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1/6/2019

How to match in Neurology

Preparing for a Neurology match needs some specific skills and experiences as compared to the traditional categorical specialties. We are frequently asked about the differences and how to prepare a strong application for Neurology. Over the years, we at UsmleSarthi have helped several hundred IMGs match in their dream residency, including Neurology. Based on our experience and the perspective of an IMG Neurology PGY3 resident, Dr Nishanth Korumuri, we have identified several key aspects that an IMG interested in Neurology should focus on, for a successful match.

First, lets all understand that Neurology is a is a sub specialty compared to other broad specialties like IM, which can be multi disciplinary. Neurology does mean narrowing your career path. This is what you will be doing for the rest of your life so commitment and passion are key. Think carefully and think twice because this passion needs to be reflected in your CV and personal statement.

Second, a strong Neurology applicant will have good academic record in general. If you have gone above and beyond to get Neurology specific experience in terms of electives, or observerships, that will help a lot. In most colleges, Neurology exposure is limited to a couple of weeks so get as much relevant experience as you can while in college from these electives and possibly research.

Then, there is this focus on research. Majority of Neurology programs are university based and they love research. While there are some community programs with Neurology residency, most applicants now a days do research as well to strengthen their application.

Hard work: Neurology residents work hard, probably harder compared to other medical specialties (non surgical) so make sure your hard working nature and ability to stretch that extra mile is reflected in your application and during the interviews. The reviewers and interviewers are looking for this trait.

In terms of scores, most programs average between 220 and 240 for both steps for IMGs- though specific program requirements could vary. Neurology is not a specialty where scores are the end all be all. You will see applicants match with lower scores as well as very high scores.

We strongly suggest looking into university programs to do research and strengthen your CV. As we have mentioned in several videos and blogs, generic emails may not be effective in looking for research positions. Spend time in understanding the research area of the faculty you are planning to email, customize the email and communicate how you can help them. Be ready to send out hundreds of emails.
Once you are offered a position, be it voluntary, clinical or basic research, strongly consider taking it. You can always build your professional network once you are in the system at a university or a hospital. Neurology is a small but growing specialty and researchers know each other.
If you are looking for electives as a current medical student, look up American Academy of Neurology, you will find various useful resources.

Now coming to application and interviews.

In terms of LORs, atleast 2 of the 3 LORs should be from Neurology- remember you need to show your interest and commitment. of course the quality of LOR matters as well, but the more number you have in Neurology, the better it is
For interviews, typically you will not get any medical questions. if you have done research, then ofcourse be prepared to discuss it in details. Like in other specialties, you will be assessed on your communication skills, team skills, any leadership roles and application of medical knowledge.
Remember, Neurology programs are looking for your interest in the field and your fit to the program.

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1/6/2019

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Pathology FAQs for IMGs

Why is Pathology becoming easier for IMGs?

Pathology is getting more IMG friendly by the day. The job market for Pathology in the US is not that great. It is important here to understand that the definitions of a “good job market” differs between an AMG and an IMG. For an AMG, a good job market is defined as high-paying initial jobs (>300K) in tier 1 cities or near their hometown or any other location with temperatures above 700 F during most months of the year. Understandably, these locations are already saturated and more often than not the AMG pathologists have to relocate to places they do not want. In addition, Pathology is a high-end service and by its inherent nature requires one to subspecialize. It means that AMGs have to wait for one more year to start paying off their huge student loans. AMGs are increasingly staying away from Pathology residency which is obvious from the recent NRMP stats that shows that 65% of Pathology residency positions are filled by IMGs (both US and non-US combined). Most IMGs are okay with the current job market and are having no problems in finding jobs because most of them are very flexible on geographic location as well as initial salaries.
In addition, the US programs have had very good experiences with IMG residents. Most places have one or two IMG “STAR” residents who had finished their residencies in their home country and are way ahead in the game compared to their peers. These positive experiences have opened new avenues for IMG applicants.

Why do Pathology programs do visa easily?

On the contrary, there are only a few programs (15-20) that sponsor H1b visa. Like I mentioned, Pathology is a high-end service and most community hospitals are not well-equipped to start and maintain the infrastructure required for a Pathology residency program. This leaves mostly the big university programs that do not sponsor H1 visas even in other specialties. However, it seems like the J1 visa rejections for Pathology programs is much lower as most of these programs are well-known universities with great rapport. So most Pathology programs sponsor a J1 visa and this is problematic because the number of waiver jobs is limited in Pathology compared to the primary health care specialties.

Is Home country residency in Pathology a ticket to bucket-load of interviews and confirmed match?
Home country residency is the definitely the best credential to have in your profile if you are applying for Pathology residency match. The impact is almost equal to having three good USClinical Experiences (observerships are considered USCE in pathology). However, home country residency alone is not “a ticket” as such. It has to be complemented with either of these credentials:

Scores above 240, or
3, 1-month observerships with good letters
Long-term research in Pathology + 1/2 observerships
Exceptional research background in Pathology
Rare, hands-on Pathology experiences in the US (available only to GC/citizens), like Pathology assistant positions, post-sophomore year fellowships that go empty could be filled by IMGs
A related graduate degree from the US, like PhD. in Pathobiology, Immunology, microbiology, biochemistry etc.

Any of these combined to a home country residency increase your chances of the match. The more credentials you add, the more the numbers increase (apparently as high as 41 is documented ) but it also depends on how many programs did you apply to. There are 150 odd Pathology programs and almost 120 of them sponsor J1/H1 visa. 70-80 is a safe number to apply to.
what about scores requirements. Is Step 3 almost a requirement like it has become in Psychiatry?
As I mentioned earlier, scores are not independent factors for the Pathology match. Neither is a longer YOG. Step 3 is an absolute requirement only at those 15-20 places that sponsor H1b for the simple reason that they feel safe to start the H1 process with already completed Step 3. A few programs even cancel the offered interviews if the Step 3 is not finished but they are few rare ones. Finishing Step 3 before starting the residency is universally advised by all program directors as Pathology as a specialty is completely unrelated to the contents of the Step 3 examination and unlike an IM/Peds resident, it becomes tougher than easier for a Pathology resident to remember the clinical stuff as they progress in their residency programs.

How important is USCE/Research to Match? How should an IMG WITHOUT home country Pathology experience or residency plan it?

I feel US Clinical Experience is more important than research. USCE makes the students more acquainted with the practice of Pathology in the US compared to research which is mostly bench-work. Moreover, the letters of recommendation obtained from a daily sign-out session are more residency oriented while the research letter may make you sound more like a Ph.D. applicant. In pathology ( and in all other specialties IMO), research should only be sought after if you have finished at least 3 observerships of 4 weeks each and secured 3 US letters for the sign-out experience.
Most applicants are home country trained in Pathology but there are about 30-35% young graduates applying directly after medical school. Also, there are many applicants who apply to Pathology only as a backup to Internal Medicine. In addition to the IMG pathologists, even the other two categories can match if they get those above-mentioned 3 observerships and manage good letters. Compared to trained pathologists who usually do observerships as a colleague to the junior faculties and do really good in their rotations, the other two categories of students do not seem to match. However, this game is totally fair. There are many programs that prefer only young graduates with good scores. Also, there are many programs that entertain all kinds of applicants. In the words of one PD during the interview season, ” Do not think that because 3 out of the 6 of you are already trained pathologists, the rest of them are already out of the race. We have called you for an interview as we know that each one of you is special in your own way. While half of you are vastly experienced, the other half has great scores and are young and we need both kinds of residents to make our program rich”.
An inexperienced medical student in a Pathology rotation can still get a good letter of recommendation. They need to be sincere and show up in time. Dress well and behave well with the techs/residents/fellows/attending. A golden tip is to accept that you know nothing and ask doubts. If an attending shows you angiosarcoma, for example, go home and read up about angiosarcoma at night, come back again with few genuine doubts and discuss with the resident/fellow (to make sure you are not asking something silly) and then ask them those questions. Not only does this show that you were attentive during sign-out but also that you were interested and went home to study all about that one topic and now are willing to share the information and ask doubts. You don’t have to be a good pathologist to be a pathology resident, you have to be a good and sincere student (this should apply to all specialties).
You have to try and understand what kind of people are they looking for and see if you fit. Pathologists are clichéd to be the doctors who do not interact with people but it is not true in reality. Although we do not talk to the patients usually, we do talk to the clinicians all the time. If you come across as someone who could express themselves well over a phone call, an academic discussion, or in a written format (for example this entire write up be me ), you are a personality that would fit well in a Pathology department. Pathology is all about how well you communicate what you see to the clinicians. Communication skills are very important both to do good in a rotation as well as during your interviews.
Attempting to finish a Pathology residency in the home country in order to improve your chances for Pathology match is a bit too extreme step. Although it gives you a good backup, it takes away 3 precious years of GC application from you especially when you know that there are ways to match without home country residency too
Any other important trend that IMGs should be aware of?

A recent trend among non-visa requiring candidates is to look for Pathology assistant jobs. This is the strongest hands-on grossing experience that anyone can have in the US as an IMG. J2/L2 EADs can also be employed to these positions.
Doing all your Pathology USCE in one single institution or state may be considered as a lack of flexibility and it is preferable to do at least one rotation in IMG friendly places like NY so you seem more flexible
The job market is getting much better. This is reflected by increased numbers of job postings on websites like pathologyoutlines.com and sudden fellowship position openings in offseasons that show that people got a job and they left their second scheduled fellowship so that it shows up now.

The basic principles for Pathology match are similar to other residencies. It is a good time to enter into Pathology residency as it is not very competitive now. As the job market keeps getting better, the balance will shift to the other side in due time. I have met thousands of Pathologists during my 3 years of residency and 2 years of practice in India and my research stint at Mayo Clinic for one year and I am yet to meet a sad Pathologist. As you get to know more about the subject, you start loving it more. All the best!

Dr. Anurag Sharma, Pathology resident. Cleveland Clinic

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1/6/2019

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Pathology residency prospects: is it easy for IMGs?

This was written by Dr. Anurag Sharma, a pathologist.

Few facts about Pathology residency in the US:
1) There are just 500-600 spots.

2) AMGs have not been interested in Pathology residency for almost 15 years now. The first reason is that it is a 4-year residency and requires fellowships to get good jobs which increases the time period to 5 or 6 years. Anyone would want to become an internist in 3 years and start earning if they have a 500K loan to pay off. Jokingly, people say that the AMGs applying to Pathology are so less that the only qualification for an AMG to get Pathology is to apply to Pathology. The second reason is that the job market in Pathology has NEVER been good in the US. A 79-year-old US Pathologist commented on my “matched” status that it is great as long as you are not looking for jobs. From what I have gathered from my experience till now is that US grads define job market much different from IMGs. Salaries are compared with fellow surgeons and everyone wants to stay in California. We know, we will even go to Alaska for half the surgeon salaries. Still, the real picture would be evident once I go to that scenario myself. Being a pathologist, good/bad job market doesn’t matter to me. I will do it either way as Pathology is my life now.

3) IMGs, as you know, are never too fascinated with the paraclinical specialties.

4) 2+3 makes the number of people applying only around 1000-1500 at max which increases the odds.

5) Most programs have an absolute requirement of past pathology experience, either a home country residency, a Ph.D. in lab-related disciplines, post-sophomore year in pathology, postdoctoral research fellowship, 3-4 observerships, experience as lab techs or pathology assistants. However, few including top ones like MGH, BWH, JHU etc prefer more fresh graduates with good scores.

6) Old YOGs are seldom a filter in Pathology with the average YOG being 6-11 years for 50% of matched candidates.

7) The programs range from low tier to mid-tier to elites with the competitiveness increasing in a very steep manner. While the low tier ones are so hungry to fill their spots that they would close their eyes and select a clear-cut IM applicant with okay scores despite knowing it was just his/her back-up while the elites would act like a typical IM/Peds program and ignore all your emails (from observerships to letter of intent) and won’t even send you the rejection email .

8) Observerships are valid USCE in Pathology as everything in Pathology is Observing!

9) They love smart people who could talk and communicate properly as communication through written speech or by phone in an intraoperative consult is the only way a pathologist connects to the surgeon and the patient.

10) Pathology resident has to read a lot. At least 20 books are finished from cover to cover in 4 years of residency.
So, it is not all Hunky dory! I felt morally obliged to share the current scenario so everyone could see beyond my glamorous posts and make a truly informed decision.

Despite all these shortcomings, there are some positives which might help you make your decision:

1) It is an open-book specialty. You can sit on a case (unless it is an intraoperative consult), show it to your colleagues, send an image to your mentor, or read it in all the books possible before signing it out. There won’t be a patient staring at you all the time while you are doing this.

2) The slides don’t talk back and lets you do your job.

3) Weekends are yours and any time beyond 5 pm is completely yours. It has a good work-life balance.

4) Average pathologist compensation according to Medscape is 293K which is far above that of an internist or a pediatrician without good fellowships. However, this average is the result of pathologists earning on a spectrum from 150K to 700-800K but it is true for all specialties.

5) Due to the wonderfully designed and protective wordings which you will learn in your residency, you have to try really hard to invite a lawsuit which is a big problem here.

6) You can sit on the microscope and work till you die.

7) You get your hands on the best research projects and are usually at the center of all high-powered projects as you are that one bridging point between the Ph.D.s and the clinicians.

8) You get to teach all levels of trainees and doctors if that is what interests you.

Bottom-line: This specialty has its own set of problems and its own sets of perks. Just do a lot of research yourself and then decide if you are okay with this specialty before jumping into it just because you read few good posts on Facebook.

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USMLE residency specialties

How to match in Neurology

Pathology FAQs for IMGs

Pathology residency prospects: is it easy for IMGs?

USMLE Residency specialties

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