First Aid for the IMG From
a successful international medical graduate comes this
reassuring guide to preparing for the USMLE and residency.
Focuses on the U.S. directed curriculum, healthcare
delivery system, and ethical issues--and the differences
IMGS should expect.
specialty you match in does not determine what you will be doing
for the rest of your career
There are plenty of people who are not doing anything
remotely related to what they majored in during college, and
in medicine the same is true. Many success stories exist where
people have started in one field, perhaps even completed an
entire residency before changing their minds and picking a completely
different specialty. There are residents who decide after one
year of a particular field that another field of medicine is
the one they really want to pursue. There are many roads that
lead to the same final place, and it doesn't really matter how
you get there.
That said, how does one decide on a specialty? Hopefully during
your clinical years, and perhaps even in your basic science
years, there have been a few fields that you have really enjoyed.
Perhaps a particular type of patient, the group of residents,
or the intellectual challenge has excited you enough to consider
pursuing a specialty.
a specialty is not easy.There are many factors to consider
Interest. Does this specialty get you excited?
Do you look forward to or dread coming into the hospital for
this specialty? Can you see yourself practicing in this specialty?
Do you see yourself getting bored with this type of work? Imagine
yourself in the shoes of your attending, and decide if this
is the type of work you thought you would enjoy doing.
Lifestyle. Will the lifestyle of this kind of physician match
the kind of lifestyle you envision for yourself? Do you see
yourself having enough time for your family and friends? Do
you think you will be able to survive the rigors of a residency
in this field?
Career. Does this specialty give you the opportunity to specialize
and pursue a fellowship that you may have a future interest
in? You may consider choosing a specialty like internal medicine
if you have interests in many different medicine specialties,
but aren't quite sure which one you like best (e.g., cardiology,
nephrology, and infectious disease)
Job opportunity. Some people may advise you to pursue a specialty
because it is especially "hot" or try to convince you not to
choose a specialty because it is overcrowded. People may advise
you that there is not a single job in specialty X in a region
of the country you hope to work in. Monetary compensation may
also be taken into account. When choosing a specialty, you should
really pick something that will bring you happiness, and we
advise following your heart; don't let the market decide your
specialty. After all, by the time you finish your training,
much of what people have told you will be obsolete. And if you
wanted to get rich, you should have pursued an MBA or joined
an Internet start-up.
are many resources to look at when researching a specialty.
Visit the Frieda-AMA site and this will give you a
basic idea of some of the statistics for a specialty: years in
training, number of residency programs, average salaries, etc.
There are many books and articles written on the subject of residency
matching. You can ask your student affairs office which books
they recommend. In addition, various academic societies such as
American Academy of Family Practice, American Academy of Pediatrics,
etc. often have student resources available. [visit
our specialty contacts page]
most valuable resources are the people around you
Perhaps your most valuable resource will be the students
who have gone before you, interns, residents, and attendings.
Ask physicians at all levels of training about their feelings
regarding their specialty. What do they enjoy the most about their
field of medicine? What do they dislike? Would they do it over
again? How did they decide to enter their chosen field of medicine?
On those long call nights when you are waiting for people to roll
into the ER, pick your resident's brain for information!
Many medical schools will assign an advisor to you during your
senior year. Choose a person working in your specialty interest,
or simply choose someone whom you know well, so you can talk candidly
about your future. This person can serve as your sounding board.
Try to work through the decision making process on paper, and
talk out loud with your advisor. Often, the process itself can
help in your decision. Don't feel pressured to enter the same
field that your advisor is in, they are there to help with your
decision and will understand if you choose to pursue something
do I decide between specialty A and B?
One of the best ways to decide between different
specialties is to do rotations and subinternships in both of
your fields of interest. Which of those fields can you see yourself
in? What aspects of the various specialties do you find yourself
attracted to? One useful, although somewhat painful method to
find out which field is right for you, is to write personal
statements for both fields. This sounds like a great deal of
work, but you'll probably find that one personal statement is
easier and more comfortable to write. In writing the other statement,
you may find yourself struggling to fill the page with reasons
as to why you would pursue that field.
do not need to make the decision very early in the application
The fourth year is yours! Take the time early
on during your year to do electives in areas that you have even
a remote interest in. These may surprise you and uncover an
interest you never knew you had. Or, they may solidify a dislike
for one field of medicine. You may discover that you hate screaming
children and decide not to pursue pediatrics. Or, you may find
that you get a rush from running to the delivery room while
on a high-risk obstetrics rotation. Take the time to figure
things out for yourself.
Don't stress out! The world will not come to an end if you don't
know by the spring of your junior year what specialty you wish
to pursue. You may decide to apply in two specialties and then
use the interview process (along with visits of residency programs)
to decide. Alternatively, you may take a year off from school
to think about your choices more carefully (perhaps to explore
research in a specialty). No matter what happens, you should
always feel that you are in control and that the final decision
is yours alone.