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IMG Residency Match Forum International Medical Graduates (IMGs) discussing the residency matching process.

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Old 04-08-2015
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Cool Smashingdude experience for the Application Season/Interviews/RoL/Match: An honest review!

Alright, alright, alright!

So, I matched! I have been meaning to write my review, some tips/tricks for future IMG's. I also want to write a final thread after this post, analyzing my experience as a whole. For now, let me break the Match down for all those IMG's stuck in this limbo of getting into residency.

A bit about me since this will give you a perspective.
250/250 for Step1 and CK, Step3: 241, CS, All first attempt.
2012 European Grad
Need Visa
9-month observership experience in US, outpatient clinics. Nothing fancy
Few research here and there, nothing published
Applied only to H1b sponsoring programs, around 144, for IM
Got 16 IVs, Went to 12, Cancelled 4. Ranked 11.

Software of Satan: The Eras
You should have finished all your exams, and paperwork by the first week of September. It is all right if you are not ECFMG certified by that time, as long as you are in the process, most programs do not mind.

That being said, it is really important that you have Step1, CK and CS scores in the system. Some programs may wait for your CS stores, but you will hurt your chances if not all these three scores are in the system. IMG's need all the points they can have, so make sure your schedules are aligned in such a way that all your marks will be in the system.

Actually, the preparation for ERAS should be started much earlier. ERAS opens quite early, I think it opened in July this time. You should register and get a token. From then on, it is a tiring process of filling out your application. Roughly, if you have all the documents, it takes around a week. Let me elaborate on its components.

’I beg you to hire me’ aka Personal Statement

Dead important! This is the tool that actually separates you out from all the other applicants. Whoever says it does not play a major role is talking crap! All university programs rely on PS to screen IMG's. AMG's do not have much of a problem, and can get away with a lax PS, but not IMG. Everything is against us, so you better make that PS sing!

Make sure your PS is proofread, grammatically correct and has a proper length, and is interesting. I know personally someone whose PD didn’t invite him because she didn’t like his grammar! You need to make many drafts of it, and show it to your friends/colleagues, and know their opinions. Try to keep it professional, but make it exciting. Do not just write you are good in this thing; rather explain by relating an incident or a story. That helps tremendously!

’This **** is good, u should totally hit it bro!’ aka LoR

Oh, the freaking bane of every med student! LoR from US helps a lot. LoR from home country is like that broccoli - everyone knows it is good, but then they kind of throw it anyway. They do not help, that is the bitter truth. You need strong connections and contacts to get into the residency system. I used to think it is a bias or unfair, but actually now that I have been through the system, it kind of makes sense.

It is like buying stocks. The programs are looking for stable investments, and we are the stocks. The programs can only know our worth from our scores, which is by far the best index, and if they have some good reviews on us. Just like if you are applying for any major position, the managers will call your previous employee to know more about you. It happens everywhere, in every field. Look at the entire application season from the PD point of view. He has to literally sift through 1000’s of applications, and invite around 60-100 people, and give place to 10-15! There is no way he can know our worth if he does not have some kind of review written by someone from his system.
The screening criterion to gauge their investment is something like this:

-Scores (with a second filter to exclude repeat applicants or those without CK or CS)
-Med School
-Visa issues (i.e. citizen or not)

Therefore, as an IMG, you can see that everything is against you. If you do not have visa issues, you have solved a major hurdle. I will elaborate on this a bit later. However, for others, getting contacts and a good solid LoR is a must.

You do not have to pay money to get good LoR’s. If you can get strong LoR’s using some connections or rotate through some university hospital, then that is amazing. Otherwise, just get LoR’s from any outpatient clinics. I did not get any LoR from any university hospital. I was only able to get LoR’s from outpatient clinics. The doctors were nice enough to give me good recommendation. But again, it would have been much better if it were from a University hospital, some professor of some sort.

This is what I ended up doing. I uploaded two letters from US outpatient clinics, observerships of around 9 months, one letter from my University professor, and one letter from a hospital I rotated while in my home country. My suggestion for IMG’s is to upload at least three US letters, and 1 home country letter. I ended up getting around 16 interviews, so I think it worked! I do not know if that is because of my scores, or because of my LoR’s, or because of my PS, but it is a combination I think.

’Don’t know what or why I did it, but hey I have it!’ Aka Research

The easy answer, if your research does not have any publication in a reputed journal, its bollocks! If you have, then it is good for you. However, I really do not know if they help. I know of many PD’s who don’t consider research as that important. They consider the scores more important than research. If you do have to do something, I advise Step3. That really helps. Get that exam out of the way, and you will add points to your CV. I think that may have been the reason why I got good number of interviews.

'Fishing in the vast unknown seas' aka How to search and know programs

Ah, the tiring hours spent in front of the laptop, the 1000 emails sent, the phone calls until my voice squeaked! It is all a normal process, and a nightmare.

When I started looking for programs, I did not know what I am looking for. I just had a few vague pointers from a few friends, but I ended up wasting a lot of time. Here is what I advise for future applicants:

-Make an excel sheet, organize them in a table by state, city, name of the PD/email, name of the coordinator/email, phone number, visa requirements, IMG percentage, fellowship opportunities, research, community or university or univ-affliated. This will save you a lot of time, trust me.

-As early as July, start searching programs using FRIEDA and just Google the crap out of them! Confirm the visa requirements by emailing them. Call them, bug them.

-How do you know a program is good? Well, the easy answer is, you DON’T. As an IMG, you cannot be picky. Apply to as many as you can. And, please, don’t say you have financial issues and can only apply to a limited number. As an IMG, we all have financial issues. Nope, that is the wrong way to look at it. You are getting ONE chance in a year to apply, so borrow or rob or do whatever, but make sure to apply as wide as possible!

If you did not apply wide, you will not get those many interviews, and will have to wait for the next year! Consider this ratio. I applied to 144 and got 16 invites. That is around 11%. Imagine if I had applied only to 50 programs, I would have only got 4-5 interviews!

You will decide later if something is good or not after interviews. For now, you are just shooting arrows, so the logical idea is to shoot as many as you can. If you have visa problems like me, then apply to only the programs that will sponsor that visa.

-Visa is a HUGE issue! I was thinking it is a small hurdle, but things have changed. Back in the 90’s, it was not much of an issue. Now, hospitals just do not like to get into that hurdle of sponsoring someone, and turns out his paperwork is delayed, and you are starting the year with one less resident! Hardly a few university programs sponsor H1B. For me, I only could get H1b, so I applied to all programs that sponsored H1b (around 144).

Once you have nailed down the programs, search and add them in ERAS. Finalize everything and wait for the application season to open. In addition, a good thing is to let the programs know you will be applying to them and are interested.

The day you punched your laptop and threw the mouse away aka The Application Day!

It was a chaos this year. The server crashed and everyone was cursing ERAS. Everyone was trying to get into the system and apply to the programs. Fun fact: It does NOT matter. You can wait for a day or two. Programs do not begin downloading application since like 3-4 weeks into the season; in fact, some download them in November. Therefore, it is completely all right to get into the system by the 2nd day. Try your best to register on the first day, but if you cannot due to system or server crash, then just apply the next day. No need to stress over it. It will be all right, trust the zillion of us who were cursing ERAS on the 15th of September!

That being said, do not be too lenient. Do not wait 2-3 weeks. It is best to apply within the first week. Anything later does hurt your chances.

'Oh thou interview, where art thou?' aka Getting invitations

Dreadful days! You would be dreaming in your sleep of your phone ringing with a new email from ERAS. It is such anxiety provoking. However, my advice is this:

-Please do not participate/start a thread and compare how many IV’s you are getting compared to others. I mean, what is the point? Can you do something now to change your outcome? Why you have to feel like **** seeing that someone with the same credentials as you is getting 5 interviews, and you did not receive any till now! It is a pointless thread, and I do not see any good coming out of it. It just raises anxiety. Know this – once you click that apply button on September 15th, you have done all that you could have. There is nothing else for you to do.

-You can email the programs and show interest. There is a difference between this and asking status. Please, do not ask status. It is rude and pointless. If you do want to email, mail your interest, and write a good cover letter, not just “Hey, I looked in Freida, and I liked you, and I think we can be great together!” It is not a matchmaking system. Rather, make your cover letter (and your subject line!) stand out. Address the PD’s properly with the last names, and make your cover letter short and interesting. Do not just start saying what scores you have and all the 1000’s publications you have done. Nope. Look at it from PD point of view. He/She would be reviewing 1000’s of emails. No time to read through all the emails. So make it short, interesting and catchy, and send them in mid September when you have applied.

-There are two waves of interview invitations. The first one is mostly for AMG/US citizens, and it usually happens in beginning of October. For IMG’s, it starts in mid October. The second wave is in mid November. The last one is in December when people have cancelled interviews and spots open up. It is natural to feel frustrated and start ranting. In fact, I only had a few by the end of October or early November, and went on a rant on the forums. My advice to my formal self, be patient! They come in their own sweet times.

-Should you call them? It is quite hard to say. I tried calling every one of them. Many of them will not take your AAMC number. Some will jot down a note about your interest. However, I highly doubt if it helps. Many a times you would be leaving voicemails, and I left a thousand. I doubt if the coordinator can do anything, as the selection committee are usually quite secretive about their process, and just let the coordinators know whom they have picked. What call will help is a call directly to PD, but good luck in that! It is a nightmare trying to get to him/her. Even if you do, you have like a minute or two to bring to his attention something unique about you. Oh not to mention if you are calling over-seas, say hello to crappy signal!

So in a nutshell, calling is quite questionable. Personally, it was a waste of time for me. It did not help much. Yes, email to the PD may help, but make it unique and catchy as I explained earlier. One PD was impressed by my email, and I got an offer like a month later. I do not know if that was because of my email or because he skimmed my application.

Definitely, what will help is a call from someone reputable to the PD. Like your attending or the one who wrote LoR for you. Yes, if you are lucky to have known such a person, beg him to call for you. That has the best chances of securing interviews, as well as getting you high on the rank order list!

-How many times should you email/contact the programs? Do it once you are searching about programs, then once when you apply and show interest, and then later in end of October/early November just to let them know you are still very interested. Most important is when you apply, so make that cover letter sweet and sound! Also note, its good to remind them during the rank order list submission of your interest.

The nut-cracking, wallet-squeezing travel season aka Planning/scheduling

Ah. That is my exasperation of the money spent and the hectic schedules. Please accept one bitter fact. You cannot save money, and it is extremely irritating and hard to schedule interviews. First, it is hard to get the dates you want. Second, flights/staying is not cheap. Here are some tips that I learnt:

-Use Airbnb! It is a great way to save money instead of staying at hotels or inns. Or if you can find a good student hostel, they help as well.

-Southwest are just great! Not only you can cancel flights and reschedule without a fee, they have great service. Try to use it as much as possible.

-It is pointless to save a few dollars and make hectic ‘get a bus-walk 10 miles-get a train-wait an hour-get a bus’ schedules! First, it can be daunting in an unknown city. Second, it is not safe. Why risk yourself to save a few dollars. As I mentioned, you just cannot save money. I tried but it just does not work. So be ready to spend some dollars!

-If you are in the north east, Amtrack is a great way to commute; however, the difference from flights is not much. You may get some good deals online and if it is just another city in the same or neighboring state, you may use it. Greyhound is similar in the sense that if it is nearby like a few hours away, then you may save some money. However, it is pointless to make a long and tiring bus/train journey, only to arrive at your interview exhausted and burnt out. Nope, you will not save much. Trust me, I researched every method to commute and travel, but it just does not work!

-The average cost of the interview season comes to roughly about 3000-4000$. This includes everything from food, flights, lodging, bus, taxis. Be prepared for this.

-If you have friends in the area, that is just great. Ring them up and bother them. That is what they are for!

- Travel light. Get a suit and few shirts. It’s hard to move from place to place, so ladies, don’t carry your gazillion shoes and matching dresses: P

Lo and behold, the dreaded day comes i.e the Interview day

So, you have worked your ass off to reach this day. Cant’ screw it up, so here are some high-yield pointers. Most of it you already know, but I will just enumerate a few. The first interview is the most difficult. After the first one, all the rest will feel like ‘meh’ i.e. second nature. You do not really care that much.

-Have a good night sleep. Wake up early, and dress to rock! You have to be stylish and appealing. Look professional. Have a light breakfast, and leave early. Remember, it is ALWAYS better to be early than later. You do not know the city or the bus/train routes. I used to leave like 2 hours ahead of the start time. It was a great decision. It shows professionalism and punctuality.

-When you arrive, try to be calm. Relax. Speak with the other colleagues. This is what I did for most part. I used to just start blabbing about anything, from movies to the weather, to the funny things I saw at the subway. You lower your own anxiety, and of everyone else in the room. Be courteous and humble in your conduct, and treat everyone with respect. Laugh and crack jokes with your colleagues. Oh boy, I cracked most of them up! They, too, appreciated it as the whole day is just filled with anxiety. Better, laugh it out!

-Get friendly with everyone. I talked and interacted with the coordinators and the residents. It shows that you can integrate easily. Do not just stay silent and to yourself. Show interest.

-Breakfast/Lunch. Oh boy, as most IMG’s are short of cash, I used to make sure I stuff myself with as much food as I can. So please, do eat! It lowers anxiety and is calming as well (eating releases serotonin, and you need all the serotonin you can get!!!)

-You should have done some basic research about the program the previous night. This helps in answering, “Why choose our program” By basic things, I mean:
ABIM scores
Fellowship opportunities
Rating in Hospital/state (i.e. I chose it because it’s well recognized ‘blah blah blah’)
Area (i.e. I have relatives/family here. This is good as it shows ties)
References (i.e. my friend graduated from here and he used to talk all the time about how great this place is)
Research opportunities
Read the website. See unique things. Maybe major milestone. Maybe humanitarian/community efforts.

-The interview in general is pretty straightforward. Most PD are nice and welcoming. Few can be a pain in the ass as they try to evoke a response from you. More on this later. Know the common asked questions and have their answers ready (Google them, tons have written about it). Not just memorized. Nope. Please, do not be robotic. It looks pathetic when you are trying to remember a line you wrote.

By far, the most important place and time on earth when the phrase ‘Be yourself’ matter is this one! Be true to yourself. Do not try to act out a personality that you are not, as the PD’s know it quite well. Be courteous, respectful and always smile!

However, if you are the boring kind, please do not be yourself then. That is the only exception. Be exciting; your voice/tone should be full of energy. And the most important thing of the entire interview: CONFIDENCE. If one thing I have learnt, is that confidence goes a long way. Even if you have done crap things on your CV or have just bluffed, it is your confidence that is the dealmaker, or the breaker. So, sing your achievements with confidence, even if they are tiny.

Lastly, try to tell your good qualities. Do not just say you have this or that. No, rather, elaborate on it by relating some incident or story or something that proves you have that skill. It is pointless to say “Oh I am a great team-player or have great decision-making skills”. Rather, relate an incident that links up to these skills. That is the best way!

-Some programs like to throw in clinical questions. These are the small community programs. However, most of the time they are simple straightforward questions. Nothing you cannot do. I was asked in one of the programs about Pyelonephritis and treatment of CHF. Simple stuff. So, do not panic. Most of the time they will start with a clinical question and then change the conversation entirely to your personality. These are just ways/tricks PD’s use to stress you out.

-Some PD will act mean. Oh boy, one PD acted so mean, he insulted my culture and religion, then my manners and etiquettes, and then threw stereotypic remarks. He was trying to get a reaction from me. I remained calm, and tried to reason, but he was daunting! However, in the end, he apologized and told me this is one of his ways to test residents, since sometimes patients say the same things. Therefore, all in all, it was all an act! Therefore, any PD who is giving you this kind of a hard time is probably acting, and trying to get a reaction/response from you. Stay calm, and keep smiling. Do not argue; try to question why he thinks in this way. Become like one of those long CK questions, and show ethics.

-Have some good questions ready. Like what are your chances of getting into fellowship or what kind of mentors are here etc. Not just the basic ‘what are your ABIM scores’. You can read that on the website!

-Indulge in all the activities. Talk in the rounds, take part in conferences, ask questions in lectures/morning reports, and talk to residents in the lunch. Imagine yourself that you are actually working there on that day! That is the best way to show interest, and the chiefs notice this, as well as the PD.

-One key advice that I got from my seniors and some friends. Make every program feel like they are your world! Like you would rank them the highest! Make them feel like they are the best thing that ever happened to you, and you are so blessed to have 'met' them. Make them feel you will 'propose' for sure, and marry them! Even if its a crappy program, and you get a bad vibe from the beginning, your job is to make them feel that this the only interview that you have, and you want it so badly!

Having said that, don't show desperation. Its a sign of weakness, not confidence. I mean, don't ever so 'please rank me high'. Or 'where will you rank me'. Or please I'll sweep the floors for you. Rather, show interest in a good way 'I like your program, and will consider it the highest'. Its a very subtle line. You have to make them believe you are giving them all the interest, but not make them believe they are the only interview on your list. You have to make yourself desirable. Make them feel that you will consider them, but at the same time, you are not desperate and have other interviews.

Its all an act! Be a great actor. Show them all the interest, but at the same time show a bit of pride and confidence. Its exactly like going on a date. If you show too much desperation or are very clingy, you will be left hanging all alone. Rather, show interest, compliment them, make them feel they are special, all the while letting them know that you are independent and have much better options as well.

Love letters i.e. Post-interview correspondence

So you have done the interview. Should you give them a card now or email or what the hell should I do?

-I personally wrote cards, and sent them within the next 3-4 days. Later during the rank order list, I sent an email reminding them about my interest.

-Some people choose to only write email. That is fine as well. I do not think any PD changed his/her mind based on a thank you note. It is just courtesy.

-Some people send to everyone they meet. Ah, please no! It sounds more desperate then trying to hook up with your ex! Just the people who interviewed you, and the PD. That’s it.

-Make your thank you note exciting and throw in some thing to make it stick. I mean, write something that happened during the IV that you liked, or a discussion you had with the PD, so that he/she remembers you.

-Don’t expect a reply. Most of them don’t. Some send generic letters/emails. Do not get your hopes up as well.

’Which program was which, oh crap!’ aka Rank Order List

Aright, so you have made it this far. Now comes the day to submit RoL. But one key issue. You do not know how to rank! Here are some tips:

-I regret not making a diary and writing down after every interview my thoughts about it. I always thought that I will remember, but after a few interviews, you will mix things up. So, be smart. Come home after interviews, and write notes. Write the things you liked or disliked.

-Make your own point system. Give every program points depending on fellowship opportunities, research, visa, place, the overall feel etc. This helps as well.

-Send reminder emails around this time. Keep showing interest.

-Ultimately, it is the place you felt comfortable, and you liked! Go with your gut feeling. Weigh in your future options like fellowship opportunities or the place you want to settle, but ultimately rank according to the comfort you have with that program. You would be spending 3 years there. It is pointless to stay in a place you do not like or enjoy.

’The most important day of your life’ aka Match Day

You have worked hard. You have put all your eggs in the basket. Hopefully, you will get the place you matched. Word of caution; do not be disappointed if you do not get the first place you wanted. Consider yourself lucky! Many did not even match…!

This brings me to my fellow colleagues who did not match. I feel sorry for you people, and no words can sympathize enough. I know many of you are questioning yourself that you deserved to be matched or you really were worthy, and I do not have answer for these. It is a strange system; the entire Match is a funny process! If it helps, know that your hard work will definitely pay off, sooner or later. It is just a matter of time. The storm is always raging before the onset of dawn.

Therefore, my fellow friends, do not be disheartened. Work on your weak areas, try to identify your mistakes, and strike back with full force and might. Work on your interview skills; train with an honest friend. Get Step3 to boost your CV, and take part in a research that will produce some publication, not just any kind of research. Also, make contacts! Rotate and do clinical externships under powerful doctors/physicians. Get their LoR’s.

Last words

Phew! That is the longest thread I have ever written. This is my second last thread. I have one more that links all of the threads, offers an overall picture of the system and will be my goodbye to these forums.

I hope my experience can help you all. I only wish every one you the very best!
Persistent and perseverance, and the flowing waterfall carves rivers along the lofty mountains
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250/250/241/CS, 2012 European Grad, 9m USCE, Need visa, MATCHED to IM
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Last edited by Smashingdude; 04-10-2015 at 04:44 PM.
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Old 04-08-2015
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Congratulations! And thank you so much for your post...much detailed and very helpful.
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