Caribbean medstudent dilemma

[Gavanshir]

Hey friends, I've been posting on these forums for a long time now and I thought I'd get some advice from you in my most recent dilemma.

 

My background info:

 

B. Sc. - Concordia University in Cell & Molecular Bio & Political Science (GPA=3.15)

Canadian citizen, US permanent rez

MCAT: 26 (PS:8, VR:10, BS:8; R)

Good research, ECs, awards, work experience and LORs.

Age: 26

 

I'm currently a term 1 medstudent at Saint George's University in Grenada. I'm doing well and enjoying it. But unfortunately the residency situation for Caribbean grads seems to be deteriorating and by the time I graduate I might be faced with quite a few difficulties when it comes time to selecting a field. I guess I also in some sense feel that I "deserve better" and know that I never gave it my best when I applied to medschool back home. I never applied to Canadian schools because I knew I wasn't competitive, I did apply to my state school through AMCAS before coming down here. I'm a big fan of research and would like to have as many opportunities available to me as possible, this just isn't possible with a Caribbean education and while I don't know exactly what field I want to end up in, I don't think family medicine is for me.

 

I can stay here in the beautiful Caribbean and become an MD in 4 years, but recently I've been thinking about going back home to Montreal and doing a second degree at McGill, and applying in North America again. I've already used up my provincial financial aid so I would be going through FAFSA (US Finaid) to finance a second bachelor's degree. If I do stay here I'll be in debt of around 300K USD which will factor into my choice for residency as well.

 

I'm wondering if anyone has been in a similar situation and can offer some advice. I should mention that I was working full-time when I took the MCAT and admittedly didn't put in enough prep time (although McGill and other QC schools don't require the MCAT). I've always found this forum to be a great source for advice and different perspectives so please don't hold back. Thanks.

[tooty]

I think your chances of getting into a Canadian med school needs to be better than that of Caribbean grads' residency prospects 'deteriorating' to justify you leaving your current program.

 

How exactly is it deteriorating? Can changes be so hard and swift in just 3 years time? I would make sure that there is a high enough risk before taking drastic measures.

[Mashmetoo]

I think your chances of getting into a Canadian med school needs to be better than that of Caribbean grads' residency prospects 'deteriorating' to justify you leaving your current program.

 

How exactly is it deteriorating? Can changes be so hard and swift in just 3 years time? I would make sure that there is a high enough risk before taking drastic measures.

 

O things are getting bad fast. We are hearing about it even in the DO world. But I agree with tooty.. you'd need some good justification for leaving now.

[Gavanshir]

I think your chances of getting into a Canadian med school needs to be better than that of Caribbean grads' residency prospects 'deteriorating' to justify you leaving your current program.

 

How exactly is it deteriorating? Can changes be so hard and swift in just 3 years time? I would make sure that there is a high enough risk before taking drastic measures.

 

That's a great point. It's very hard to gauge which is more or less likely.

 

As of now, the number of positions in US medschool classes have increased by around 30% and new medical schools (including DOs) are opening their doors while the number of residency spots remains the same. This has largely increased competition and Caribbean grads have to absolutely ace the USMLE to have a shot at mostly undesired residency locations by US/Can grads. That's the reality of it, SGU probably has it best in terms of residencies because of the high quality of its graduates but nonetheless it is becoming much harder.

 

This is this year's match list which is pretty good but every indication points to a downturn.

 

https://apps.sgu.edu/ERD/2011/ResidPost.nsf/BYPGY?OpenView&RestrictToCategory=PGY2&Count=-1

 

Another factor that just came to mind is my age, I'm 26 now so I'll be 27 or 28 at the time of application, I guess that would affect me negatively as well.

[bloh]

Your fastest (Canadian) shot would be to do well in the next 2 years and apply to the few best-2 schools. That's risky and comes with no guarantees. I have no idea how American schools calculate GPA so I can't comment on those.

 

Honestly, given that you are a US permanent resident your best bet is to stay at SGU and study hard. You can match into just about anything you want if you do well on your tests.

[123cookie123]

As someone who has already matriculated at a medical school (even if it is an offshore school) your chances of starting at any other school is slim to none. For admissions purposes you will be considered a transfer and there are plenty of threads on here and SDN as to how near impossible that is. If I were in your position, I would've done a SMP at a school that pretty much guarantee admission to their med school, but as they say hindsight is always 20/20.

 

Honestly, I'm not sure where you're getting your information from but it's not as bad as you make it out for FMGs (especially FMGs with American experience and American residency status). Not to mention SGUs coup on the NY hospitals is really irritating actual NY allopathic schools because THEIR students are having difficulty getting rotations/residency due to the agreement between SGU and NY hospitals.

 

At this point, all you can do is ROCK your USMLEs and your rotations and make sure to make some good contacts while in the States and you should be fine. To use another cliche, life is all about WHO you know and not WHAT you know. Allopathic students are forced to "settle" for 2nd or 3rd choice residencies all the time not because they aren't qualified but because spaces are so limited that proper contacts are KEY and unless you're born to a PD (aka very few people) you, like the other thousands of students, must forge these connections through your rotations.

 

Good luck - you've got a bright future ahead of you...it's up to you what you choose to do with it.

[Gavanshir]

As someone who has already matriculated at a medical school (even if it is an offshore school) your chances of starting at any other school is slim to none. For admissions purposes you will be considered a transfer and there are plenty of threads on here and SDN as to how near impossible that is.

 

I don't think withdrawing from a Caribbean program is considered is as big of a deal, especially because I'm in my first term and if I do withdraw there would be no record of my academic work here. Also I assume most North American programs would understand my reasons for wanting to matriculate in North America.

 

I agree with the rest of your comments, it hasn't gotten as bad as it can for IMGs and things are actually improving in Canada vs the States where they are deteriorating.

 

I did consider SMPs, the reason I didn't do it is because of the high tuition/chances of success ratio. I couldn't afford to pay 40-50K/year for the slim chance of matriculating. I really haven't found any programs that close to guarantee admission.

[SolitaireAddikt]

As someone who has already matriculated at a medical school (even if it is an offshore school) your chances of starting at any other school is slim to none. For admissions purposes you will be considered a transfer and there are plenty of threads on here and SDN as to how near impossible that is. If I were in your position, I would've done a SMP at a school that pretty much guarantee admission to their med school, but as they say hindsight is always 20/20.

 

 

Actually, I know someone who was admitted to medical school in Canada after spending one semester in the Caribbean. I've heard a couple other stories of people doing similar things as well. From what I've heard you can leave international (non-NA) schools to go to NA schools no problem; it's more of a problem if you drop out of an NA school and seek admission at another.

[Gavanshir]

Actually, I know someone who was admitted to medical school in Canada after spending one semester in the Caribbean. I've heard a couple other stories of people doing similar things as well. From what I've heard you can leave international (non-NA) schools to go to NA schools no problem; it's more of a problem if you drop out of an NA school and seek admission at another.

 

This is true, 2 of my own classmates left the island last week after they received acceptances to McGill. Another one to Rosalind Franklin in Chicago.

[123cookie123]

I may have been misunderstood. I didn't mean to imply you have no shot at transferring, just that it is very hard to do so (so hard that several offshore medical schools explicitly state it on their websites that you shouldn't matriculate with the expectation of transferring). Sure, there will always be that one person your friend knows, but when you consider on average how many students matriculate at SGU per year (something like 400 I believe? or close to) 3-4 transfers is not significant. Now I don't know the stories of these people, but I'm willing to bet they didn't withdraw until they had an admission offer in hand. Now in your case, that means having at least 2 other semesters under your belt before you matriculate. Or, if you drop out and don't get in, that sets you back a year (and judging from your post, time is a big factor for you). Not to mention withdrawing may leave a sour taste in the mouths of admin at SGU, so you may or may not be able to resume your studies that easily there, and when it comes to off-shore schools, SGU is probably the best you'll get given their hold on NY hospitals.

 

Also, I'm not sure what exactly you're referring to, but once you have matriculated there will always be a record of that (you paid fees didn't you)? Not to mention, AMCAS explicitly asks if you've ever MATRICULATED at a medical school before (which you would need to answer yes to or risk expulsion should you be admitted to an LCME school, and I personally know of such a case where the student was expelled 2 weeks before his graduation for failing to disclose his entire academic history when applying). In short, they will know, and if by some stroke of luck you manage to get around it when applying, pray you don't get caught down the road. Lastly, even if you do not disclose your time at SGU - schools will ask what you've been doing during the time you were there. I seriously wouldn't risk it.

 

Can you transfer? Yes. But it will be REALLY hard and only after you've taken Step I, completely killed it and have a near 4.0 GPA in your basic sciences. Even then, you're fighting an uphill battle. You could withdraw and apply to schools, but in Canada/US a 3.15 isn't going to cut it anywhere, and from what i hear the US doesn't really care about master's programs the way Canada does - which means you'd probably need to do another UG degree (setting you back another 2 years min.) Or you could retake courses you did terribly in and take advantage of DO grade-replacement, but I'm not sure what your stance on DOs is.

 

Honestly, I wouldn't risk it. There are too many unknowns in that equations and so many things can go wrong setting you back. But, ultimately the decision is yours. I do hope you do more research (outside of internet forums) before you make any decisions. Good luck!

[Gavanshir]

Thanks 123cookie123, although I never intended to transfer and my original post is about wanting to do a second degree. Anywho, thanks for your advice.

[Slashsev]

honestly..DONT listen to anyone here...they are all bs!!

 

all u need to do is ur step 1..do well on that...worse come worse u take a year off to match..do a research year..you will get a spot...

 

with new health care bills comming in place, 14 million americans with out family doctors, they are doing al they can to plug the holes...

 

you will NOT get neuro surgery or plastics..but ull get family/internal...

[Gavanshir]

honestly..DONT listen to anyone here...they are all bs!!

 

all u need to do is ur step 1..do well on that...worse come worse u take a year off to match..do a research year..you will get a spot...

 

with new health care bills comming in place, 14 million americans with out family doctors, they are doing al they can to plug the holes...

 

you will NOT get neuro surgery or plastics..but ull get family/internal...

 

I agree, but can I afford to get an undesirable family position with 300K of debt?

[JustMe]

I agree, but can I afford to get an undesirable family position with 300K of debt?

 

So you weren't good enough to get into a Canadian med school but you're too good for an "undesirable family position"?

[MarathonRunner]

I agree, but can I afford to get an undesirable family position with 300K of debt?

 

Why is family "undesirable"? Family medicine is becoming more and more popular, for many reasons, including the fact that the lifestyle is very attractive, and that you can tailor a family medicine practice to do what you want (most of the family doctors with openings for patients where I live have a very particular population they want to deal with, so aren't accepting new patients unless you meet those specific criteria).

 

Now, it might be undersirable to you, for some reason or another, but in general, I don't think you can make a blanket statement that it is undesirable.

[Gavanshir]

Why is family "undesirable"? Family medicine is becoming more and more popular, for many reasons, including the fact that the lifestyle is very attractive, and that you can tailor a family medicine practice to do what you want (most of the family doctors with openings for patients where I live have a very particular population they want to deal with, so aren't accepting new patients unless you meet those specific criteria).

 

Now, it might be undersirable to you, for some reason or another, but in general, I don't think you can make a blanket statement that it is undesirable.

 

I should clarify: I didn't mean family medicine is undesirable. I meant Caribbean graduates fight for residency positions which are considered undesirable by Canadian/American graduates, which is why they go otherwise unfilled. Now why they are undesired by domestic graduates is likely because of a combination of location, remuneration, etc.

[leviathan]

Since you have American perm. residency status I'd probably stick it out at SGU. Things are getting tighter every year but I feel strong schools in the Caribbean will probably maintain their position while weaker schools will start to fall out of existence. The only problem is it's easy to tell someone to "kill" step 1, and another thing to actually do it. If SGU gives out the NBME shelf exams I'd see how you do on those over the next few semesters to gauge how well you'll do on the step 1. I guess you can always reapply to med in Canada while you're studying abroad too. If they'll accept your grades at SGU towards your med apps then that is a bonus.

[Gavanshir]

Arrrrrrrrrrrrrrg. I've spoken to many people by now and there are a lot of good arguments as to why I should stay at SGU.

 

As you mention leviathan I do have permanent residency, and also a good network of family physicians in the NY/NJ area which can be a source of support. My family also LIVE in New Jersey near SGU's rotation sites.

 

Despite all of this and the arguments as to why I shouldn't start my premed experience over again, something in my heart keeps telling me to go back to Montreal and start over again. The 300K pill is just too hard to swallow.

[Slashsev01]

+300k is an investment

 

u will make up the money in 5-10 years time, the carribean system isnt designed for non affluent families...most will be in debt for the rest of their life...

 

if u wanted money...id do an MBA and make 500K salary..save time and make more money..ahahahh

 

u have the final say..but with 3 years left (realistically 1 year..if u do bad on the steps)..its a short time to gamble...risk vs reward

[Egad00]

I'm suffering from a similar dilemma.

 

I've been accepted to Ben Gurion in Israel and I have spent the last few weeks prowling the boards, reading articles, staring at the CARMS statistics tables with growing concern. Money and risk are big issues - if I ultimately don't match, how will I pay off what will be an insurmountable amount?

 

It's easy to say "do well and you'll be fine", but that is everyone's plan of attack - and ultimately 20% of IMGs who enter the match make it. That percentage drives me crazy.

 

My options are to stay behind, bone up on my french and apply to the French schools in Quebec (I'm a perm resident), go to Israel, or abandon Medicine all together.

 

It's tempting to go to Israel, I'm 28, it's the easy way out right now, job hunting is difficult and stressful in its own right, and it's supposedly not a high risk option (I'm really not sure about this last point - being an IMG looks like it's high risk period, and without having school by school stats - not "i have a friend of a friend' information, I don't know how anyone can make this assertion).

 

For what it's worth, friends tend to have a lot of faith in you, which explains why people will encourage you to stay at SGU. I know because I've had several tell me to go, work hand, and I'll be fine. I really don't know what to do.

[metukah]

I'm suffering from a similar dilemma.

 

I've been accepted to Ben Gurion in Israel and I have spent the last few weeks prowling the boards, reading articles, staring at the CARMS statistics tables with growing concern. Money and risk are big issues - if I ultimately don't match, how will I pay off what will be an insurmountable amount?

 

It's easy to say "do well and you'll be fine", but that is everyone's plan of attack - and ultimately 20% of IMGs who enter the match make it. That percentage drives me crazy.

 

My options are to stay behind, bone up on my french and apply to the French schools in Quebec (I'm a perm resident), go to Israel, or abandon Medicine all together.

 

It's tempting to go to Israel, I'm 28, it's the easy way out right now, job hunting is difficult and stressful in its own right, and it's supposedly not a high risk option (I'm really not sure about this last point - being an IMG looks like it's high risk period, and without having school by school stats - not "i have a friend of a friend' information, I don't know how anyone can make this assertion).

 

For what it's worth, friends tend to have a lot of faith in you, which explains why people will encourage you to stay at SGU. I know because I've had several tell me to go, work hand, and I'll be fine. I really don't know what to do.

 

Egad00: I am in a simillar situation, except instead of Israel its to the carribean and I have been driving myself crazy with making a decision amongst all the unverstainty. its a really tough call. there should be some kind of support group for students who are considering jumping into the IMG pool lol.

 

How do you think you will ultimately make your decision??

[Egad00]

Ultimately, my gut and my brain are telling me not to attend. Since my parents are the ones who would have to co-sign my loan, I am considering taking the wimpy way out and leaving it for them to make the final decision - I've made peace with not going, though. I can't imagine dealing with the constant stress of not matching, while CMG know they're set once they start med school.

 

If I were in your position, I would look at the number of Canadians who matched at your school versus the number of students (Not just the match list) and ask your school for the contact information of those who have matched under the guise of "residency advice". That is what I did. Even then, the information I got from the residents I spoke to was mixed. One said it was not a major problem and just involved some forethought, while the other said it was very difficult (even with research and electives done exclusively in Canada) and suggested trying again in Canada.

 

I've read A LOT of the information available online (CARMS, editorials, and forums) and I've spoken to several friends. The main issue with the latter is that people you know really do believe in you and can't imagine how you could be in that 50% who don't make it.

 

 

 

Egad00: I am in a simillar situation, except instead of Israel its to the carribean and I have been driving myself crazy with making a decision amongst all the unverstainty. its a really tough call. there should be some kind of support group for students who are considering jumping into the IMG pool lol.

 

How do you think you will ultimately make your decision??

[MD2015]

I've been accepted to Ben Gurion in Israel......Money and risk are big issues - if I ultimately don't match, how will I pay off what will be an insurmountable amount?

 

It's easy to say "do well and you'll be fine", but that is everyone's plan of attack - and ultimately 20% of IMGs who enter the match make it. That percentage drives me crazy.

 

My options are to stay behind, bone up on my french and apply to the French schools in Quebec (I'm a perm resident), go to Israel, or abandon Medicine all together.

 

It's tempting to go to Israel, I'm 28, it's the easy way out right now, job hunting is difficult and stressful in its own right, and it's supposedly not a high risk option (I'm really not sure about this last point - being an IMG looks like it's high risk period, and without having school by school stats - not "i have a friend of a friend' information, I don't know how anyone can make this assertion).

 

 

For what it's worth, friends tend to have a lot of faith in you, which explains why people will encourage you to stay at SGU. I know because I've had several tell me to go, work hand, and I'll be fine. I really don't know what to do.

 

Egad, I am not in your shoes, however, having come this far, I would continue on and go to Israel, accepting the risks involved as part of life. Nothing ventured, nothing gained and you want to live the rest of your life with no regrets!

 

Learning French and trying the Quebec route is no easy task. They have an amazingly difficult French written exam that you must excel at as a condition precedent to being allowed to proceed to the interview - and it is far from a slam dunk. And why give up on your dreams? Who said life is easy? Best of luck in your choice and life!

[Mithril]

Egad, I am not in your shoes, however, having come this far, I would continue on and go to Israel, accepting the risks involved as part of life. Nothing ventured, nothing gained and you want to live the rest of your life with no regrets!

This is probably the most asinine reason I've ever read for going international. You remind me of another poster that strung a bunch of random idioms together and masqueraded it as advice, albeit crappy advice. Egad00 needs to be realistic about his chances of coming back to Canada to practice if that is truly his goal. He should be aware of the heavy risks involved of going to a school outside Canada and the US instead of treating his life like some sort of feel-good drama with a happy ending. I highly advise against going international unless you plan to do post-graduate training and your career in that area. Otherwise, you face a long uphill battle with a high chance of failure and debt in comparison to CMGs.

 

Egad00, you should at least try McGill one more time if you haven't and consider American schools instead.

[noodlej]

I was in a similar position 2 years ago, when I applied and got accepted to SGU. Had an an A average but bad MCAT score, and never applied to canadian/american med schools because of the MCAT and didn't have US citizenship.

 

I had everybody's support and knew of a few success stories, but something just didn't feel right, and after I started doing research I realized that there were too many unknowns, a lot of stress, huge debt, and no guarantee at a residency. In the end I rejected their offer, did a lot of soul searching and decided to pursue a different profession. Now I am at a PT program in Ontario and am not planning to apply to med school after.

 

I can't give advice since the pros/cons are different for different people but a lot of people don't consider the cons. The reality is that there is a high attrition rate in the carribean (not sure about Israel) since they accept 500/term, 1000/year this number alone is scary since ontario accepts a total of 1000 med students between 5 med schools. Of course the main problem is the declining residency situation where only 40% of the people that apply manage to get a residency in the US and the match success rate is declining because of the increasing number of CMG's and AMG's. Rough estimations mean that only 20-30% of people that start eventually get a residency (carribean).

 

Finally it is a myth that canada has a shortage of doctors. There are already orthopedic surgeons, cardiac surgeons as well as other specialists that are facing a declining job market with few job opportunities, just look at hfo job info.

 

http://www.theglobeandmail.com/life/health/canadian-surgeons-face-flat-lining-job-market/article1920006/

 

As many others have said, the road of an IMG is a long and hard uphill climb up a very tall mountain and unfortunately most will not reach the top.