It's been a while since I posted and I apologize for answering your emails late. I have been very busy and a lot of debts have to be paid from all the loans that was taken for school. But for this post I want to be brief and I want to remind everyone about what they should pursue.

Before applying for residency, you must plan things through very well to the exact detail. You must be realistic and you must also choose a path that you love.

What I noticed ever since I graduated is that throwing your interest at all directions isn't the smartest move. If you want Internal Medicine, then do anything and everything to get yourself there, if you want family then get yourself in Family. If you want to get into a competitive then work hard to get in. Don't let the fact that you are from a Caribbean Medical school get in the way of getting into a residency of your choice. Currently Saint James students are getting into Anesthesiology, Emergency Medicine, and Surgery.  Other Caribbean medical students are getting into other specialties as well.

At the end of the day, follow your passion, and work towards the medical specialty that you can see yourself doing for the rest of your life. Whatever you do make sure you give your 100% and don't look back. When you follow your passion and not the money, then you will see that the money will come and you will do something you love.

Research as much as you can on what specialities interest you. If you have time after graduation, then volunteer at different specialities to see first hand which one catches your attention. The reason I suggested volunteering because you may not get the same feel for it as a medical student when you were rotating.

The residency process is no easy ride. It will be harder than studying for the boards.  If you study for the boards then you have a good chance of doing well.  However, when it comes to residency you can have all your requirements but there's still no guarantee of getting residency, even if you get a lot of interviews.

Consider the following when you apply for residency:

• Apply to all your programs on the first day, it's usually September 15th.
• Don't expect to get interviews from all the programs you applied to.
• You will be disappointed from time to time, but always keep your head up.
• Make sure you get all your USMLE scores submitted before September.
• Make sure you "waive" your right to see your letters of recommendation.
• Research the programs before applying to them; make sure you fulfill all their criterias.
• Do not rely on "hookups" from your friends who are already in residencies.
• The best and the only person you to impress is the program director.
• Go to medical conferences before September.
• Always apply to Family Medicine programs even if you are seeking another specialty.
• When applying broadly, it means apply to multiple specialties, but remember to back your choice up if you get interviews.
• Always be kind and courteous to everyone, especially to program coordinators, they are the gateway to a residency position.
• Timing is everything so doing everything before September gives you the upper hand.

I hope this helps, and please give me your feedback.

The Canadian Ministry of Health is going to cap out how many Canadian citizens are allowed to get residency positions in the US.  I don't understand the reason behind it because Canada needs doctors, but it's important to know all the facts if you are Canadian citizen.  For those who plan to get a J-1 visa, you have you re-new your work visa every year but you need Statement of Need one time for ECFMG.

Get US Citizenship If You Can
If you are in basic sciences or in clinical rotations, do your self a favor and find a way to get US green card or citizenship. A strong factor for applicants to get residency is their visa status. Residency programs do have the ability to sponsor you but they will choose not to if they can avoid it because the fees and paperwork is overwhelming; also they don't have the staff to do all that.

One of the most frustrating things I came up with is there is not much guidance when applying for residency.  SJSM does a good job in guiding the ECFMG and ERAS process but they stay silent when it comes to licensing questions.  SJSM encourages to research States that will offer residency licenses to their students.

I think the best thing for you is to research which programs Saint James students got residency in in order to increase your chances to get matched there.  Not only that you should also consider programs with students from other Caribbean medical schools who matched there; such schools as Windsor, MUA, AUA, St. Matthews.  Ross, SGU, AUC, and Saba are the big four and they have full accreditation of all 50 states, in addition they have a giant alumni network.

The problem with SJSM is that a lot of students graduate in different years and they do not keep in touch with the Alumni network.  Do to that, they do not care about any graduation ceremony. Fortunately, SJSM's alumni network is growing and I encourage everyone to be part of the network.

If you are a SJSM alumni who matched, then please call SJSM office at their office, and leave your contact information with them so if any recent graduates needs guidance, they can call you.

I encourage all of you from Windsor, MUA, AUA, St. Matthews, and other schools which I don't know of, to guide new graduates from your respected schools.

If you are a Canadian citizen without US green card or US citizenship then I strongly advise you to NOT apply to any international medical school.  The Canadian government has put a cap on how many Statement of Need (SON) documents that will be issued.

In order for the ECFMG to sponsor your J-1 visa, you need a SON from the Canadian government to be sent to ECFMG.  The SON is needed because after you finish your residency training or fellowship, you are to return to Canada and stay there for 2 years before you are allowed to come back to the US for a job.

One of the most disgusting things I have witnesses from others and experienced myself is the people who were friends before residency do not ever want to speak to you again.  I remember I helped a friend of mine during rotations, and I used to look out for him, but after he got residency, he doesn't reply to my emails or my texts.  We have a mutual friend and our mutual friend tells me he's still in contact with him so, it got me thinking how easily people forget those who helped them once they reach the top.

I don't regret helping that individual but my experience does help me realize that a good face may have poison behind it.  I never expected anything back but this experience helped me learn not everyone you help will help you when you need it the most.  I wish him the best in his career and his life.

My advice to all of you is, choose your friends wisely during medical school.  Always help anyone who needs it but have your guard up.  Don't blame them if they can't help you, may be it's out of their hands.  But it's better to be straight forward about it.  You will know who will take that extra effort to help you even if they were not successful.

Remember success is leased everyday; you have to work everyday in order to old on to it.  It's going to be your friends and co-workers who will help you hold on to success.  If you turn your back on them when they need your help, then you have a higher chance of loosing your success.

You thought as America being the leader of the free world, discrimination would be gone in a high-end profession such as medicine, but you're wrong.  I have spoken to several medical students in the past year and current residents and I just had to point out something to those who are looking into which residency programs to apply to.  Just because you have good USMLE scores and the residency programs accept IMGs doesn't really give you the green light to apply.  They also look at your skin color.

How to screen residency programs:

• Do not randomly apply a residency programs from ERAS.  Go visit the residency program website and take a tour of the website.
• Visit their current residents sections, 1st, 2nd, and 3rd year residents.
• First check to see if they have 1 or more IMGs among their residents.
• And then check to see if those residency programs have non-Caucasian (non-white) people in that crowd. 
• If there is not a single minority among the residency crowd, then put it as a red flag and do not waste your money applying to that program.  Chances are that if you are a minority, they may overlook you.  If you have good USMLE scores, then you may have a shot at an interview, but look at their selection of residents and judge for yourself if applying to that program is worth it.

I just gave you my two-cents.  I could be wrong but I went through many residency programs and I'm making a decision that would increase my chances of getting interviews.  Good luck to everyone.

It's been a while since I updated and I have fair reasons.  I am currently focusing on Step 3 and working on programs to look into.  It's imperative that from now till application season, you do all you can to rev up your applications.  You need to stand out and try to look at your self from a residency program director's point of view.  I have been in contact with residents, residency faculty, and other fully licensed doctors on what to do and what not to do.  Here is the list:

• Do not wait! Apply to all the programs you will ever apply to on the first day.
• Try to meet the chief residents and program directors in any way possible
• Do clerkships in the hospitals you want to get into
• Try not to apply to too many different specialities, if you want Internal Medicine (IM), then stay with Internal Medicine.  Stick with 2 or 3 different specialties so it'll be easy to focus on them.
• Get PERSONAL letters of recommendations from your attending doctors, and waive your right to see them.
• Be ECFMG certified before applications are sent if you can.
• If you graduated very early then get USMLE Step 3 out of the way.
• If you graduated very early then work at a clinic, programs are looking for experience.
• Start writing your personal statements very early and make sure they are free from any errors. Get your friends, family, even other medical students to read them.  Also, personalize each personal statements to the state.  Find a connection to the residency programs such as if you did rotations there, or you worked there, or went to undergrad there, etc.

I hope this helps.  I'm extremely busy at the moment running around doing many things so I'm not blogging as much.

Did you ever run into someone who says he/she got a connection with a residency program? If so, then take that with a grain of salt. From my experience, those connections never come through unless they are strong connections.

If you depend on connections alone to get into residency, then you may be disappointed. Connections are one of the top ways to get a residency but they are rare. I noticed only family connections go through but everything else is useless. If a sibling, a spouse, a cousin is in a residency, then it’s easy to get in. However, if it’s anyone outside of the family, then the chances are very slim, because the people in the inside may not take the extra step to get you in.

The only way to get in is through your hard work, or smart ways to win the attention of directors and other staff members of the residency programs. It’s imperative to plan ahead and make sure that you impress the staff from Day 1. If you consistently contribute to the hospital you want a residency in, such as random projects, then you will increase your chances to get a residency position.

Whenever you are getting ready for residency, keep in mind that it's going to be a lot of work.  I'm still trying to get my studying as I still need to take care of my board exams.  Also, taking the exam and getting the scores back in time is going to be an issue because it's better for the residency programs to have all of your USMLE scores in their hands by the time of the application.  Also, make sure to get your letters of recommendation (LORs) very early, do not delay on that because attending doctors take forever to write them.

So far this is what my check list looks like.

1. Get ERAS Token
2. Get NMRP Token 
3. Get AAMC ID; it's usually the same as the MCAT for those who took the test before medical school.
4. Get USMLE Transcripts
5. Get MSPE (Deans Letter from school)
6. Create a resume for residency program directors
7. Letters of recommendation
8. Write a personal statement
9. Research on states that accept SJSM graduates
10. Research residency programs
11. Call up residency programs to see if they would accept my credentials
12. Apply for ECFMG certification

Let's face it, if you are an IMG you will have challenges and it you should recognize that there will be tremendous amount of obstacles before you land on a residency spot.  The biggest obstacle will be where to get a residency. What I noticed is that some students will apply blindly to numerous residency programs without researching. You should always research to see if your school is approved in the state and you should also research to see if the residency program will accept you. Most states don't DISAPPROVE Caribbean medical schools and they have the APPROVED list of schools.  If your school is not in the DISAPPROVED list then it's good; however, some residency programs will only accept students from schools in the state's approved list.

According to the IU Health Ball Memorial Hospital Family Medicine Residency Program web site:

Before applying, please visit the Indiana Licensing Board's web site to determine if your school is approved for licensure in Indiana. If your school is not on the "approved" list, we will not be able to consider your application.

According to the Indian Licensing Board, Ross, Saba, SGU, and AUC are the only foreign schools which are approved. And all other schools which are not in the disapproved list are taken in a case by case manner. Some schools in Indiana will not consider students if they are not in the approved list. So, students from SJSM, MUA, Xavier, AUA, AGU and other schools, don't bother applying in Indiana. Don't waste your money in applying for programs in states that your school is not approved in.

Another issue you need to consider is when will you get your medical license. Residents usually sit for USMLE Step 3 after the intern year of residency and get their license. However certain criteria have been changed and now some states require residents to complete their entire residency in order for the state to issue their medical license if their school is not from the approved list.

According to the Georgia Medical Board:

Graduates attending schools not listed in the Medical Schools Recognized by the Medical Board of California must complete three (3) years of post graduate training in a program accredited by the ACGME.

Basically post graduate training is residency and you have to finish your residency in order to get your license.

According to the Alaska Medical Board web site, it doesn't have much restrictions except just passing your boards and be a legal US resident.  The following is from the board's medical statues & regulations:

Sec. 08.64.225. Foreign medical graduates.
(a) Applicants who are graduates of medical colleges not accredited by the Association of American Medical Colleges and the Council on Medical Education of the American
Medical Association shall
  (1) meet the requirements of AS 08.64.200(a)(3) and (4) and 08.64.255;
  (2) have successfully completed
     (A) three years of postgraduate training as evidenced by a certificate of completion of the first year of
postgraduate training from the facility where the applicant completed the first year of internship or residency and a certificate of successful completion of two additional years of postgraduate training at a recognized hospital; or
     (B) other requirements establishing proof of competency and professional qualifications as the board considers necessary to ensure the continued protection of the public adopted at the discretion of the board by regulation; and
  (3) have passed examinations as specified by the board in regulations.
(b) Requirements establishing proof of competency under (a)(2)(B) of this section may include
  (1) current licensure in another state and an active medical practice in that state for at least three years; or
  (2) current board certification in a practice specialty by the American Board of Medical Specialties.
(c) In this section, “recognized hospital” means a hospital that has been approved for internship or residency training by the Accreditation Council for Graduate Medical Education or the Royal College of Physicians and Surgeons of Canada.

Be smart and research before applying for residencies so you will save your self time and money and increase your chances of getting a residency.

Congratulations to the SJSM students who worked hard and got matched for the 2014 year. The following are names of the students who got matched, the specialty, and the state they are matched in. Keep in mind that this is the partial list which was listed from SJSM's website. Some students did not want to be listed so the actual list is possibly longer.

1. Sajeeb Adhikary – Psychiatry, MI
2. Farhan Ahmed – Family Medicine, KY
3. Maria Azeem – Family Medicine, AL
4. Tae Ho Choi – Family Medicine, ND
5. Shae Datta, Internal Medicine, NY
6. Dimitri Edirmanasinghe – Psychiatry, CANADA
7. Mahveen Ethezaz – Family Medicine, MN
8. Sanju George – Psychiatry, DE
9. Jarrett Gillette – Family Medicine, IL
10. Inas Hagroo – Internal Medicine, MI
11. David Jeager – Internal Medicine, NY
12. Jelisia Kamel – Family Medicine, CANADA
13. Junzhi Lin – Internal Medicine, IL
14. Raafia Muhammad – Surgery, NY
15. Kamalakshi Narahari – Internal Medicine, IL
16. Andrew Poulos – Family Medicine, WI
17. James Reed III – Family Medicine, SC
18. Mohammad Sadi – Internal Medicine, IL
19. Samir Shahen – Family Medicine, IL
20. Usman Umar – Family Medicine, LA
21. Moaweya Zayed – Family Medicine, MN

Hard work pays off so, good luck everyone!

Getting a letter of recommendation (LOR) can be challenging.  Doctors at teaching hospitals have so much going on and your LOR is one of the last things on their list. They may write you a general letter of recommendation which may not benefit you. A personalized LOR from your attending doctors can go a long way. Also, make sure your attending doctor uploads the LOR and not yourself. If you waive the right to see your LOR then there is more value to it; if you upload it then your LOR's weight is not as good. If you get a chance to sit down with the doctor, you should tell your attending doctor to write you a letter with key points.

I spoke to a doctor about it and when a LOR is written, there are some points to keep in mind:

• Your letter should have your AAMC number somewhere; right after your name is a good spot.
• Make sure there is emphasis on what rotation you did and how long you conducted the rotation.
• Also make sure your attending doctor writes a theme of "teamwork" in your letter body, because teamwork is highly important to residency programs. You will be working as a team in residency so that should be written somewhere in the letter.

The following is an example of an LOR:

To whom it concerns/program director,

I worked with [First Name] [Last Name] (AAMC#)...

Body of the letter...

Sincerely,

[Space for Doctor's to Sign]


Doctor's Name
Doctor's Title in the Hospital

Here are AAMC's guidelines for a letter of recommendation.  I gave few pointers on what you should have in your letter, but the AAMC guidelines will give you the details about it.

I spoke to two different doctors from Northwestern University. One is a board certified GI doctor who’s been practicing for 35 years. Another doctor is a board certified cardiologist, who is also an associate professor, and a researcher in hypertrophic cardiomyopathy. They gave me similar advice, which you should pay attention to.

As an IMG, you should be well aware that we need to be more competitive than our AMG counterparts. We were not spoon-fed like American medical students; therefore, we have the ability to go beyond the norm in order to land a good residency.

When we need to consider residency, we need to cover four things and we need to be on top of it. As an IMG, this is the least that we should do.

1. USMLE Step 2 CK score should be competitive. If you did well in USMLE Step 1 then that’s great, and if you didn’t do all that great then this is the chance to make up for it. The USMLE Step 2 CK score should be competitive; try to score as high as you can. Also, make sure your Step 2 CK score is higher than Step 1 score because it’ll show the residency board that you are improving. And also make sure you pass the USMLE Step 2 CS on the first try.

2. Clinical clerkship grades should be close to 4.0 as much as possible. Us IMGs are fortunate that we can do clinical clerkships and it’s part of the curriculum. Use your clinical clerkships to the best of your ability and do your best to get straight A’s. The grades in clinical clerkships are weighed heavily because it’s conducted in the US. Your grades in the island is not as important as your clerkship grades because those grades cannot be assessed on the same, fair level.

3. Letters of recommendation (LOR) are important because it gives an insight of your strengths and weaknesses by the attending physicians who worked with you. It’s very important to get LORs from attending physicians who will praise your work specifically and avoid the attending physicians who will only write a generalized LOR. Also, before you start your clinical clerkships, try your best to get attending physicians who are directors or chairman of departments because it will increase the value of the LOR.

4. Research is a vital part of your application. For those who did not transferred out of SJSM, it is part of your requirement in order to graduate. SJSM requires all students to conduct some kind of research to receive their MD degrees. According to all Northwestern University physicians, research will set you apart from the rest of the applicants. Research work at notable institutions are very good such as University of Chicago or Northwestern University. However, you can also do research with 3rd year resident doctors in the hospitals you do rotations in.

In addition to the four things I mentioned, do extra curricular activities such as volunteering at other hospitals or getting involved in heath fairs. This will show residency boards that you are just more than books and grades.

I know this may be confusing to some but it’s very simple once you fully understand the difference. A hospital that has a residency for a certain program will have a green book status for that particular rotation. And if there are other rotations then it will fall as a blue book.

For example, for Jackson Park Hospital, it has a family medicine residency program; therefore, the family medicine rotation for medical students counts as a green book rotation. However, the internal medicine rotation at Jackson Park Hospital counts as a blue book because the hospital does not have an internal medicine residency program there. Other core rotations count in the same category such as Psychiatry, OB/GYN, Pediatrics, and Surgery.

If you want to go for Internal Medicine residency then you may want to do your Internal Medicine clerkship at Mercy Hospital instead of Jackson Park Hospital. Some residency programs prefer their applicants to do all their core rotations with a green book status; however it’s not universal so don’t worry about it. The reason I say this is that a lot of FMGs get residency programs in IM but they have no US clinical clerkship experiences. With SJSM you have 80 weeks of US clinical clerkships so that’s why you shouldn’t worry about it.  The same goes with other non SJSM Caribbean students, they have 72 weeks of US clinical clerships.

This year, Saint James School of Medicine has a very high number of people matching in the national match program.  SJSM posted the list on their website.  How many applied for the match is unknown but apparently there are 28 people who pre-matched/matched. Other than Internal Medicine and Family Medicine residency programs, there are individuals who matched in Anesthesiology, Pediatrics, Psychiatry, Neurology, OB/GYN, General Surgery; I bolded the competitive specialties.

So the next time you ask yourself if you can get a residency in the US by going to SJSM, just look at the list and be motivated.

I know at least 7 people personally who are on the list and I’ve seen most of them on the island going to class, studying, and partying, and so keep your chin up and work hard. One of them just texted me saying that by God willing, that I will be where he is soon.

So for those who are on the islands, Bonaire or Anguilla, or who are in clinical clerkships or studying for Step 1, just remember to work hard and soon you will reach your goal.

Let’s get some things cleared, because like most first year medical students in the Caribbean, I didn’t have much of an idea of what is what. But the information that I have presented below is from another doctor, a Canadian doctor. I can’t say much from my side because I haven’t been through the residency process.

AMG, IMG, and FMG
AMG stands for American Medical Graduates, IMG stands for International Medical Graduate, and FMG stands for Foreign Medical Graduate. AMG should be a no brainer; students who graduate from US medical schools. IMG are US Citizens/Canadian citizens who graduated in a medical school outside of the US. FMG are non-US citizens who graduated outside of the US.

Priority in Selection
Did you know there is a priority selection in getting selected for residency. For example Anesthesiology, Radiology, and Dermatology are three fields where AMGs are most likely always selected. And IMG and FMG must do a lot in order to get a fellowship in those three fields, such as doing and extensive amount of research. The following is the selection priority for residency.
1. American Medical Graduates
2. International Medical Graduates (US-Citizens)
3. International Medical Graduates (Canadian Citizens)
4. Foreign Medical Graduates

Yes you got that right, they will choose a US IMG over a Canadian IMG. I know it’s discriminatory, but I think it has to do with the whole paying taxes thing, but I can be wrong, don’t quote me on that. The residency board will always select a US citizen over a Canadian citizen if both have the same level of scores. However, if a Canadian IMG has a 95% and a US IMG has a 85% score on the Step 1, the choice is obvious, they will choose the Canadian.

If I was wrong in anything in this blog post, then by all means please point it out by commenting below.

The field of Family Practice is not really a competitive field in the United States. Most medical students avoid getting into the field because the money is not all that great compared to other specialties such as dermatology or radiology. Medical students have enormous piles of debt once they finish medical school so, they will choose the highest paying job in order to pay off their debt ASAP. Physicians consider Family practice field as the lowest ranking field; however, that’s about to change with the new healthcare plan set by President Obama. With the new nationalized healthcare plan there will be an additional 30 million people getting healthcare and the demand for primary care, specifically Family Practice doctors, are now needed.

How much do Family Practice doctors make?

From January 21, 2011 physicians get from $120,731 to $169,119. During residency, residents in family practice get a very handsome salary above other residents from other fields because the demand for primary care doctors are soaring. They get from $46,000 to up to $60,000 just for residency! And just like internal medicine family practice doctors makes a killing in the rural areas than in the urban areas.

How to be a Family Practice doctor after high school?

- 4 years of undergraduate work

- 4 years of medical school

- 3 years of residency

So yeah about 11 years just like internal medicine, and like internal medicine there are subspecialties which includes the following:

- Adolescent Medicine

- Geriatric Medicine

- OB/GYN

- Pediatrics

- Sleep Medicine

- Sports Medicine

Source: Salary.com

We actually have a visiting professor from University of Montreal, Dr. H, who is a researcher, and who also teaches the MD2 Neurology class. His specialty is Neurology. He offered an opportunity for a small group of SJSM students to do a research project with him. He told us if everything works out well with the project then our names would be published in several medical journals. I'm definitely going for it.

Apparently this teacher works in the research facilities of University of Montreal and he will guide us through this. I know I’m an MD3 and I have enough on my plate but something like this doesn’t come everyday. I know for a fact that if I’m successful then this will help me significantly in getting a good residency. Residency directors want to see more than just passing USMLE and doing rotations. They want to see research and as much clinical experiences as possible before graduating medical school.

Dr. Jessen Mukalel MD is a SJSM graduate from the 2006 class and he is currently a doctor of anesthesiology in Chicago, IL. If you want you can look him up in the Illinois Medical Board. He speaks about his experiences of going to Saint James School of Medicine and he stresses a lot on preparing for the USMLE Step 1, which is the most important test out of all the three tests.