbean school as opposed to a US school or would he recommend SGU to someone applying to medical school?

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    2. Hi there! I actually did a post about this exact topic. It can be found here (From April 2014). Hope it is helpful!

      http://thescurlockscene.blogspot.com/2014/04/international-medical-graduate-would-we.html

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  20. Thanks for sharing. My wife and I are AUA or Ross bound. I'm interested in general surgery and her in family practice. Any advice on trying to get into competitive residency as an IMG?

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    1. Hi William, congrats! Your wife should have no problem matching into a FM residency, as it is considered fairly "easy" for off shore students. General Surgery is a bit of a different story. You'll need to absolutely kill your boards and having some contacts in residency programs wouldn't hurt. I would suggest having a back up plan that you would be happy with doing or be willing to do a prelim year in surgery. The problem with that is that there is no guarantee of a permanent position so it can be very risky. I believe that there were close to 500 students from SGU who entered the match in 2014 and only about 20 of them matched into gen surg. That number kind of speaks for itself about the difficulty. It can be done, but it is VERY hard. Good luck!

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  21. Hey, I know Josh from Newcastle! Congrats to you guys. I'm finishing this year and praying for the best. Cheers to your beautiful family!

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  22. Dear Stephanie,

    First of all, congratulations to Josh! He deserves it after all the hard work! I would also like to thank you for putting in the time and effort in creating this blog. It was a lot of help. However, I was wondering if I could ask you and/or Josh on some advice/suggestions for my brother's current situation. He is in a similar situation as what Josh had experienced, but only with a few differences. For privacy reasons, I won't discuss it over the web but if you could kindly reply to this message at: the007th@yahoo.com and we can start from there, I'd really appreciate it. Thanks!

    Kevin

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  24. Hi Stephanie,

    Congratulations to Josh and your family. It's so inspiring and motivating to hear his success story. My friend is in a very similar situation at the moment, and I know he would really appreciate getting in touch with you/Josh for some advice. Would you please send me an email with your contact information so that I may forward it to him - subal.asghar@gmail.com.

    I hope to be in touch with you soon.

    Best,

    Subal

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  25. Dear Stephanie,

    I just found your blog right now when I am in the soap phase and it is nerve wrecking. Being and IMG, it is needless to say how I feel about everything right now. I would like to share and seek some advice from you if you do not mind. Please reply me at ala.synthase@gmail.com. I would really appreciate it, thank you.

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    1. This comment has been removed by a blog administrator.

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  26. Hi Stephanie,
    I am in the process of going through SOAP right now.. with only 1 hour left to get a call or an email you can say I am feeling rather hopeless but trying to hang onto hope. I am sure you are busy and may not see if this in time before 5.. but even if you see it after do you think you could please email me I have a question about the email your husband sent. Thank you soooo very much.. your story just gave me a bit of courage and a HUGE push to fight though the tears and remain positive. My email is qtimed@gmail.com.

    Thank you so much.

    ReplyDelete
  27. Dear Stephanie, thank you so much for this information. Your blog is the most accurate description of what we go through.
    I am also an IMG and would very much appreciate if you had time to contact me at mraquelbc@gmail.com
    I have not got any offer and I am struggling preparing the emails to contact the programs.
    Thank you again for such a great blog!!

    ReplyDelete
  28. Morning Stephanie,

    I read this blog about a year ago, and figured that going into a specialty like FM or IM would not be quite as nerve-wracking. Little did I know. Now I'm sending out the "hail-mary" emails that you talked about, but I was wondering if you knew what kind of content your hubby put in the emails themselves. Just general info about being interested in the programs or all his CV/PS/Scores, etc?

    Please email me back at borisrgalkin@gmail.com with some advice, I would really really appreciate it!

    Boris

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    Replies
    1. Boris, I am sorry to hear about this. His emails were very generic. His name, he didn't match, he included all of his stats, test scores, gpa, etc in the body of the email but also attached his master file from his school with transcripts, test transcripts, MSPE, etc. Other than that, the email was pretty basic as he composed it VERY quickly,

      Delete
  29. Hello everyone! I'm sorry that I'm not able to email you all individually, but I did this post last night as a follow up to this one, with a little more information on what we've done. I hope it might be helpful to some of you and best of luck! http://thescurlockscene.blogspot.com/2015/03/the-match-soap-and-reality-of-being-img.html

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    1. While I am happy for your husband, his story is exactly why I will never even consider the Carribean.

      He was one of the top students, had great recommendations, and had a beautiful wife (it's true). But not only couldn't he match during the first cycle, he couldn't even match during SOAP.

      It took a last ditch email to luckily find a spot. And while it's better than nothing, your husband matched into a preliminary spot- which a lot of people call dead ends.

      Say what you will, but even the best from the Carribean get screwed. Whereas the worst in the US have an easier time

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    2. Yes, Anon, that is why I have written this post so that those that are considering Caribbean schools are aware of the challenges they may face. And yes, he ended up in a prelim spot during last year's match, but if you read my current posts, you will see that he matched into a categorical gen surg spot this year. We are very happy with the outcome of our story and while I agreed that those in the US have it easier, some people just don't get accepted to US schools. We are still happy with our decision to go to SGU so that Josh could become an MD. But I hope that those that read this blog know that it was definitely a bit of an uphill battle.

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  30. Thank you for your personally time in sharing this experience on the web! It has been a tremendous blessing to others! As someone said previously, this was an act of God. And I actually believe God will do it again and again and again to help those who want to fulfill their dream of being an MD. Thank you for not giving up, thank you for spreading the courage to countless IMG who may face this situation. My wife and I will join your family in prayer and hopes as he finishes his program in MA.

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    1. Thank you William. Good luck to you and your family!

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  31. While I am happy for your husband, his story is exactly why I will never even consider the Carri bean.

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  36. Wow really good article, Thanks for the great information. It is very useful and valuable.
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  38. I know where I'm going and I know the truth, and I don't have to be what you want me to be. I'm free to be what I want.Thankyou i really love it

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  41. I would like to thank you for the efforts you have made in writing this article. I am hoping the same best work from you in the future as well. In fact your creative writing abilities has inspired me to start my own BlogEngine blog now. Really the blogging is spreading its wings rapidly. Your write up is a fine example of it.
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  49. Hi Thank you for writing about your experiences. I am a US resident but have went to medical school in the UK and I have been working in internal medicine since I graduated in 2010. I met my husband in the UK and now that we are married I want to go back to the US. I am just about to start studying for USMLEs and I know I need very high scores in these exams. I wish to do family medicine but on looking at a lot of the residency programmes they want you to have graduated within 5 years. By the time I get through all steps of the USMLEs and am eligible to apply to the match it could be 7 years since I graduated. Do you have any experience with this and any advise for me? I feel overwhelmed certainly as it is a massive risk as I am well on my way to becoming a Dermatologist in the UK (which I know is not an option in the US). Many thanks.

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  58. I love a happy ending!

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  61. what i can say about this post!! really amazing and loved

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  66. Hi there! I just want to say that I really enjoyed your website. You provide a lot of high quality information. I’m currently a dermatology resident who developed a interview video series to help people match to their dream residencies. We’re focused on helping IMGs (both American and Foreign). Check it out at http://www.residencyinterviewquestions.com – I think it would of interest to your readers. We’d appreciate any mention at all! We’d definitely love to link to your site too.

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  69. I’d prefer to use some with the content on my blog whether you don’t mind. Natually I’ll give you a link on your web blog. Thanks for sharing.
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  71. Dear Stephanie and Josh,

    Thank you for sharing your stories. I am also an SGU'er. I'm in my 4th year and on the track of applications and waiting for interview emails.

    I can really empathize with the hardships that you guys had gone through because we are currently experiencing similar things with the application process. I just wanted to say I'm really proud to have alums/alum family like you guys who share your experience. It definitely is encouraging to see success stories!

    Thanks again for sharing!

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    Replies
    1. I wish you luck during your application season. Keep your head up! It can all work out despite how it may seem at times!

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  72. Hello,

    I'm happy to know that you succeeded in this process. My question is, what advice would you give to a student who has recently been accepted to a Caribbean medical school who never had the stats to even apply to a US medical school? Is it really that risky to go to these schools or will really hard work, just like with your story, lead to success in the end?

    Thanks

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    Replies
    1. Hi there, thanks for commenting! Um, I mean I really can't say what would for sure lead to a success story as IMG. Ours did, and we know plenty of people who have successfully matched after coming out of a caribbean school, but I know many others who either never made it through school to begin with or didn't match and still haven't. I will say that doing well in school is obviously important, as is the ability to excel on the Steps (especially step 1) in order to get a residency position. You need to have realistic expectations coming out of an international school. Peds, family med, internal med, and psych residencies are far and away the most likely positions to get and should be the expectation out of a Carib school. You have to weigh your options, we would have been in a world of hurt debt wise had josh not matched and I know people who are almost half a million dollars in debt right now that can't graduate because they can't pass step 2. So it really is hard for me to say. Good luck in your endeavors and if you do decide to go to the Caribbean school, I wish you success.

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