Tag: foreign

Posted on by

Poor Step I USMLE Scores- What Do I Do?

USMLE Step I

Hello Dr. Barry Julius, 

Question About Step I USMLE Scores And Application:

I am a foreign medical graduate that finished Med School in 2016. During this 2 years I’ve been studying and taking the USMLE steps, I took my step I USMLE and got an unsatisfactory score of 209 for multiple reasons. Then, I took my step II CS, passed the first attempt, and received a step II CK score of 250. I have an upcoming paid rotation (very hard to find in radiology) in a large city for 3 months starting in February 2019. Unfortunately, I don’t see myself doing anything else than radiology. Since I grew up with it and came from a family full of radiologists back home, this is what I see myself doing and breathing.

Am I dreaming about getting into a radiology residency? Or, is it possible and should I keep on pursuing it? I have all the upcoming months to make my application stronger and more appealing to apply in 2019. I am thinking about taking the step 3 USMLE if that would help my application. However, I have heard mixed opinions about completing it before applying. Also, I don’t have any research. Moreover, I have also found conflicting information on the importance of research for radiology applications.

I would really love to enter a radiology residency but I want to keep it real. Can I have your professional opinion on whether it will be possible. Also, what should I do this time to improve my chances. Or, should I just wake up and look for another option?

Thank you very much for your response,

Concerned Applicant

Answer:

Honestly, since you are a foreign grad, a score of 209 on Step I USMLE may limit your ability to obtain interviews. However, some programs may still give you one because you did so well on the step II exam. I think it is worthwhile to attempt the application process. You never know. But, I agree that it may be very challenging for you this year. You should temper your expectations for getting into a radiology residency.

In terms of the USMLE series, in your case, I would probably consider taking the USMLE Step III and try to ace the examination. A good score would confirm that the initial Step I exam results were a fluke. But, be careful. If you perform poorly on it, you can ruin your application. So, you need to study hard! (Not that I expect that you wouldn’t do so)

Also, it is often just as competitive to get into a prelim year prior to starting radiology residency. All foreign grads need a clinical year in an ACMGE certified program in the United States. So, make sure that you also apply for this as well. Foreign clinical programs are not a substitute.

Finally, as I’ve told some other foreign grads before, you need to make sure that you get to know the program director at the site of your paid rotation, This will help you get your foot in the door for an interview at least at that site. Also, this person can be a great resource to find a way to get involved in radiology research that can also bolster your application. Potentially, this person can also give you a good recommendation. That would help as well.
Let me know if you have any other questions,

Regards,

Barry Julius , MD

Follow-up Question:

Thank you very much for your answer.  I have to apply to both programs at the same time, meaning the first categorical year and radiology at the same time. Is that correct? Is there a possibility to start a separate IM program and then transfer after the first year to radiology?

I think it’s a little bit easier to get into internal medicine residency for the IMG. And, some programs require a lower Step 1 grade. As per your advice, I will definitely take the step III before applying and try to complete some research. It is hard to find, but hopefully, during my upcoming rotation, I can get my hands on something. 

Finally, I forgot to mention that I have a U.S. residency. So, I think that would improve my chances a little bit since I have seen lots of programs not interested in sponsoring VISAS, is this correct? I just want to make my case as strong as possible when applying to improve my chances, but I’m also considering internal medicine residency as another possibility because of my bad STEP 1 grade. 

Thanks again for your reply,
Concerned Applicant

Follow Up Answer:

It is possible to start a separate internal medicine program and then transfer over to radiology. However, I would recommend applying to both a preliminary clinical year and the categorical program as well as the three-year IM program. But, I would make sure to rank the categorical radiology and prelim clinical year programs first. You should be able to use the IM three year program as a backup if all else fails.

And, I agree. U.S. residency will help you a bit to secure a residency slot. It’s one less problem for the residency programs to worry about when you apply.


Good luck!

Barry Julius, MD

Posted on by — 1 Comment

Is It Still Possible To Become An ABR Certified Radiologist Through The Alternate Pathway?

Dear Barry,

I am also interested as Fiona in the alternate Pathway. My biggest question here would be, if I have any chances after ABR certification in actually pursuing a career as an independent radiologist in the US. As far as I understand, in many if not all states, you are required to complete a minimum time of postgraduate education, within an ACGME accredited program, before being granted the corresponding state license to practice as a physician. Considering the rule that you are allowed to take a fellow position in an ACGME accredited fellowship program ONLY if you graduated from an ACGME accredited residency program (this because of recent changes); how could any radiologist trained abroad be able to fulfill the state licensing requirement after doing the 4 year alternate pathway. (To my disappointment explained here by the SPR – Society for pediatric radiology – ¨ http://www.pedrad.org/Education/Fellowship-Directors/Pediatric-Radiology-Fellowship-Directors-Library ¨ )

The ABR clarifies that the changes introduced by the ACGME are not affecting the alternate pathway, which I understand and see as no impediment for certification, however I still don’t see clearly the possibility of full licensing. Why would a foreign radiologist be interested in ABR certification if the chances of practicing radiology in the US are so scarce or null in the future.

One last question: wouldn’t a fully trained radiologist from abroad be a good candidate to match through the traditional residency system, under your perspective as a program director?.

(Dear Fiona: Maybe we can get in contact and share our views and findings. Please email me if you are interested).

Thank you for reading this, cheers, Esteban.

 

——————————————————————-

 

Here are answers to your two separate questions here. To refer to the other information about the alternate pathway go to the ask the residency director question at the following link: How To Complete The ABR Alternate Pathway As A Foreign Physician

 

Answer to First Question:

In order to be licensed in a state, you do not get your certification from the ACGME. Rather, the ACGME certifies the program that you attend as a resident, fellow, or attending. So, it is still possible to be certified by the ABR and to get a state license via the alternate pathway. However, as you mentioned in the new addendum in 2015 to the alternate pathway, you will have a difficult time getting into an accredited fellowship via the alternate pathway because of the new requirement (having to get an ACGME fellowship only after completing an ACGME accredited residency).

Regardless, it is still possible to use the alternate pathway to become an ABR board certified radiologist. So, how would that happen?

Two Ways To Satisfy The Alternate Pathway Requirements.

1. An ACGME accredited institution would need to sponsor the foreign radiologist for a junior faculty position for four years. In other words, the institution would be responsible for getting the H1B visa for four years so that you could work in the ACGME accredited institution in the United States. The problem with this- the sponsoring institution will incur lots of legal and immigration fees in order for the applicant to get the H1B visa and the junior faculty position. So, it is unlikely that the institution will take a foreign applicant unless he/she offers something special or is trained in a subspecialty area that is useful to the institution and a United States applicant cannot fill that need. Therefore, it is true that the institution is much more likely to take a United States applicant than a foreign applicant for a faculty position.

2. It is possible to get an unaccredited fellowship in an institution that has an ACGME accredited residency program. This year of unaccredited fellowship would be enough to count toward the requirement of having 4 years of training. You would need four such years as this. Through this pathway, you would potentially only have to deal with the issues of getting a J-1 visa, which is a bit easier than an H1b visa.

Issues For The Alternate Pathway Applicant

For both of these alternate pathways, there is a possible complication of some individual states not recognizing the training of foreign residents who do not complete an ACGME accredited residency/fellowship. This means that the alternate pathway training may limit which states he/she chooses to work.

As you can see, it is possible but a bit complicated to go through the alternate pathway via both methods. The ABR alternate pathway has become a rarely trodden method of obtaining a radiologist position in the United States. (It is not impossible, but very difficult and probably involves lots of connections!!!) In addition, there is a risk that your opportunities as an alternate pathway candidate, could be more limited.

Answer To Second Question:

From an associate program director’s perspective, I would love to take a candidate who has been trained as a full-fledged radiologist in another country. Our job becomes a lot easier since these residents are usually very independent. In fact, one our best residents has been a candidate such as that who attended our program four or five years ago. He was absolutely fantastic!

Again, however, there are several impediments for the foreign radiologist who wants to repeat a United States residency. First of all, many programs do not want to have to deal with the stresses of getting a J-1 visa sponsorship for their foreign applicants, even though a J-1 visa is usually not that difficult to obtain. And, second, there is a prestige issue for many programs. Some high-end university programs take pride in the fact they do not take foreign applicants to their program. (Even though they will not say it on their website or brochures)

Bottom line… It is becoming more and more challenging for the foreign applicant to obtain a spot in a United States training position to eventually become a United States ABR trained radiologist. It’s not impossible but it’s very, very difficult. The applicant that is successful is going to have to be at the apex of the foreign applicant pool and is going to have to be on top of the visa situation.

 

Director1

 

 

Posted on by — 9 Comments

How To Complete The ABR Alternate Pathway As A Foreign Physician

 

dear sir,
I have completed my radiology residency from India in 2015 and I wish to pursue radiology residency in usa.
I am unsure of how alternate pathway for radiology.ABR website says one must have a mix of radiology residency /fellowships/faculty post for four continuous years.If residency itself is for a duration of 5 years ,how would it be possible to have a combination of residency and fellowship for 4 years?
Is it possible to get 4 fellowships consecutively at the same institute?
kindly help me in this regard.

regards,
Fiona

Director1 response:
Radiology residency is for a total of 4 years in the United States. Prior to beginning a radiology residency, you need to have an additional year of clinical internship, usually medicine, surgery, or a transitional year (a year of multiple electives). The expectation from the ABR is that you will either repeat an entire 4 year radiology residency program at the same place (not the initial clinical year). The other possibility is that you have the experience to complete part of a radiology residency program and complete subsequent radiology related fellowships. So, you could theoretically have any combination or permutation of experiences, i.e. 2 residency years and 2 distinct fellowship years, 4 fellowship years, and so on/so forth. As you stated, all the years need to be performed at the same institution.

There are some large institutions that do have more than 4 different types of fellowships. But, if you did attend a United States residency program, more commonly, the foreign resident/fellow would complete a 2 or more year fellowship instead of a typical one year fellowship. (Nuclear medicine, neurointerventional, and neuroradiology fellowships can be 2 or more years) As long as you complete the prescribed 4 years in a radiology related area, you can satisfy the requirement.

Take a look at the following URL:

https://www.theabr.org/diagnostic-radiology/initial-certification/alternate-pathways/international-medical-graduates