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.