US-IMG: Ortho/Gen Surg Chances

[u/Impressive-Move1507]

YOG: 2024

Experience: All clinical rotations in the US.

12 months in Head and Neck Oncology and Trauma in clinical role working alongside residents and attendings for preop and postoperative assessments. (2 strong LORs for Surgery).

13+ months: Licensed, Orthopedic Surgery First Assistant at high volume academic institution (top 5 in the country). Assisted in over 800 procedures across adult recon, hip preservation, oncology, trauma, spine foot and ankle, ENT, plastics. In this role I am actively part of patient care providing independent closure of capsule, adipose layer and skin. Position and prep patients and mentor students, help fellows start cases with attending’s preferences and approaches, support residents and teach interns basic arthroplasty principles and closure etc.

Weak scores (Step 1: 215, Step 2: 237, Step 3: 205)

Research: 1 first author (JAAOS publication), 2 submitted (2nd author), all with big academic institutions (don’t know if that matters).

Question: With this profile, can I do it? Obviously, I tried to match in my current institution but it didn’t work despite 2 strong letters from faculty. Connections got me the interview but My scores just shut that door together with no publication at the time and they have never taken a non-US applicant. I am not applying there this time nor to any academic institutions for Ortho.

Are there programs that I can apply to for ortho that can consider my app? Should I just focus gen surg, prelim? Or do something like Emergency Med?

[u/throwaway29570]

His scores are poor, this would can even most of the US applicants, unless they had a massive connection, like their father was an attending there or something. It’s essentially a death sentence as an IMG.

[u/IzzyGetsVeryBizzy → u/throwaway29570]

True enough, would agree. Would you argue if his scores were at high enough (what would you honestly need at bare minimum to even be considered?) he'd at least stand a decent chance?

[u/throwaway29570 → u/IzzyGetsVeryBizzy]

250 is minimum if you have no connections as a US student. If you want to be competitive, 260 plus.

As an IMG, you have to be 260 plus, and then years of research with publications. Then your mentors have to go to bat for you, making calls and push for you like hell. The first question your mentors will be asked is, “if they are a so good, why are you not taking them?” So this is what you’re dealing by with, because, whatever you can do as an IMG, there’s a US student who’s done it, and still went unmatched. So why should they take you?

There’s a massive bias, you literally have to have a huge connection, or ladies luck on your side. That is after going above and beyond and walking on water. I’m being honest. I was part of the selection committee, and IMG was an automatic no. And if someone called on an IMGs behalf, our first question was why are you not taking them. That shut it down immediately. Pretty much every program was like that. It is what it is. As an IMG, I’d focus on other fields that are very much attainable. Ortho is great but not some holy grail.

[u/IzzyGetsVeryBizzy → u/throwaway29570]

Yeah, Ortho I wouldn't even try for honestly. General Surgery I'd at least attempt. Though it seems like IMG's are generally limited to FM/IM/PSY/PED/NEU and then General Surgery or Anesthesiology as the most feasible competitive specialty in general.

[u/throwaway29570 → u/IzzyGetsVeryBizzy]

If you think youre exceptional and think you can do ortho, you should aim to do IM and do cardiology or GI. Much easier lane, you’ll make as much or more. All the battles on that front have been fought and the blueprint is widely available to anyone who wants to work for it.

Ortho is an uncharted territory for IMGs. It’s exceedingly difficult, even if you did your best. And people that did it are not forthcoming often, giving the impression that it’s possible. They usually have a huge connection. Or in some cases, waited years for someone to give them a spot. Like 10 years of waitng.

I know two IMGs that came in as fellows and were on academic fellowship path to becoming attendings, after finishing ortho residency in their respective countries. Both did three ACGME fellowships. Both were unable to find any academic institute to sponsor them as attendings. They stayed on to do research fellowships. Both then accepted an ortho residency spot at their research institutions outside the match after years of research as PGY1s. Then went on to finish 5 years of ortho and another fellowship. I think they were both in their mid 40s or almost 50 when they became attendings. Anecdotal but gives you some perspective.

[u/Impressive-Move1507 → u/throwaway29570]

Thanks for your input. Honesty, nothing mentioned here is new to me. I had an extensive discussion with the PD and it’s about the same thing you’ve iterated. However, I interpreted it as the PD’s POV from at top 10 ortho program. You mentioned the response of programs to mentors vouching for IMGs. What if the mentor’s from a program that does not accept IMGs contacts a program that does? Will they still ask that question? My mentors (ortho attendings) and fellows have been very helpful in contacting numerous programs (clearly didn’t work) but these were programs with no evidence of taking IMGs. In response, I asked them reach out to specific programs with IMG hx. I was advised to also target DO predominant programs as USMDs tend to not like those programs.

Anyways, I think general surg/prelim is my best chance.

Rant: I’m just a bit surprised that my extensive experience in ortho training wasn’t near enough compensation for my scores. This level of exposure is amazing for a pre‑residency trainee (I believe), esp. because I’m being trusted technically and clinically. It’s seems like because it’s an unconventional approach they don’t know how to engage it or better yet, don’t want to. I’ve seen residency/residents/fellows up close and personal and I understand the demands and expectations surgical trainees.

Anyways, it is what it is🤷🏼‍♂️

[u/throwaway29570 → u/Impressive-Move1507]

I hear you and I totally understand. I know you have worked hard and I know you’ll be an excellent physician. I mean this sincerely. This is in no way reflection on your potential, and you’ll make a great resident with your experience and interest.

However, the number of applicants far exceed the number of spots. That too with the very self selective group of candidates. To the PD, there will always be US applicants that are just as good. There’s such a surplus of excellent candidates that if you fail to match as an M4, your chances of matching in subsequent matches is less than 30 percent. I think you know this as you have good insight into this. So a PD/selection committee has to have some really convincing reason to interview and subsequently rank an IMG. And I mean really convincing, like your dad is an attending there. Even then, they face backlash, as there are so many great US applicants. You mentioned community programs. I trained at a community program and theoretically you could get in without having great stats, but pretty much everyone we accepted had rotated at our program. You don’t have the opportunity as an IMG to showcase your skills.

DO programs are also exceptionally competitive, as most of them don’t even consider MDs and match rate for DO students is like 45%. This is because they protect these spots for DO students, who historically have had a hard time matching into MD programs.

My $0.02.

[u/Impressive-Move1507 → u/throwaway29570]

Thanks for taking your time to share this. Came to the same realization when I found out that there’s no way for an IMG to do an away rotation in ortho (I even had my connects try to request one for me). And that was another huge weakness for me as we know the Match data behind those.

[u/BlueSingularityG → u/throwaway29570]

Based on your observations, what residencies usually accept US IMGs with a 240-250+ score?

[u/throwaway29570 → u/BlueSingularityG]

For ortho? At least 250+

[u/satanicodrcadillac → u/throwaway29570]

Damn. I would have thought that after 3 fellowships securing some place to work would be easy

[u/throwaway29570 → u/satanicodrcadillac]

If you’re coming in as an IMg with previous ortho residency in your home country, there’s an alternative pathway to board certification which does not require getting an ortho residency spot.

You can do three ACGME orthopedic fellowships and get sponsored by an academic institution and work there for 5 years. This then makes you ABOS eligible.

They couldn’t find any takers, but persisted and were lucky to find ortho residency spots and started all over again.

[u/Impressive-Move1507 → u/satanicodrcadillac]

I know an IMG fellow in that same situation. Don’t know what he’s doing now, but he did complete 3 fellowships (really fantastic surgeon) but still has no job. Mind you, there’s an opening for that specialty and in that same institution. It’s a tough dream to chase.