How to get a residency Part 1: The School

Please post your comments and questions

Program directors do not know who you are.  How are they supposed to assess your quality?

The name of the school for U.S.  graduates.

What country you came from for International Graduates

What I am writing about here is NOT my personal opinion. I am writing this to help you get insight into how the mind of the program director works. I am not always agreeing.

For instance, I recently spoke to a surgical program director who did NOT want to take anyone graduating from a Caribbean med school. His reasoning was anyone in a caribbean school was someone who could not get into school in the US.

I do not agree with the attitude, but it must be addressed.

US schools are considered better because there is a more uniform ‘product’. US schools have a rigorous accreditation process that is identifiable and measurable. Most international schools do not.

Recently a student from a caribbean school got very upset with me about this. He said “Our school is just as good” Then he admitted that with >1,000 students in a single year and the fact that most of the 3rd and 4th year had to be virtually self-arranged by the student, that, perhaps this might lead to some quality issues.

Here is the rank order

1. US grads

2. Americans who went to international schools

3 Internationals in international schools

4. Internationals with Visas

Before you start getting upset, or feeling ‘discriminated’ against, this works at EVERY level.  In New York there are a lot of 1st class schools. A student applying from Stonybrook or Buffalo will have a harder time in getting an interview that the students from Columbia, NYU or Cornell.

I was at Boston University last year. You might think they would feel relaxed and at an advantage.

they don’t. Why?

“We are in the city with Tufts and Harvard”

Remember, it is like an arranged marriage. They do not know who you are at first. They know the name of the family.

Please post your comments and questions.



9 Responses to “How to get a residency Part 1: The School”

  1. Arps Says:

    Interesting to know the hierarchy.

    1. But why are International students with visa below IMGs?

    2. And also, what all steps can be taken by IMGs to improve their chances of getting into a Residency of their choice?
    (There’s definitely the USMLE score, that is undoubtedly the most important criterion. But then a lot of people in competition do score a double 99.. so that doesn’t leave much of an edge)

    • Conrad Fischer Says:

      IMGs with visas are considered less desireable because some people do not show up or do not have their papers handled in time to start.

  2. doptimistic1 Says:

    thanks for taking the time to help, how about specialties and the level of competetitiveness? For example family practice vs im for a US international grad? or dare I ask about dermatology..

    • Conrad Fischer Says:

      PLEASE ask about dermatology! That would make you the tenth person this week.

      Dermatology cannot be reached just with scores.

      • optimistic Says:

        and how do you reach it? research, US clinical experience, or mostly one’s connections?
        so scores are important, being charming is not good enough 🙂

      • Conrad Fischer Says:

        Being charming helps, but you have to get into the interview to be chqarming. And I do NOT think that ‘connections’ are teh main thing, since you are applying far and wide.

  3. nani Says:

    Thank you, Dr Fischer for taking the time to tell us the “ugly truth” and say what others won’t because people might misinterpretet it or consider it discriminative.

    It is only logical that you prefer that which you are familiar with. I know the qualifications and deficiencies of the schools in my country, and so do Americans with their on graduates. They now more or less what to expect. So it is surprises me when people take it the wrong way.

    When we decided to come here we knew that unfortunately we were in a disadvantage when compared to US graduates, but we must also remember that we have been given the opportunity to continue our studies here, and that is also something we should be grateful for. We should be trying to thrive, to prove we can excel, more than complaint.

    It is more a matter of attitude, more than knowledge of ability, I think.

  4. nani Says:

    OR skill, not ability hehehe 🙂

  5. Mauricio Soto Says:

    It’s good to have the vision of an “Insider” on the mind of a Program Director.

    I can just imagine how hard must be for IMGs to prove their worth in spite of their country, language or race. And we must face it, some (if not most) of the time, we are not in US standard of care.

    If someone says “Sarcoidosis” in a DDx in Latinamerica, it’s some sort of geek who is actually studyng for USMLE, not only for his local grades. Same thing if an USA intern or resident brings an Chagas’ Disease diagnosis in the wards =)

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