Matched into Emergency Medicine as a non-US IMG (visa requiring IMG, Medical School in India) without contacts.
Many successful match stories have helped me a lot and this is me giving back, sending hope and positivity. I hope all of you also pull others up when you match.
It is still difficult to believe at times when I look back. I have had my lowest lows, and this match was maybe the highest high. Everything was uncertain all along till match day. What I did differently I think was not giving up on my dream despite all the odds, gave my best and kept striving till the very end.
I received many requests to share my match story and I hope some of you will benefit and pursue EM against everything and everyone who discouraged you, stood in between, pushed you down, said it is impossible or too big a dream. If this article helps even one crazy, stubborn dreamer of a person, my unique journey and sharing it publicly is all worth it.
Let me remind you of the grim figures. Out of 2652 EM positions filled in 2020, only 30 are non-US IMGs including me. In 2019 only 27, in 2018 only 29, in 2017 only 20 and in 2016 only 23 were non-US IMGs. This is despite the significant increase in EM positions offered over the years: 1,895 positions in 2016 to 2,665 positions in 2020.
Preparation and Experience
Here is my story. I am writing about everything that helped me match and then specific to EM with additional tips on what you should do to increase your chances for a successful EM match.
YOG: 2017 (no home country residency)
Step 1, Step 2CS, Step 2CK, and Step 3: cleared at first attempt (Please don’t ask credentials as I am not comfortable sharing. It has been a long and arduous USMLE journey. I have given my all and am happy with my scores. I believe scores don’t define you and the journey is much more than just high scores. I did not have 260s/270s… if that makes you feel any good about yourself.)
USCE: 10 months in total.
Work experience: 8 (in the US and Canada; 2 sub-internships: one in EM and one in IM; 3 electives: one IM, one EM, and one FM; 3 observerships: EM, IM, and Anesthesiology).
Strong personalized letters of recommendation, especially SLOEs (standardized letter of evaluation by US EM physicians). Got recent SLOEs/LOR from US physicians before/during application and had some previous ones from Canada as well. Strong LORs from each rotation and from medical school.
Research experience: 6 (been part of different studies)
Presentations: 5 (2 poster presentations and 3 oral presentations at international conferences including the European Academy of Pediatric Societies and Pediatric Academic Societies Meeting in the US)
Awards: Gold medal in Obstetrics and Gynecology, award by Sardar Patel University; International Travel Grant from Indian Council of Medical Research to present at EAPS conference 2012 in Turkey; Third prize in research by health minister of India at AAPI Global Healthcare Summit 2014- Oral presentation; First prize at the Gujarat State Conference on Adolescent health.
Publications: 2 (first author and primary investigator, knew my research study thoroughly)
Volunteer experience: 4 (from medical school)
BLS, ACLS certification (2015; renewed during interview season in 2019).
Member of ACEP and EMRA for the past 4 years (did a lot of research on everything related to EM and how to increase my chances, read a lot of EM articles, reviews, anything that gave me insight on what they are looking for).
Attended ACEP conference (attended every lecture I could, talked to as many EM physicians and residents, attended the residency fair, attended EMRA events, EM subspecialties meetings and events, tried to network as much).
Standardized video interview (SVI; additional requirement for EM application): scored 95th percentile (this was among all EM candidates, most of whom are AMGs).
Personal Statement from the heart and soul, highlighting why EM and I are meant for each other. Many interviewers had read my PS. I will recommend that you write it yourself expressing your passion and not copy something written by those outside of EM.
Did my very best in the interviews (was the only non-US IMG among all EM candidates). I had prepared very well but on the interview day, it is not all about that. It is about you as a person. I was myself and everything that I did or said came to me and flowed very naturally. I was living the dream I had dreamt for years.
Received other interviews in Anesthesiology, Internal Medicine and Psychiatry (let me clarify that I applied widely but smartly so that I could get maximum interviews in what I could afford. The goal was to match, and I spent a lot of time and effort researching every program and specialty I was interested in. I am versatile, and I could genuinely make specialty directed applications and prepare for interviews in each specialty. I am deeply grateful for the number of interviews I received in the different specialties. I was happy and excited about my decision of pursuing these 4 specialties but in my heart, EM was the one, the secret dream all along. I did not have many interviews… if that makes you feel any good about yourself.) All my interviews went well, and I came out feeling that I was true to myself and had given my best shot.
Called for second look in the EM program: did my best, shadowed in the ER whole day, tried to get as much information about the program. I had not prepared much. I was simply myself: open, free, excited and felt very comfortable in the ER and with all aspects of EM.
Emergency Medicine and Anesthesiology were my top choices. I couldn’t believe I matched into EM. It was surreal, a dream come true!
You can stop reading here. The next part is more of a personal story I thought was important to share.
Everything mentioned above helped me. But why I matched despite the negligible probability I think are my failures and setbacks. I was an above-average, hardworking, high scoring student all my life but USMLEs had put a tremendous pressure on me to score very high in the first attempt. I was going through family issues and was not mentally prepared when I first started. Step 2CS was comparatively easy for me. I faced personal failures, challenges and struggles in the preparation phase for Step 1 and Step 2CK. I was happy, satisfied with my Step 1 preparation, and was overjoyed with the score but was aiming higher for Step 2CK. I was getting high scores on UWSA and NBME and was confident in scheduling the exam. On the day of exam my health was not good, but I had prepared myself to go for it, come what may. I struggled with time but did my very best. I came out thinking that I had nailed it. The score was lower than my Step 1 score and it had hit me very hard at the time. I felt I was a failure and thought of quitting on EM and my pursuit of a US residency altogether. I was late for the 2019 match as I had postponed the Step 2CK exam. The result came out later than expected and I got my ECFMG certificate also later than usual. It was a total mess. Still I thought of giving it a try and went ahead and applied to some IM and few EM programs. It was late January 2019 and I got waitlisted at a couple of IM programs and one EM university program. That gave me hope and I learnt a lot about the application and match process. SOAP was just depressing as there is not much hope being a non-US IMG. I had lost a lot of time, money and effort. What I had not lost was hope and my dream. I am narrating this depressive episode as it was this personal failure that made me more determined and resilient than ever. Don’t be afraid to fail, to take risks, for the challenges and failures are indeed opportunities in disguise. As soon as SOAP ended my only focus was on the 2020 match. At that point I had stopped thinking about specialty, interviews or the match. I was pushing myself to remain positive, motivated and do my best on the USMLE Step 3 exam. I took it in time and scored well but that wasn’t enough to match at my personal best. I started researching every program on ERAS, Freida, and Residency Explorer websites. I drafted personalized emails with my scores and CV in search of USCE, was applying for more and more USCE, took the SVI (standardized video interview) in time and scored very high, wrote magical personal statements from the heart and planned to apply to more specialties. I got strong letters of recommendation from each faculty that I closely worked with (in the 4 specialties) and not all were from big universities. I had got strong personalized SLOEs for EM from Canada and the US. I applied on 14th September with 3 LORs and uploaded the 4th later. I renewed my ACLS certification. I made sure my application was complete and accurate and submitted it with all the documents and scores in time. I am emphasizing it because your application is very important and needs to show all your strengths and accomplishments. The application with CV, PS and LORs is the one that gets you the golden interviews. I was doing more observerships after applying and planning to go to the ACEP conference (for EM). I had financial constraints and tried to save as much by staying at my relatives’ place, not going for paid USCE, applying for research positions (though that didn’t work out), buying cheap flights, hotels, food, etc. I had done extensive research on which programs to apply so that I can save money and apply to more programs, the right programs. I applied to more IM, some EM, some anesthesiology and few psychiatry programs. I enjoyed the ACEP conference like I was at Disney. I had been longing to attend for many years and efficiently made use of my time there. Later I sent emails to everyone I had talked to and hoped someone would respond. I got positive emails from some but no interviews immediately as they had never considered a non-US IMG. I was overjoyed when I got my first interview in October. I was surprised by the different specialties’ interviews and was hoping no one found out. I was then getting worried by November but gradually got some more interviews. I got the EM interview invite that I matched to in December. I even got invites in January. I am guessing only one interview was because of the conference. Real-life cases, experiences, publications, presentations, research, competencies, awards and accomplishments, hobbies and extra-curricular activities, and interpersonal skills, soft skills made a difference in the interviews. I had given my best performance and had a good feeling at the end of each one. It was only when I was called for a second look that I first started raising my hopes for EM. I knew they will rank me at the second look but still didn’t have any expectations. All the program directors I met had read my CV, PS, and LORs. The person I became while overcoming the challenges and failures in this process and in life is what they were looking for. On match day, I was hoping to match and had no idea it would be my dream specialty of EM. Scores and SLOEs are very important, but they will only take you so far. A holistic application and a well-rounded person, someone your team can fall back upon, someone that they can trust at 3 am when there is no one else and there’s an overflow of critical patients, someone who cares enough and dares to make the right decision, someone who listens and puts the patient first- are some things that are required of an EM physician and that is what they are searching in applicants. The ones on the front lines in this pandemic, the ones risking their lives and families, the ones putting their duty first, the ones making difficult decisions, Emergency Medicine physicians are some of the real healthcare superheroes. In EM you need to know the basics of every other specialty, a balance of medicine and surgery, sensitivity and strength, knowledge and skills and be able to work in a team with your head, hands and heart. PDs are very experienced. Be honest and be yourself. If it is meant to be, it will be. If not, embrace your destiny and be grateful, love your life…for only then will you work hard, reach your full potential and life will love you back. I hope this helps those who know their ‘why’ and are genuinely interested in EM and a US residency. If I can do it, you can too. People say, ‘miracles happen’, I have learnt to confidently say, ‘made it happen’. Be positive, be strong, be inspired and keep going forward no matter what! I wish you the very best!
Dr. Shruti Kamat