Audacity of Hope and Grit

A lot of people have urged me to write my USMLE journey last year as it has been an inspirational one for the ones who know me...a sort of miracle….a story of resilience, blood, sweat, tears, hope, divine intervention, and blessings and help of a lot of people along the way most importantly self-help and help from god :). I truly believe self-help and divine help truly manifest roads and pathways that others cannot perceive. 

So I am a graduate of 2012, worked for 2 years in a hospital in India in Internal Medicine.  Although I always wanted to go to US for higher studies since 1 year of med school, while I was in intern year, I got influenced by my cousins who portrayed a bad light of long winding journey of medicine and less pay in India and made me insecure and in an indirect way encouraged what they were pursuing and I started to give CAT exams to do MBA in India and then GRE to go for masters in US. Thus even after such a great career graduation, I was chasing a fool’s dream and studying and solving MCQs of English and Maths. I passed them as well with decent scores.

In 2013, I gave up these foolish attempts and tried to focus on USMLE after studying for the other types of exams for 2 years. I had a hard time to get back on track and I failed miserably on step 1 in 2013. In 2014, I got the opportunity to go to the US for 2 month of rotation at a reputed hospital and gave my CS then which I easily passed with flying colors. By June I got a research fellowship opportunity to do research at an IVY League hospital. I was on a good track professionally and personally even though I had a mild set back. I continued to study and in August gave my step 1 and passed with a 198 and in October I tried to give my step 2 CK as I have been constantly studying but failed. I gave it again in April and failed again. I then gave step 2 CK in December and passed after 2 failed attempts. By that time I was doing 1 and a half years of free cheap labor of research. My mentor took pity on me and tried to help, and with some contacts I got an interview that year which was nothing more than a courtesy call. In 2016, I gave my step 3 and failed again. By this time, I had won a few international awards, filed for a patent, formed a company, and have won research posters awards locally and nationally in the US. I also completed several research courses in the IVY league school and took teaching opportunities to teach research at my institution. People were reaching out to me on facebook to collaborate to do papers with me. So my CV was getting better and better but my attempts were embarrassing. 

In 2016, June, I found a partially paid different research lab and moved there. My IMG colleagues in previous labs were matched into the IVY League hospital for IM. I swallowed my pride and embarrassment and continued to work earnestly. My new research mentor loved me. I had 2 interviews that year. Both again were courtesy or because I kept pestering them. But they hated my scores and attempts and found ways to reject me. 

Each March was a month of pain for me. Getting “Sorry you did not match” in NRMP, the grueling and cruel SOAP period and then reaching out to the empty slots only to realize they are not going to take me. My parents were growing more and more anxious about me and my future. My long interracial relationship with a white boy fell apart and I was in agony personally and professionally with no money. I could not afford to burden my parents to stay in the US after 3 years of coming year. I was taking care of people to stay in the expensive city. 

In 2017, I found a fully funded paid research position where they pay  a resident or postdoc salary (around $40K/per annum. Working in anesthesia made me fell in love with anesthesia. By that time I had completed my step 3. Now I had 1 attempt in step 1, 2 attempts in step 2 and 1 attempt in step 3. (total 4 attempts)...my so called “credential” were YOG 2012  (>5 years), 198 (1 attempt), 208 (2 attempts), and CS (no attempt), and step 3 213 (1 attempt). I still dreamed of matching into anesthesia, one of the most competitive specialties, that too I wanted to get into the IVY league school I worked in. Because MIND RECOGNIZES NO BARRIERS.  By that time, I had become an expert in networking. People all around knew about me. I kept bugging every colleague and senior I know who were friends with me in fb for opportunities. My network skills landed up in an anesthesia interview at my institution for the two years I worked there. They liked everything about my CV except of course my scores and attempts.

But 2019, I have reached the 5 year period of my J1 research visa means if I don't match next year, I cannot continue this never ending cycle. Also my funding in the research was getting over with the 2 year period and my mentor encouraged me to find a position elsewhere if I don't match. With my networking skills, I found a job as a data analyst for a 100,000 $ salary in the North East which I could potentially take on an O1 visa. Many seniors told me to quit this dream and take up an industry job, physician assistant, or do something else. All this time, my parents also kept telling me to come back and do a PG in India. Yet the dream of doing clinical medicine in US burned in me and the more people discouraged, the more persistent I was.  

After the match of 2019 in March when I still did not match, I was lost, in the tail end of my visa, with no support system personally, growing into my thirties, unmarried.  I sent letters to all the fellowship programs selling my CV. I got 2 geriatrics, 2 ID and 1 nephrology interviews and offers. Finally I took a fellowship offer and  relocated. My program director adored me. She spoke highly of me to everyone around and gave me one of the best LORS i ever had. So in the year 2019, I applied with a fellowship, active medical license and a PgY4 salary. I also managed to bag a grant for my research with my extensive research experience which was one of its kind as no fellow has ever bagged a grant for my QI project. That year, I got 4 IM interviews, 1 FM and 1 neuro interview. They were all impressed that I was going to do a PgY1 after a PgY4 experience. I was so sure that I would match. But alas, the month of March proved once again painful for me. This was 5 years of painful March. But my grit knew no bounds. 

My program director was surprised. Everyone in my program was surprised when I did not match. This time I am on a J1 Clinical which means the waiver will come in place if I don't find a clinical position and will have to go back to my home country. I was in a panicky mode. I reached out again to fellowship programs. I again got ID, nephrology, hospice and palliative medicine fellowship offers. I was like when will this cycle end, and finally out of no where, from my constant persistence, push from the GME and recommendations from my PD, a position opened up in my own residency program where I was doing fellowship and in the COVID-19 era, they just took me instantly into IM. This was nothing but a miracle. But the miracle was created by my persistence, my grit, good will of my mentors, my years of experience and above all god’s grace. 

I hope none of you goes through the long, arduous, tumultuous path that I went through. But if someone is going through it, I want to let them know that opportunities and help can happen and be created with hard work, persistence, and divine help. 

Looking back, I would have never sidetracked to other fields while doing medicine, try to do steps in the med school and I believe that could help with the score as you are actively in touch with it. I also encourage networking and participating in conferences as with a good score, these networking can take you to great places. Since we are all a fan of bullet points, let me jot down a few bullet points from my experience.

1. Start Early: Never get side tracked from your goal. If your goal is to pursue USMLE start from first year of medical school, baby steps and you will be a board certified clinician in US early. That is the earlier and more focused you start, the faster the success in this journey seeks you. 
2. Keep doing MCQ in med school. Doing MCQ is a skill that requires practice and is mandatory to score well in USMLE. If you have good scores, none of you might have to go through what I went through. 
3. Support system: Life is unpredictable, don't get bogged down by setbacks. Create and appreciate your support system. It can be dynamic but my biggest and solid support system was my parents. There are friends also who have helped me emotionally. I also find meditation and spirituality very helpful for me to regain my inner peace and voice. 
4. Mentors: Mentoring is important in this journey. I would also like to thank USMLE Sarthi that provided me with resources, mentor and support during the last 3 years of my journey. Pawan who is the founder of Sarthi is very helpful and has patiently walked with us in this journey and I appreciate it. My assigned mentor is a source of inspiration for many and was also a strong reference point for me and he would give me encouragement and help me to find ways to pursue my dreams and goals. 
5. Noise cancelling machine: They are helpful not only in libraries when you study but also in life when others tell you to quit, you cannot make it or anything which does not resonate with your goals. I have seen IMG doing IM residency in IVY league schools including internal medicine  and anesthesia.  have seen people who had gone through more years of pain getting through, I have also seen people who decide they don't want to pursue this. 
6. Network: With right scores, I have seen networking take you to places which are awesome. It can also help you if you don't have great scores. So whether you are introvert, extrovert or ambivert like me, start making connections. 

Finally, in this time of interview season, I would like to remind all of you that you can create your own path for success. Don't get bogged down by the number of interviews you have versus your peers. It's your own relationship with your higher self that matters and counts while manifesting opportunities and getting strength to pursue your dreams. Your journey may be long or short, but in the end it's your journey and your dreams. So be positive, happy and walk your path.

Good Luck!