Countdown to the MATCH

#23 - The White Coat Investor

#22 - Dr. Aimee Chin

#21 - Dr. Steve Dragosljvich

Illegal questions are always a hot topic surrounding interviews. As you all know, the NRMP sets very strict communication rules surrounding the Match process, and have very specific requirements of what constitutes “legal” communication.  From the proverbial horse’s mouth, the NRMP Code of Conduct reads: “To promote the highest ethical standards during the interview, ranking, and matching processes, program directors participating in a Match shall commit to: Refraining from asking illegal or coercive questions Program directors shall recognize the negative consequences that can result from questions about age, gender, religion, sexual orientation, and family status, and shall ensure that communication with applicants remains focused on the applicant’s goodness of fit within their programs”. Furthermore, federal law prohibits most of these questions for any job, not just residency, and it is illegal to make hiring and firing decisions based on this information.  SDN, reddit, ValueMD, the usual forums people frequent usually have some version of “is this an illegal question” threads with arguments for and against. My personal and professional thought are that they will happen. Overall - it will happen - these things come up in casual conversation all the time, and usually work their way into conversations that are comfortable during an interview session. Sometimes it is not the interviewer, but the applicant who brings it up, and the conversation flows from there. Just a quick PubMed search has a 2016 study from Academic Medicine with a sample size of 11,000 applicants - Two-thirds of applicants reported being asked potentially illegal questions. Their data revealed that more women than men reported receiving questions about marital status or family planning in that study.  Similar results were reported in the initial study in 2013 in the same journal - about two-thirds report an illegal questions, and questions about marriage and childhood were a large majority of those questions. There is no red light, no button, no siren that goes off, and no red phone you pick up to report the incident when these topics slip out, and my recommendation is to just keep rolling and try to redirect to more topical issues. The rules are there to protect YOU, so you can offer the information, hospitals are just not allowed to ask you. Conspiracy theorists will say that you will give too much away by asking these loaded questions - and that may be true, but I’d say you are reading too much into it. Often these are not brought up in a malicious way. Some examples of how they can work their way into conversation: The real Catch-22 in my opinion is that they are important issues to you as an individual - if you have kids childcare is important - if you are a specific religion, perhaps being close to a specific house of worship is important - lots of decisions can hinge on these so called “illegal” topics and could help you pick one program over another, or at least give you some comfort about your overall “fit” with a program. .  If you feel you have been targeted - discuss first with the PD, then the NRMP / ACGME. Thanks for listening, hope you enjoyed the content and find it useful. Please subscribe to catch each new episode as they are uploaded, and if you find the content valuable please take a bit of time to leave a review on iTunes to help get the word out to other med students looking for answers.  Also feel free to give us some feedback on what you think we could improve on. Remember to send your questions to us through our website at www.matchgurus.com, or twitter @theMatchGurus - I personally answer every email and twitter DM we get.  Our book is also available on Amazon in paperback and eBook - less that 10 bucks - it is a quick read you can easily knock out on the flight to your next interview. If you find it helpful, please take some time to leave a review for that on Amazon as well - it means a lot. And of course, any of you looking for in-depth specialty-specific preparation for your interviews drop me a line and we can discuss our coaching packages. Take care.

S01E15 - Illegal Questions

I recently had the opportunity to chat with Dr. Megan Tresenriter, one of the creators of Swap and Snooze - a free service you can use right now when scheduling interview travel.  They help arrange medical student hosts for interview candidates to not only help you save some money on the interview trail, but also get an authentic experience and see how the students or residents at that hospital live, their surrounding city, and a look at life outside the hospital. I take full responsibility for a patchy internet connection the day we talked, but we managed to edit together a good bit of our conversation - so without further ado - Dr. Tresnwriter: Thanks for listening, hope you enjoyed the content and find Swap and Snooze useful on the interview trail. With all of the money you’ll save on hotels, you can pick up a copy of our book, or contact us for personalized coaching services and mock interviews.  Please subscribe to catch each new episode as they are uploaded, and if you find the content valuable please take a bit of time to leave a review on iTunes to help get the word out to other med students looking for answers.  Also feel free to give us some feedback on what you think we could improve on. Thanks again, remember to send you questions to us through our website at www.matchgurus.com, or twitter @theMatchGurus. Take care.

S01E14 - Swap And Snooze

While I’m sure you all hang on my every word, just in case any of you skip to the next track at the at the end of every show, I want to lead off this episode with a reminder that my partners and I are primarily a boutique coaching and mock-interview service. Too many times we’ve seen very strong applicants either sound average or even absolutely tank their interviews, and conversely weaker candidates outshine their peers and end up high on rank order lists. Interview day means a lot, you only have a handful of hours with a handful of people to impress, and there are things we can teach you that help you put your best foot forward when it matters the most. Our calendar is filling up quickly, but we offer a free 15 minute trial to show you what we can do, and our most popular package is now discounted for the remainder of this 2017 season to just $499 for three 30 minute interviews.  After the first interview, you’ll end up with explicit feedback on your verbal and nonverbal communication style, specific diction to use when answering questions that will help you stand out, and how to work the strongest points of both your personality and CV into the questions you are sure to be asked. We do the same homework I ask you to do and we role-play specific programs in specific cities to best simulate your actual interview day. The remaining two interviews give you a chance to put that feedback into action, and approach questions with a new angle that highlights what program directors want to see.  It is not too late to any of you who are listening to this in the middle of or even towards the end of your interview trail - if you were just blindsided by questions you didn’t prepare for, or had confidence walking into your first few interviews but now want to polish some rough edges before you talk with your dream program - drop us a line as well and we can look at our schedule. Allright - for today’s topic, to cap off the questions you should be asking programs, I want to simply read an article I wrote for Student Doctor Network entitled The Million Dollar Question.  Link is in the shownotes, and it is based on advice I’ve given countless times, and still think holds true. I want to read it only so that the content isn’t diluted by one of my usual ramblings, and so that you can reflect on why you think it is important, and how it can help you ultimately  decide on the program that is right for you. The Million Dollar Question   Interview season. The time of year that roads and skies swarm with the best and brightest medical students to all corners of the country taking aim at the next step in their training – residency. Believe it or not, behind the shiny brochures, extravagant dinners and polished powerpoint slides, residency programs are just as nervous about attracting top talent as you are about getting your top choice. The interview trail is usually a blur of dry cleaning bills, rental cars, and the smell of breath mints masking cheap coffee mixed with nervous sweat. The broken record of the obligatory “strengths and weaknesses” question loops in your head. One of the more terrifying moments in the day comes when an interviewer asks: “What questions do you have for me?” Regardless of who asks it–the intern only four months above you in training or the gatekeeping program director–you know you have to ask something. So why not make it count? Things like call schedule, orientation timelines, research requirements, away rotations, moonlighting, and meal plans may look important to you on paper, but should not be foundations of choosing one program over another. In fact, the best questions regarding most of these details can not truly be asked until you are in fact already a resident. The proverbial hindsight being of course 20/20. Is a meal plan a perk if the food is terrible? Moonlighting opportunities? Moot point if your paperwork and 45-minute commute are already pushing duty hour restrictions. It is simply not possible to ask an informed question on the specifics of most logistical things before setting foot in the hospital. The best bang for your buck in this golden opportunity to ask them anything boils down to one “Million-Dollar” question: Where do the graduates go? Most programs are proud to tell you, and will have specific data on hand for at least the last 3 to 5 years. Fellowship, small group practice, academic center, private practice, rural areas, urban centers, with program alumni, unemployed, mom’s basement–the nuance in these specifics will speak volumes. From this data you can easily glean: board passing rate research requirements the reputation of the program over geographic regions the reputation of the program in competitive fellowships a network of alumni to help with future job placement faculty strengths procedure exposure much, much more If all graduates of the plastic surgery program you are looking at go into a maxillofacial fellowship at an Ivy League university hospital, and that aligns with your goals, great! You can assume the program has a good reputation, skilled specialty faculty, sound research, strong professional conference participation, and that residents see a heavy maxillofacial caseload. If this is not in tune with your dream of becoming a burn specialist however, you may want to look at programs with a different focus. You may feel like a specific family medicine program trains the most well-rounded doctors by exposing them to a rural patient population and teaching procedures like colonoscopies and cesarean sections. If on the other hand, you were planning on practicing in an urban area after graduation, those procedures will be lost to specialist. A residency program at a larger training institution might be better suited to your future goals of working as a primary care physician in an urban, specialist-heavy environment. Variety is paramount here. Private practice, fellowship, rural, urban, hospital setting, outpatient setting, in-state, out of state, etc. A diverse mix of jobs tells us that the graduates leave the program prepared for anything and are competitive in any marketplace. Free white coats each year? That will run the department a few dollars annually. Free food? Maybe a few thousand dollars over the course of a residency. Daycare? I’ll admit that might be hard to pass up in certain instances. Upon graduation, however, the stakes go up exponentially. Consider the above scenarios: a plastic surgery program can graduate three to four residents annually with average starting salaries in the $300,000 range. A family medicine program can churn out six to eight graduates with starting salaries of about $150,000. Crunch those numbers, and you guessed it: $1,000,000 worth of contracts signed by each graduating class. Follow all of the usual advice: put your best foot forward, have fun, be yourself, and get ready to talk about the summer research poster you submitted at least 30 times. When the time comes–and it will–remember the “Million Dollar” question, and pay attention to how it either expands or limits the scope of your future practice. Most importantly, envision yourself and your level of future happiness in the scenarios that unfold. Closing: Short and sweet today - thanks for listening, as usual I hope you enjoyed the content and find it useful. Please subscribe to catch each new episode as they are uploaded, and if you find the content valuable please take a bit of time to leave a review on iTunes to help get the word out to other med students looking for answers.  Also feel free to give us some feedback on what you think we could improve on. Remember to send your questions to us through our website at www.thematchgurus.com, or twitter @theMatchGurus - I personally answer every email and twitter DM we get.  Our book is also available on Amazon in paperback and eBook - less that 10 bucks - it is a quick read you can easily knock out on the flight to your next interview. If you find it helpful, please take some time to leave a review for that on Amazon as well - it means a lot. And of course, any of you looking for in-depth specialty-specific preparation for your interviews drop me a line and we can discuss our coaching packages in more detail. Take care.

S01E19 - The Million Dollar Question

Today I’ll continue the series of questions you need to ask programs with three more areas of focus. Remember that each and every program will have some time for you to ask THEM questions. Not asking anything makes you come across as uninterested, asking something you can look up online makes you look like you didn’t do your homework, and asking good questions can show that you know what you are talking about.   I’ll follow the AAMC document introduced last episode, link in the shownotes, and and cover three new topics. My goal is to explain the logic behind them, and let you know what to expect in an answer. Employment Issues What are the basic resident benefits? Is parking a concern for residents at your program? Are meals paid for when on call? What is your family leave policy? Is there reimbursement for educational supplies and books? Are moonlighting opportunities available? What are the rules for moonlighting? How are residents represented at the institution level? How is the resident member of GMEC selected? Is there a union? Is membership mandatory? Are there dues? Is there a House Officers Association? Questions to specifically ask other Residents What are the strengths and weaknesses of the program? Would you consider the same program if applying again? Is there an appropriate balance between service obligations and the educational program? Is there enough ancillary support to minimize "scut?" What has changed since you came to the program? Is the program responsive to suggestions for change? How accessible is the faculty? Is the relationship with faculty collegial? Do the residents get along with one another? How do your residents get along with residents in other programs? In what activities are you involved outside of the program? How does your spouse/significant other like the city/area? Questions to ask Yourself Finally, you will likely find yourself facing a decision between one of several programs which are all extremely similar from academic and patient-care standpoints. At this time, it is very important to consider factors relating to your personal happiness and comfort for the duration of your residency. Can I be happy working in this program and with these people? Am I confident in the program and the sponsoring institution? Are there factors that make this place (city/town/rural area) an attrac tive place for me to live during my residency? (Factors that you may include are prox imity to immediate and extended family, happiness of spouse/significant other, housing, cost of living, quality of secondary school system, community opportunities, and recreational activities.) Closing: Unfortunately that’s all the time we have for today’s show. Thanks for listening, hope you enjoyed the content and find it useful. Please subscribe to catch each new episode as they are uploaded, and if you find the content valuable please take a bit of time to leave a review on iTunes to help get the word out to other med students looking for answers.  Also feel free to give us some feedback on what you think we could improve on. Remember to send your questions to us through our website at www.thematchgurus.com, or twitter @theMatchGurus - I personally answer every email and twitter DM we get.  Our book is also available on Amazon in paperback and eBook - less that 10 bucks - it is a quick read you can easily knock out on the flight to your next interview. If you find it helpful, please take some time to leave a review for that on Amazon as well - it means a lot. And of course, any of you looking for in-depth specialty-specific preparation for your interviews drop me a line and we can discuss our coaching packages. Take care.

S01E18 - Employment issues, questions to specifically for residents, and questions to ask yourself

Today I’ll continue the series of questions you need to ask programs with three more areas of focus. Remember that each and every program will have some time for you to ask THEM questions. Not asking anything makes you come across as uninterested, asking something you can look up online makes you look like you didn’t do your homework, and asking good questins can show taht you know what you are talking about.   I’ll follow the AAMC document introduced last episode, link in the shownotes, and and cover three new topics. My goal is to explain the logic behind them, and let you know what to expect in an answer. Clinical Duties What is the general call schedule? What provisions are made for back-up call or sick-call coverage? What type of structure for supervision is in place? Do your residents express that there is an appropriate balance between independence and supervision? How does the resident’s autonomy change as he/she progresses through the program? What type of ancillary support is available (phlebotomy, respiratory therapy, social workers, etc.)? Does the general volume of clinical responsibility support a balance between service and education? Do your residents express they are involved in too much non-educational activity (i.e., “scut work”)? Resident Performance How often are residents evaluated? What is the structure of the evaluation (forms, face-to-face, etc.)? What other forms of feedback does the resident receive ( in-training exam, etc.)? What support structures are in place for residents in academic need? Program Performance What is the status of the program’s accreditation? If there were any citations at the last review, what has been done to correct them? When is the next Residency Review Committee (RRC) review? Are there any plans for changing the program size or structure? What is the status of the last Accreditation Council for Graduate Medical Education (ACGME) Institutional Review? How solid is the financial status of the sponsoring institution? How committed is your institution to resident education and graduate medical education in general? How isthis evidenced? What percent of your residents complete your program? What percent of your graduates pass the specialty boards on their first attempt? Where do your graduates go (e.g., fellowship, academics, private practice)? Closing: Unfortunately that’s all the time we have for today’s show. Thanks for listening, hope you enjoyed the content and find it useful. Please subscribe to catch each new episode as they are uploaded, and if you find the content valuable please take a bit of time to leave a review on iTunes to help get the word out to other med students looking for answers.  Also feel free to give us some feedback on what you think we could improve on. Remember to send your questions to us through our website at www.thematchgurus.com, or twitter @theMatchGurus - I personally answer every email and twitter DM we get.  Our book is also available on Amazon in paperback and eBook - less that 10 bucks - it is a quick read you can easily knock out on the flight to your next interview. If you find it helpful, please take some time to leave a review for that on Amazon as well - it means a lot. And of course, any of you looking for in-depth specialty-specific preparation for your interviews drop me a line and we can discuss our coaching packages and mock interview services. Take care.

S01E17 - Clinical duties, resident performance, and program performance

Over the next four episodes, I’ll cover the questions you need to ask programs. Don’t forget - during the interview process, they ask you plenty of questions, but each and every program will have some time for you to ask THEM questions. First of all, always have a question. Not asking anything makes you come across as uninterested.   Instead of reinventing the wheel, there exists a PDF file online that has been floating around for many years put out but the AAMC that does a great job of breaking down the types of questions that will help you determine if a program is right for you. In the next few episodes, I’ll break those down for you, and let you know what to expect, why they are important questions, and what to look for in answers. As always, there is a link to the document in the shownotes, or you can just google AAMC “Don’t Forget to Ask.”    The document starts: Don't Forget to Ask: Advice from Residents on What to Ask During the Residency Interview The process of applying and interviewing for a residency position is complicated and can be stressful. This process involves both “selling” yourself to a program, as well as collecting the information that you will need in deciding how to rank the various programs you visit. Programs that you consider will all have unique strengths and weaknesses—some of which may not immediately apparent. The following list of questions was created by residents and students from various backgrounds as a guide to assist you in identifying and assessing those strengths and weaknesses. Use this guide in constructing your own more specific questions, and in exploring your own expectations and preferences. Your residency training is an important experience. Identifying the program that is best suited to meet your educational and professional expectations is paramount. Some questions are best answered by other residents in the program, and some questions you will need to ask yourself. Ask the program administrators and residents for specific examples that give a true understanding of the program. Be honest with yourself about how you want your residency experience to be structured. Good luck! And remember, always be yourself. Education Is there an orientation program for incoming residents? Is there a formal didactic curriculum, and what is its structure? What are the informal learning opportunities (i.e., bedside rounds, etc.)? What programs exist for resident education (e.g. , lectures, journal clubs, grand rounds, board review courses,)? Is there a feedback structure that allows for the resident to evaluate the program’s curriculum? Is attendance at regional and national conferences encouraged? Is it funded, and, if so, to what degree? What are the required rotations for the first year? Subsequent years? Are then any required rotations that take place outside of the city? Are there opportunities to do “away” rotations? Is there a formal mentoring program for new residents, and do faculty serve as mentors? Research Opportunities Are research opportunities provided to residents? Is this a required experience? Is there a possibility of "protected" time for research? How are fellowships handled? Teaching Responsibilities What teaching responsibilities for medical students are expected of residents? If residents have teaching responsibilities, how much time per week is spent with students? Is it "protected"? Is there any formal training for residents on how to teach students and other learners effectively, and how to provide feedback? Closing: Unfortunately that’s all the time we have for today’s show. Thanks for listening, hope you enjoyed the content and find it useful. Please subscribe to catch each new episode as they are uploaded, and if you find the content valuable please take a bit of time to leave a review on iTunes to help get the word out to other med students looking for answers.  Also feel free to give us some feedback on what you think we could improve on. Remember to send your questions to us through our website at www.thematchgurus.com, or twitter @theMatchGurus - I personally answer every email and twitter DM we get.  Our book is also available on Amazon in both paperback and eBook format - less than 10 bucks - it is a quick read you can easily knock out on the flight to your next interview. If you find it helpful, please take some time to leave a review for that on Amazon as well - it would means a lot. And of course, any of you looking for in-depth specialty-specific preparation for your interviews drop me a line and we can discuss our coaching packages and mock interview services. Allright, take care.

S01E16 - Resident education, research opportunities, and teaching responsibilities

Let’s continue breaking down some common questions you will experience on the interview trail. Dr. Mike Olson and I will discuss what we think the “question behind the question” is, and what programs are looking for in an answer. Questions about your behavior. For example:   Tell me about a stressful patient encounter you had in medical school and how you handled it. Tell me about a time you disagreed with an attending physician and how you handled the situation. Tell me about a time you had to work with someone you didn’t like - what was the outcome? Tell me about the last time you failed at something.     Questions about your personality. For example:   Tell me a joke. If you were a plant, what type of plant would you be? Draw a picture of me as a character in your favorite movie.     Unfortunately that’s all the time we have for today’s show. If today’s topic struck a cord with you and you would like to practice your interviewing skills, drop us a line over at the MatchGurus.com and we will set up a speciality-specific coaching package and mock-interviews designed specifically for you. We still have a few slots open, and interview season is just around the corner.  Please subscribe to catch each new episode as they are uploaded each week.  If you find the content valuable please take a bit of time to leave a review on iTunes to help get the word out to other med students looking for answers.  Also feel free to give us some feedback on what you think we could improve on. Thank you to everyone for listening, remember to send you questions to us through our website at www.thematchgurus.com, or twitter @theMatchGurus.  Our book is also available on Amazon - please leave a review there as well. Take care.

S01E13 - Questions about your behavior and personality

Let’s continue breaking down some common questions you will experience on the interview trail. Dr. Mike Olson and I will discuss what we think the “question behind the question” is, and what programs are looking for in an answer. Questions about previous patient cases. For example:   What was the most interesting surgical procedure you scrubbed on and why? Tell me about your most memorable patient experience.   Questions based on ACGME Core Competencies. For example:   What does professionalism mean to you? Tell me about a time you were able to work in an interdisciplinary team successfully. How familiar are you with evidence-based medicine in decision making?   Questions about clinical decision making. For example:   Are you familiar with the new hypertension guidelines? Tell me what you know about the treatment of COPD exacerbations. If you are paged to the ICU and find an unresponsive patient, what is your first instinct?   Unfortunately that’s all the time we have for today’s show. If today’s topic struck a cord with you and you would like to practice your intervieweing skills, drop us a line over at the MatchGurus.com and we will set up a speciality-specific coaching package and mock-interviews designed specifically for you. We still have a few slots open, and interview season is just around the corner.     Please subscribe to catch each new episode as they are uploaded each week.  If you find the content valuable please take a bit of time to leave a review on iTunes to help get the word out to other med students looking for answers.  Also feel free to give us some feedback on what you think we could improve on.   Thank you to everyone for listening, remember to send you questions to us through our website at www.thematchgurus.com, or twitter @theMatchGurus.  Our book is also available on Amazon - please leave a review there as well. Take care.

S01E12 - Questions about patient care and clinical decision making

In the next three episodes I want to help break down some of the most common questions you will experience on the interview trail, as well as some uncommon and even illegal ones. Dr. Mike Olson and I will discuss what we think the “question behind the question” is, and what programs are looking for in an answer. In this episode, we will discuss questions about you, questions about your future goals, and questions about the field you are applying to. Questions about you. For example:   Tell me a little bit about yourself. Who would you say “you” are? How would your friends describe you? How do you spend your free time?     Questions about your future goals. For example:   Why do you want to be an emergency physician? Where do you see yourself in five years? What does the ideal residency look like to you? What are your post graduation plans?     Questions about your chosen profession. For example:   Which personality traits do you have that will make you a successful surgeon? Who inspired your interest in Urology? Where do you see the field of pediatrics in 10 years?     If today’s topic struck a cord with you and you would like to practice your intervieweing skills, drop us a line over at the MatchGurus.com and we will set up a speciality-specific coaching package and mock-interviews designed specifically for you. We still have a few slots open, and interview season is just around the corner.  Please subscribe to catch each new episode as they are uploaded each week.  If you find the content valuable please take a bit of time to leave a review on iTunes to help get the word out to other med students looking for answers.  Also feel free to give us some feedback on what you think we could improve on. Thank you to everyone for listening, remember to send you questions to us through our website at www.thematchgurus.com, or twitter @theMatchGurus.  Our book is also available on Amazon - please leave a review there as well. Take care.

S01E11 - Questions about you, your future goals, and your chosen profession

Questions on today’s podcast come to us from Dr. Sagar Shah via twitter - you can follow him @thisissagarshah In a short exchange he asked questions a lot of our IMG clients ask, and I thought the answers would be valuable to a wider audience, so I’ll answer them here. There is a lot of good information available online from different sources like the ECFMG, ERAS, etc.  so I won’t regurgitate a lot of that stuff and will instead give more personal advice. Any US student who wants to get a bit of understanding may also gain some insight from today’s topics. As you may remember from earlier episodes, only about 50% of any given match year over the last 10 years has been US allopathic MDs, IMGs made up about 40% of the pool or may not know, IMGs currently make up about 25% of the physician workforce. Most of those in Internal medicine, psych, pedi - more primary specialties. Regionally, New Jersey, New York, Florida, and Illinois had the highest concentration of IMGs when last polled in 2009 - could have shifted a bit since. The country supplying the most IMGs is India, the Caribbean schools collectively make up a huge chunk - Dominica, Grenada, Netherlands Antilles, then Pakistan, China, Philippines, Mexico - overall 127 different countries granting ECFMG certificates in this 2009 paper. So, a bit of perspective - as a US student you will absolutely work with an FMG in the near future, and as an FMG, you will not be alone when you match into a US residency program. Let's get into the questions: Dr. Shah asks: Can you give a good strategy for IMGs? This is a very loaded question with about 50 questions encapsulated into this one - so I think I know what you are asking and I’ll try and outline a “good strategy” for any IMG.  When we work with clients, each individual candidate is unique - geography, speciality, graduation year, family concerns, US experience, visa status, etc - so it is hard to point a whole group of people in one direction with advice, but there are some highlights: Do as well as you possibly can on the USMLE. I can not emphasize this enough.  Some foreign schools already have credibility in certain states or in certain programs so that PDs and state licensing boards are familiar with the caliber of graduates that come out of them. Lots don’t - so doing well on a standardized test makes you look good comparing apples to apples. Be prepared to do whatever it takes - multiple review courses, thousands of dollars, multiple months off for individual study.  SImply put, the higher your score, the better your chances. Know your priorities - as an FMG, getting a US residency spot is already a hard process, for you and your family, and it is a hard choice both personally and professionally when deciding what you are going to prioritize. Ultimately you may find yourself needing to choose between practicing any type of medicine in the US vs practicing a specific specialty anywhere on earth. You will often see IM or FM residents in US programs who were Orthopedic Surgeons or Ophthalmologists in their home countries, but they choose to change specialty to practice medicine in the US. On the flip side you see US citizens who go out of the country for medical education, fall in love with Dermatology or Otolaryngology to the point that they remain in their training country to practice that passion instead of trying to get into the hyper competitive US options. Think about these options when deciding what would benefit you and your loved ones the most.   Be flexible - the saying “beggars can't be choosers” absolutely applies here - apply to a huge number of programs, and absolutely apply to multiple specialties. Consider multiple geographic regions.  If finances are a strain, you can focus your efforts, but the reality is that extra 12/16/26 dollar fee to tack on one more program is a drop in a bucket and can get your foot in the door to a six figure salary for the rest of your career - now is not the time to pinch pennies. Be realistic - short term - knowing where to apply and how to go about it, and long term as well. Some IMGs end up compromise too much and get stuck in patterns of multiple prelim years, malignant programs, grad school, and other endeavors to try and become more competitive for the match and can paradoxically become less competitive, and really mount up debt. Some test prep courses can be these endless loops of multiple time test takers, who can ace qbanks but not get residencies - end up a tutors, advisors, lab assistants, phlebotomists, foreign MDs are definately not guaranteed anything in the US. Know how competitive you are and focus your efforts accordingly. Use your connections - anyone you know - and I mean anyone, previous alumni, any friends or relatives, anyone you rotated with on AI or observership. Play to your strengths - whenever the opportunity arises - PS, LORs, interview, make sure you let them know you speak multiple languages, talk about your hands-on experience, paint a picture of IMGs as a group that is hungrier, harder working, more resilient, more flexible - willing and able to move countries to train.  As any US students listening may not realize that different countries have regulatory bodies and medical training outside of the US can be drastically different - US students have curriculum that can be evidence based, problem based, well researched, validated tools, etc. learn from an online module, and get excited when an attending lets them throw a few simple interrupted sutures during closing - when students in Mexico for example don’t have the luxury of having a note taking service, or even professors who know what is covered on Step 1, but they were first assist in transplant cases with a resident in charge  - no fellow, resident, other students fighting for the case. Be optimistic - don’t believe everything you read on SDN or valueMD or other forums. Plenty of IMGs have jobs. In fact, IMGs make up about 25% of the current physician workforce.  This is a subject that hits close to home as personally, I am an IMG, and it is the reason I wrote my book and the reason I started this business was to help IMGs - I think they are a vital portion of the medical workforce and bring elements to US medicine that will continue to drive it forward. “Millennial” generation with note taking services, angry when a professor didn’t tell them what question was going to be on a test, upset over anything less than perfect on an evaluation form - nauseating and not indicative of patient care. IMGs traditionally flying blind, fighting tooth and nail for any position available often taking USMLE on their own, with bootleg study review materials, fighting for any leg up, fighting to find material relevant to the USMLE vs deciding between 4-5 books to see which is best. A handful of common US student complaints are about not getting enough away rotations, or the lack of financial support or housing, or getting an evaluation from a resident that an attending signs, or even an attending you didn’t really spend time with. Meanwhile IMGs may have clinical rotations in 7 different cities with a loose word-of mouth network of where to live, and shared subway cards, IM in Chicago, then OB in NYC, Psych in LA - and they are grateful for a LRO in English from ANYONE, much less the person who will give them the best letter.  Long list of intangibles that IMGs deal with often that departments may or may not know - you have been through a lot, you will get through this too. Dr. Shah asks: What is more important for IMGs - research work, or electives and observerships? Clinical, clinical, clinical. Research is important, but to frankly answer this question, I have to emphasize clinical patient care. You are looking to get into a program to take care of patients, so show them you can take care of patients - the more involved the better. Get an LOR out of the experience, and if possible get it at a hospital you want to train at. Dr. Shah asks: What are the common mistakes made by IMGs when applying to residency programs? Prior to applying - Not doing your homework - not using connections, not looking at the specifics of visa paperwork, how to get one, which ones you need, if a program will sponsor it. State specific in some cases, program specific. Commonly overestimate their value - look at your scores, look at your application, you will not get ortho - there is a difference in being optimistic and being delusional - miracles may happen elsewhere, but don’t bank on it in the Match. Commonly underestimate their value - in the current landscape, there are still not enough US grads to fill all of the available spots - your life, happiness and career are not worth too much compromise. Bad program, on probation, abusing residents, poor education, poor employment opportunities - that will be a bigger stain on your record than your foreign school - at the next level you are always judged by the most recent level - you are no longer a *** grad, you are a *** resident. Common mistakes during the interview I have seen - focusing too much on justifying academic performance - many foreign schools work on strictly objective, merit-based rewards - highest score gets the highest spot. I encourage all of our IMG clients to remember the social component - telling families they lost a loved one, discussing cancer diagnoses, end of life care, navigating health system beliefs. Nuances of the english language lost in translation - miscarriage vs abortion, obesity vs fat, spanish culture.     Forgetting that this is a job to learn - when coaching US clients we usually work on US lifelong student changing a mindset from student to employee - need to work on projecting leadership / confidence / reliability / autonomy that go with patient care, and dampen the submissive, passive traits. IMGs I see a lot of the opposite - well established physicians that may carry respect / klout to a degree that need to change mindset to a more traditional learner. Programs don’t want to but heads with someone for multiple years who is coming in and telling them how to do things or how they used to do things back home - you are there to learn from these people, learning pt care, learning communication, learning procedures - even if you have performed 200 knee replacements back home, you are interviewing to be an intern  next year - wound vac changes, bowel disimpaction, perhaps someone half your age being your superior, etc - show THAT aspect of your personality. For our last question today, Dr. Shah asks: Looking at the current scenario can an IMG with a green card get into Radiology residency? Yes - do your homework, be flexible, be realistic, know yourself - all of the above apply. Know that they are not going to hand it to you, and you are going to have to work for it, but be optimistic. FIrst I would make sure I was a competitive applicant - are my scores well above average? Would my application as a US student be competitive? Look at “Charting outcomes in the Match” - diagnostic radiology - step 1 235, step 2 240 - Data shows while most applicants matched at 240 and above, 14 of these “independent applicants” matched with 200 or less. If you were a client, I would polish your application - make sure your strengths come across as strengths, and any red / yellow flags are addressed. CV polished, appropriate experiences highlighted, perfect multiple PS, LORs appropriately uploaded. Etc. Create a spreadsheet, look at every website to determine if they are “IMG friendly”, or call them all - or even outsource that.  When I was applying freelancing was taking off, I hired a virtual assistant call every program coordinator I was interested in and ask bluntly about cutoffs and multiple attempts, IMGs - whatever your specific situation. If you were my client, that is something we can arrange for you. Once you have your list, polish your application - would tweaks in your PS add to your application? - geography specific or school specific - are you familiar with a professor’s works, research,etc. Mention these specifics so they stand out once you clear the initial hurdles. Then, apply to every single one you can afford. That would then generate a handful of interview invitations, I would walk you through how to communicate with programs, how to best schedule, and we would practice radiology-specific mock interviews with explicit feedback on body language, diction and word choice, confidence, how to tell your story given different interviewer styles or different question types to make sure you are your best self to these handful of people in a handful of hours. We would help you create your rank list, and sit back and wait patiently. There are some other pre and post communication nuances we could coach you through if they arise. As a backup plan, take that same list of programs, and apply across the board to preliminary medicine (or surgery) programs with radiology departments you want to train at - if you don’t match in radiology, you will at least have a US residency spot as a foothold. I would show you how to structure your rank list to set you up to rank at any radiology program first, then fall to your top choice IM program. During that year, spend every free moment with the radiologists and let them know your interest. Radiology reading rooms - trauma call in the ED - hang out with the residents, and talk with faculty if available - let them know your interest bluntly and that you will be applying next year. To a US residency program, a year spent in US clinical medicine is better than 5 years at the best hospital in any other country, research, perfect step scores, etc. You would now be Dr. Shah, intern at *** IM program. Keep up with radiology CME websites / trending news - be able to discuss specifics of scans - really impress these people.  They will be doing the interviews, can pass the word up the ladder, and the more senior resident will be the chief residents. In addition, there are rare opportunities to jump into available spots mid-year - so we would be looking for any available spot that opens mid-year - funding is attached to resident slots, so if people leave secondary to illness or family crisis, or disciplinary action,etc. , there are opportunities to move laterally into programs. Not foolproof, and no guarantees, but a solid plan to set you up to be that approximately 30% of the entering PGY 2 class that comes from outside of US allopathic seniors.

S01E10 - IMG strategy and common IMG mistakes

Hey everybody this is Myers Hurt with another edition of “Countdown to Match Day,” the official podcast of the Match Gurus, and the only podcast aimed at helping applicants shine on interview day. Remember to follow us on twitter @theMatchGurus and send any questions you want answered on the show. If you like the content please take some time to leave a review on iTunes, or review the book on Amazon. In true countdown style, this season we’ll release one podcast each week for the 40 weeks leading up to Match Day.  This is season 1 episode 9 - now 32 weeks to go until #MatchDay2017. Let’s get started: What to expect - usually the resident dinner is a collection of applicants and residents, set up as an informal environment to get some questions answered from the resident point of view. There is no set question time / eating time, it just flows naturally. Who will be there: residents and their significant others - specifically to answer the most amount of questions for the most amount of people. Consider the scheduling from the other side. Residents already feel overworked and underpaid - even with free food as an incentive - it says a lot to volunteer time to go out after a 12-16 hr day only to talk about how much you love that 12 or 16 hour day. Consider the timeline as well - as chief I could always get people fighting over the first few free steaks, then late in the season it could be pulling teeth. Who to bring: spouses are ok, children, parents, friends - even girlfriends/boyfriends are not. No need to bring anything to take notes, anything to try and impress people - just an opportunity to be yourself. What to wear: not a suit, not jeans and a t-shirt - something in between - a business lunch or business dinner. Collared shirt with or without blazer, good rule of thumb is it is always easier to dress down instead of dressing up. What to order: If you have any preferences as far as vegetarianism, vegan, kosher, food allergies, etc - feel free to mention to the program coordinator - feel free to communicate without being judged. Alcohol - borderline issue - never be the first to order alcohol, tea, water, soda are safe bets - if the most senior person at the table orders a beer or some wine, feel like the ice is broken, and go for it. Always ok to abstain without fear of being judged, just don’t order bottle service, not Jersey Shore. Remember that you are always being interviewed. I understand both arguments - in a stressful environment, one glass of wine takes the edge off, however, if alcohol makes you anything less than your best self, best to abstain. Nothing new - allergies, don’t like the taste.  Nothing sloppy or saucy - think first date - want to enjoy a civilized meal in a nice setting, no need to wear most of your dinner, or embarrass yourself. What questions to ask: “front line” questions - parking, housing, child care, - things that are important to you.  As well as how they feel - do they get along with faculty, do they get along with each other, do they feel like they are learning, good balance of learning and autonomy to learn by doing Pearls: remember the resident’s names - it always comes up the next day - who did you go out with? Multiple people ask, and simply by remembering the names of your future colleagues shows an incredible amount of interest. Forgetting people or forgetting what you talked about is a red flag. You are being watched - how you interact with the waitstaff, hostess, etc all reflects on how you will work in a team. In the hospital, you have nurses, students, PT, OT, maintenance, dietary, mid levels, attendings, etc - I’m Texan, so yes ma’am, no ma’am and holding doors open for people is second nature, but anyone rude to the waiter or waitress is absolutely going to hear about it. Would always be suspect of a candidate who was rude Thank you to everyone for listening, remember to send you questions to us through our website at www.thematchgurus.com, twitter @theMatchGurus, or snapchat.  Our book is now available on Amazon - please leave a review there as well. Take care.

S01E09 - The Resident Dinner

Hey everybody this is Myers Hurt with another edition of “Countdown to Match Day,” the official podcast of the Match Gurus, and the only podcast aimed at helping applicants shine on interview day. Remember to follow us on twitter @theMatchGurus and send any questions you want answered on the show. If you like the content please take some time to leave a review on iTunes, or review the book on Amazon. In true countdown style, this season we’ll release one podcast each week for the 40 weeks leading up to Match Day.  This is season 1 episode 8- now 33 weeks to go until #MatchDay2017. Let’s get started: In this episode, I talk with Dr. Mike McInnis - we talk about Internal Medicine, how to identify a good Internal Medicine program, introverted personalities, and social medic during the interview season. Thank you to everyone for listening, remember to send you questions to us through our website at www.thematchgurus.com, twitter @theMatchGurus, or snapchat.  Our book is now available on Amazon - please leave a review there as well. Take care.

S01E08 - Dr. Mike McInnis on Internal Medicine and Social Media

Countdown to the MATCH - the official podcast of the Match Gurus is the only podcast dedicated to helping residency applicants shine on interview day. Dr. Myers Hurt discusses specifics involving the residency Match process and helps dissect common - and uncommon - residency interview questions for #Match2017.

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Countdown to the MATCH

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