1. Being a Foreign Medical
Graduate in US
Balwant S Nagra, MD
Assistant Professor
Child and Adolescent Psychiatry/Adult Psychiatry
University at Buffalo
New York, USA
Contact Info:
bnagra@buffalo.edu

2. Myth
• If you ask any foreign medical graduate
who just landed on the airport in US about
what field he or she wants to go for
residency. The answer will be ? Guess ?

3. • -Internal Medicine
• Or
• Next best answer will be
• -Surgery
• Nothing wrong with that

4. • Keep your options open
• There are so many other interesting fields
you might like working in your life.
• Every field will provide different life style,
job opportunities, and different income.
• For example; myself wanted to be surgeon
back in India but started liking Psychiatry
in US but ended up matching in Internal
Medicine.

5. • After a year in Internal Medicine I changed
to Psychiatry and also did fellowship in
Child Psychiatry.
• I am very happy in my field. I love my job
and the life style with excellent income.
• Some people keep on changing their
fields.
• Some people don’t want to stop doing
residencies and fellowships.

6. • Being a foreign medical graduate it is hard to get
in to residency program.
• You will be competing with American medical
students (my 4th year medical students) and the
students from India (who come to US with their
scores in USMLE step 1 and 2 in 99th percentile
(I don’t know how they get it).
• Now you can imagine how many hoops you
have to jump to compete with these people.

7. • Match results in 2012
• Total applicants in match=48,507
• Positions offered=24,034
• American graduates in match=24,369
• American graduates matched=15,712
(65.4%)
• You can see how many foreign medical
graduates apply each year and how many
get into residency.

8. • It is very competitive.
• So you have to work hard.
• There are so many things you have to
work on.
• First and most important thing is to get
very good scores in USMLE step 1 and 2
and pass CS.
• Avoid any attempt that will go against you.

9. • There should be no unexplained gap in your
training or gap between graduation and time of
application.
• For foreign medical graduates USMLE step 3 is
must.
• Most of the residency programs have a filter to
the applications. They don’t even open the
application which does not have certain high
score in Step 1 and 2 in the first attempt.

10. • Most of the programs also look if
candidate has research experience
including the name in some publication in
related field.
• Also some clinical experience including
observership or externship.
• Certain specialties don’t entertain foreign
medical graduates.

11. • Psychiatry is becoming very competitive.
• In 2012 match, total 1,118 positions were
offered. 680 American graduates applied and
matched to 616 positions out of 1,118.
• Psychiatry itself is specialty. It’s very much in
demand.
• These days most of people started going to 2
year fellowship in Child Psychiatry.
• If a Child is referred by his Pediatrician. It takes
to see a Child Psychiatrist 6-9 months. There is
big shortage.

12. • For USMLE step 1 and 2 the book First Aid is
must. It’s written and updated by the people who
recently took the exam and scored well. Also
read the other books recommended in the list by
this university and attend the course offered by
this program.
• For CS Kaplan has good course.
• Before I passed CS I took one day course in NJ
offered by an actor patient of Kaplan.
• It was pretty good and I passed.

13. • USMLE step 3 is pain in the neck.
• Some people started their residency before
passing step 3.
• Now when you are in 3rd or 4th year of residency
in certain specialty (eg. Psychiatry) you don’t
have time to study Internal Medicine, Obe/Gyn,
Surgery, Ortho etc.
• Some program kick out their residents after 2nd
year and don’t give them contract for 3rd year.
No one wants to be in that position.

14. • You can not get a state license to practice
without step 3.
• Every state has different time limits and limits of
attempts.
• For example: Delaware, Florida, New York,
Pennsylvania and Virginia has no limits.
• Other states has different rules.
• Pass step 3 ASAP. It will help for residency

15. • I recommend highly following material on your tips. I
guaranteed you will pass step 3.
• 1. Master the boards step 3 written by Conrad Fischer, a
well known instructor in Kaplan and Program Director In
Internal Medicine.
• 2. Premier Review course. Excellent course. They have
live lectures and also home study material available on
MP3 and lecture notes.
• 3. Flash cards for step 2 and 3 by Conrad Fisher.
• 4. Some dermatology pictures from any dermatology
book to correlate with above dermatology section

16. • Before applying for residency choose a mentor who has
been to the residency program in US.
• Get professional help to prepare CV and Personal
statement.
• Get good recommendation letters. It matters who has
written it. If it is written by someone famous, well known
in that field, its great.
• It also depends on the wording in the letter.
• When I give letter to my students. They come back after
the interview and tell me that my letter was mentioned
during the interview and most of them get their first
choice.

17. • Get help to prepare for residency
interview.
• Before putting the rank order list in the
match only rank highly the place you really
want to be. Otherwise it will be painful to
survive.

18. • Next and last thing is “How to survive in a residency
program”.
• You are under microscope all the time until you
graduate.
• Always respect the authority. It does not matter it can be
anyone, your senior resident, attending or administrator.
• Don’t make blunders. If you don’t know ask before you
act.
• Any disciplinary action will stay in your file for your whole
life and will be reported to FCVS when applying for a
license in any state.

19. • So work hard. You will do it.
• After you graduate and have your license
to practice, by then it will be a piece of
cake.
• GOOD LUCK !
• Most of the information to apply for
USMLE steps is on line.