International Medical Schools, Part II (for the current medical student)
“Can an international medical graduate (IMG) match into neurosurgery?”
“Can a foreign medical graduate (FMG) match into neurosurgery?”
The short answer is: no.
The long answer is: if you’re not dissuaded by the short answer, then keep reading.
I’ll share my thoughts for IMG and FMG who are applying to neurosurgery based on my recent experience as an applicant and my current experience on the other side of the residency application process.
First, lets show some data. How many FMG, IMG, DO and US MD postgraduate (“Other”) applicants match in neurosurgery each year, compared to US Seniors (“MS4”)?
Year Total #MS4 #Other
2014: 206: 189 + 17
2013: 203: 190 + 13
2012: 194: 170 + 24
2011: 191: 174 + 17 *Charting Outcomes*
2010: 188: 173 + 15
2009: 191: 172 + 19
Thus, in a typical year, approximately 10% of the neurosurgery spots are filled by these “other” applicants. Keep in mind that from the (anecdotal) information that I am aware of, most of these spots are filled with US MD postgraduate applicants (i.e. folks who didn’t match the previous year), followed by US DO applicants, FMG and IMG. Definitely fewer than 10, probably five or fewer FMG/IMG applicants match in neurosurgery each year.
We can drill down further into the last “Charting Outcomes” release from 2011. I had hoped that NRMP would release one from 2013, but apparently they have not yet done so. There are a few factors that clearly matter based on this data: # of contiguous ranks, Step 1/2 scores, AOA, and # of research publications. Most of the other stuff is noise.
Looking at the distribution for contiguous ranks, the distribution of ranks of US seniors and other applicants are almost complete opposites. Other applicants who matched ranked a mean of 6.3 programs, those who did not match ranked 3.3 programs, whereas matched US applicants ranked 15.2 programs and unmatched ranked 7.5 programs. Of the four independent applicants who ranked >10 programs, three of those matched! So, the goal for any independent applicant has got to be to get as many interviews as possible. The only truly modifiable factor you have as a fourth year FMG/IMG is the # of applications you send out, so apply to every single program.
Step 1/2: Whereas US senior applicants have a match rate exceeding 80% with even an average Step 1 score (>221), there is not enough data to speak conclusively about this heterogeneous population. Still, with screening for most programs at either 230 or 240, I would say that IMG/FMG should shoot for 250+ on Step 1. You need to stack the deck in your favor. Again, step 2 scores being much less important for US seniors than for IMG/FMG, you should aim to score 250+ on Step 2 as well. However, these scores are only rarely attained by IMG/FMG according to the 2011 data.
AOA: unfortunately not available to IMG/FMG.
Research publications: sure, can’t hurt. Make sure they are in neuroscience/neurosurgery, use them to build relationships with mainland US faculty.
FMG/IMG will also need to build political connections and get letters from well known US neurosurgeons and US department chairmen. Letters from elsewhere probably just wont help enough. Ideally, you need a senior US neurosurgeon / department chairman who can advocate for you because you are starting off quite far behind all of the US seniors. Obtain these letters by doing away rotations as a fourth year medical student. Maybe you can extend your fourth year and do four or five rotations in Neurosurgery, specifically choosing departments that may be relatively slightly less competitive or who have taken IMG/FMG in the past (peruse their websites and uncleharvey.com). Keep in mind that during those rotations you will have to excel individually and be found to be an excellent and enjoyable team member. This is not easy.
Unfortunately, based on the numbers, you have to prepare from the beginning of your ERAS application for the possibility you wont match.
There are two basic options for backup plans:
- If you are absolutely certain you want to pursue neurosurgery, I would strongly recommend considering trying to find a bona fide research job in a US Neurosurgery department if you don’t match the first year. You’re looking for a job that is paid, ideally full-time, (so that someone takes an active interest in your success), with a clinical neurosurgeon as your direct boss (not a basic science research PhD). If you find such a job, you will have to devote yourself 110% to it without compromise. The most likely place to take you on as a resident is the place that knows you best. Plan on spending 2-3 years working before applying again.
- Apply to general surgery or other backup programs, and then scramble (“SOAP”) if you don’t match into those. You will most likely be forgoing your shot at neurosurgery. if you want to still keep the faintest dream alive, take a spot at a university hospital which has neurosurgery residents and keep your ears open during PGY1, 2 and 3. If you decide this then you should be applying to backup programs from the beginning of your ERAS application.
So, in summary, if you are an FMG/IMG and want to be a neurosurgeon in America, then:
- Apply to every program listed in ERAS.
- Score as highly as possible on Step 1 and 2, aiming for over 250
- Rotate and build relationships with US neurosurgery departments, faculty and department chairmen.
- Consider taking an extra year / modifying your medical school curriculum to do more rotations in the US before applying.
- Decide on a backup strategy BEFORE applying to neurosurgery (either get a research job or apply to backup fields/SOAP).
All the best, and email me with any questions through the link at the top of the blog.