The Match, The SOAP, and the Reality of being an IMG (Part 2 update)

So, here we are, Match Day 2015.  Can it really be that it has already been a year since Match Day 2014, the day that inspired this ORIGINIAL post?  That post has become far and away my most read post on this blog to date.  I find it both humbling and heartbreaking that so many have found their way to my blog and either felt sorry for our story or inspired by it.

The post has been linked on other medical blogs and has been referenced in multiple forums on Student Doctor Net throughout the last year.  And because I can trace where my page views are coming from, I have seen the comments on those forums and blogs and I have to say, I have had moments where I felt very discouraged.  I realize that those that comment have neither been in our exact position, nor do they know Josh personally, and they are attempting to give a full (albeit harsh) picture of what not matching or perhaps WORSE in their eyes, matching into a prelim position means.  I've read things like "prelim positions are dead end positions," "he will never get a categorical position," "he will be worked to death and will not be respected as a prelim," and one of my personal favorites, after not getting into an American Medical School, "he should do something else and get on with life."

I have one thing to tell all the naysayers and the same thing to tell all those discouraged and disheartened about their Match success or lack their of, especially the IMG's.

Josh Matched Categorical General Surgery at the University of Massachusetts.

It pains me to say that THERE IS NO MAGICAL FORMULA to matching into categorical general surgery as a preliminary resident. Nor is there any perfect outline for finding a spot during SOAP or after.  There have been so many readers who have commented on my blog post and asked me to email you personally to answer your questions.  There have been readers who have tracked me down on Facebook or through my Etsy shop to ask questions about what we did and I understand, I really do.  You are grasping at straws here.  I understand the heartbreak you are going through after not Matching and I know the stress you have felt after not SOAPing.

What I am going to write here is what WE did and what worked for US but I know that our story is a combination of hardwork, determination, prayer, and luck.  Honestly, we needed all four of those components for this to work.  While I think that Josh is the perfect package for a surgical residency program, there was definitely an X-factor at work here.

This past year:

Joshua knew from day one as a preliminary resident that he would have to hit the ground running in his program.  First impressions are important but so are long term impressions.  He knew he couldn't start out strong in July and then begin to teeter off in the coming months.  It is a marathon not a sprint.  What you have to understand about Josh is that he is a very outgoing, competent, and  confident man as well as a natural leader.  It's possible that he thrives more under pressure than anywhere else so when he knows he has to go all-in, he does.   What you have to understand about the surgery program at UMass is that they don't treat their prelims differently than their categorical residents.  Joshua was in surgery regularly alongside attendings and the Program Director.  I'm certain that there are preliminary programs out there where this would not be the case, but Josh got lucky because he was at a program that would give him the chance to get noticed.

He got 4 entirely new letters of recommendation, three from surgical attendings he worked with during the first two months at UMass and one from the Program Director.  We believe this was key in him getting 5 interviews this year.  His test scores (Step 1: 232, Step 2: 235) and grades (graduating GPA: 3.7ish, Basic science GPA: 3.4ish) hadn't changed, if anything, he was at a disadvantage having been out of school for a year.  But we feel his new LOR's were EXTREMELY strong and so they were able to boost his application.

He was also asked to be on a committee for resident education at UMass as one of two PGY1 representatives.  We were surprised that even though he was a preliminary resident, he was given this task.  During the fall, he competed on a 3 person team comprised of one 5th year, one mid-level, and one intern in a "surgical olympics" type competition between other surgical residency programs on the East Coast.  UMass's team came in 2nd place and I feel Josh shined during that competition.  He showed confidence in himself and his surgical skills as well as pride in his program.  All of these things may not have determined his ability to obtain a categorical position, but I feel that getting your name and face out there within your program, especially if you are a prelim is of the utmost importance!  In other words, getting involved in these type of opportunities never hurts.

As it turns out, Josh Matched at his first choice program where he is currently a prelim, the University of Massachusetts.  We loved this program from the start and are so thrilled that not only did we choose them, but that they chose us.  I don't know if Josh would have matched at one of the other 4 programs he interviewed at if UMass didn't pan out, but I do know that he felt confident in all of his interviews and I would like to think that someone else wouldn't have passed him up either.  I guess we will never know and at this point, it no longer matters.

Many many things came together in order for this story to end in the successful manner that it has.  Maybe we just got totally lucky.  And if that's the case, we are thanking our lucky stars.  We have five years of a surgical residency ahead of us and you'd better believe we won't be taking any one day for granted.

Match Day 2015!

**If I haven't answered some of your questions, know that I plan to do a FAQ post as well in the next few days.  I wish I could respond to everyone that has been asking me to email them, but I'm only one person and I'm also a Mom and a wife.  I write this blog as mostly an online journal for family and friends and while I'm thrilled to be "helping" others in similar positions, I also don't know much more than what I've already written or read about online.  

Match Day 2015

I will do a big update on Josh and our second go around with The Match next week, but I just want to say with a HUGE amount of pride in my husband and in our success story that.....

WE MATCHED GENERAL SURGERY!

What Does Being A Preliminary Resident Really Mean?

I am a researcher, probably to a degree that is sometimes unhealthy.   I have spent countless hours over the last 4+ years researching online anything and everything about medical school, board exams, residency applications, and residency in general.  There really is an endless amount of information out there on the web.  But, there is NOT very much information regarding being a preliminary resident.  Granted, this is something I had hoped we wouldn't have to deal with.  But now that it is, it's very disappointing to not find much in the way of guidance online for how to navigate this type of situation.

The main issue as a prelim is that it is only a 1 year guarantee.  At the end of this resident year (July-June), Josh will no longer have a job.  One year as a surgical resident does not allow you to practice on your own, become fully licensed, etc.  In short, it's not a situation anyone wants to be in.  At the same time, it is a slightly better situation than not matching at all and having no job for the past year, no new experience, and no income.

The biggest downside for us is the uncertainty that being a preliminary resident brings.  We still don't know where we will be living after this year.  We still don't know if Josh will get to continue on in his quest to become a surgeon.  We don't know if he will have to repeat his PGY1 year or if he can move forward as a PGY2. There are so many unknowns.

Here are a few of our options as "prelims."

1.  Take and hopefully excel on the ABSITE (American Board of Surgery In-Training Examination) and wait for any PGY2 categorical spots that come available across the nation.  Apply to these programs with the backing of his current PD (program director) and hope you can secure a second year spot meaning you have wasted no time. (This is our first choice.)

2.  Reapply to the 2015 Match in General Surgery (because it was oh so fun the first time around).   We are hopeful that with some new experience as a resident, brand new letters from current attendings, an updated CV and Personal Statement, and an ECFMG certification, Josh will be granted more interviews and hopefully match into a PGY1 categorical surgery spot.  He would be repeating his intern year but would have a full residency. (We are doing this.)

** The problem with the above options is that it is likely that many PGY2 open positions will not become available until after the ABSITE scores are in, which is after Rank Order Lists are due for the 2015 Match.  If you enter the Match and do in fact match to a PGY1 spot, that match is a binding contract.  You would then be unable to accept a PGY2 position if one were offered to you.  We plan to see how interview season goes.  If Josh interviews at some programs that seem like a good fit, we would likely move forward ranking programs for the Match and not put all of our eggs into the PGY2 basket.

3. Apply to and take a PGY2 preliminary surgery position.  This is a second year spot, but again is still preliminary leaving us in a similar situation next year as we are in this year.  After a PGY2 prelim year, Josh would be able to apply to PGY3 positions that are available and hopefully secure one.  But again, this is not a guarantee and therefore our last choice.  (We will consider doing this come the Spring if nothing else pans out.)

4.  Reapply to the 2015 Match for a spot in something other than Gen Surg.  For example, Family Medicine, Internal Medicine, or Anesthesia which he is more likely to get.  Match into one of these and be happy we have a job, even if it's not initially what Josh thinks he wants to do. (We are NOT doing this.)  At least not this year.

**Josh and I have discussed it a lot and together we have decided that we are not ready for him to give up on his dream of being a surgeon.  While he could likely match into one of these specialties, doing so would close the door on surgery and we both feel that there are too many other viable options, even with extra years, that would still allow him to pursue a successful surgical career.  IF after this year, he becomes a PGY2 prelim we would likely then decide to apply to some of these specialities for the 2016 Match.  We sure hope we don't get to that point.

As I'm sure you can tell, it is a stressful time with lots of possibilities hanging in the balance.  However, this atmosphere is almost becoming "normal" around here.  Applications are open to be submitted tomorrow for the 2015 Match.  We have been finalizing Josh's application all weekend and are maintaining faith that our outcome will be different this year.  We also wish so many of our friends who are doing this for the first and hopefully only time, a successful Match season.

May the Match be ever in your favor.

International Medical Graduate. Would we do it again?

I've surprisingly received quite a bit of internet traffic on my blog this past week after my POST about Josh's trouble in the Match, in part due to the fact that he is an international graduate.  I believe the post sheds some light on some of the difficulties of being an IMG as well as the challenges and hurdles that every medical graduate must face along the road to becoming a doctor. There is and unfortunately will probably always be a stigma associated with being a foreign grad.  And so, it sparked the obvious question, given the choice, would we do this all over again?  Should anyone, especially a US citizen, consider matriculating in to an off shore medical school?

To be honest, I feel that this is such a personal decision that cannot be answered by any one person.  As with anything in life, there are pros and cons that must first be weighed to determine the best answer for you.  However, here is our experience.

Josh just didn't get offered an acceptance to a US medical school.  Whether that was due to an average undergraduate GPA, average MCAT scores, or something else entirely, he was never given the chance to go to medical school on American soil.  Perhaps he should have applied a second time.  Perhaps he should have retaken the MCAT again.  Maybe he would have been better off redoing undergraduate pre-reqs, but he was 24 years old, newly married, and ready to start down the long road to completing his dream of becoming an MD.  And St. George's University in Grenada, West Indies gave him the chance to do it.  It is extremely hard to pass up an offer to obtain your dream career when it is being handed to you, even when it is attached to a $200,000.00 price tag.

In hindsight, we were young and naive and we thought to ourselves, SGU is a US accredited program, he's a US citizen, and he will take the same exact boards, we should have no problems.  Well, SGU did what they promised us.  We paid them a lot of money and Josh and his class of over 500 students studied hard, passed classes, did two years of clinical rotations in American hospitals, passed boards, and applied to residency just like every other AMG student.  Obviously, from my last post, you can see that the residency part of becoming a doctor has been one of our biggest challenges, however, it did work out.  And it does work out the first time around for over 80% of SGU's graduates.  If you want to see just how SGU is matching their students each year, you can check out this SGU MATCH LIST 2014.  What you will see from this list is that most SGU grads match into primary care at non-University based programs (Internal Med, Family Med, Psych, Peds).  The point is that these graduates are making it to the MD, just maybe not the super specialized ones.

What we find most disturbing about the residency application process is that these students, especially ones trained at US accredited medical schools like SGU, Ross, and American University of the Caribbean, take the SAME EXACT boards, receive all of their clinical training at American hospitals and therefore receive letters of recommendation from US doctors, and yet still are considered second class choices for US residency positions because of the location of the medical school that they went to.  Are the USMLE's somehow a different test when IMG's sit for them?  Are the doctors at the hospital Josh rotated through training the SGU students in a different way than the medical students from Loma Linda University that rotate right alongside them?  The answer is absolutely not.  But, until more residency positions are opened across the US, or until the playing field is neutralized to take the strongest applicants regardless of the school they graduated from, this will likely remain the same and obviously, that is something to consider if you are contemplating attending an off-shore school.

With all that being said, our answer to the question, would we do this again?

In a heartbeat.

My husband is Joshua Scurlock, M.D.  And though those two little letters cost us a lot of money and a ton of blood, sweat, and tears along the way, he is now a doctor.  We are confident there really was never a choice of attending SGU vs. not becoming a doctor.  The United States is the land where you follow your dreams, even if that means following them outside of the US.

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.