The post boards psychosis, which is something I only read about in humour blogs or possibly made up, spawns a lot of very real questions. Should you go into residency, research or moonlighting? Should you take the USMLE or stay for training in the Philippines? Should you train in a government hospital or in a private institution?
I won’t attempt to answer for you questions that took me years to answer, or haven’t answered as of date. What I will do here is to lay out the cards, provide real live examples of what happens when you choose one or the other, and hope that this will help you make a better-informed decision.
Disclaimer: This entry is not meant to serve as an official guide to the USMLE. I am in no way affiliated with the FMSB, NBME, ECFMG, or other licensing agencies. I researched and asked friends who participated in the USMLE and ERAS, to help me decide about my next career step. For the meantime, I have decided not to take the exam. Still, I hope this helps. Think of it as a transcription of sorts.
Changing Battle Grounds
A graduate of a Philippine medical school who wishes to practice or undergo residency training in the US has to pass the USMLE and apply for matching via the ERAS.
The United States Medical Licensing Examination (USMLE) is a three-step examination for medical licensure in the United States and is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners. (Source: 2014 Bulletin of Information, www.usmle.org) There are actually four parts in the licensing process as Step 2 is divided into two exams.
Once you’ve passed Steps 1, 2CK, and 2CS (in no particular order), you can apply for Educational Commission for Foreign Medical Graduates (ECFMG) certification. You should be ECFMG-certified by the time matching applications are accepted, which is usually around July to September of each year. The matching is done through Electronic Residency Application Service (ERAS®), which is a service that transmits all the documents you need during application season to the hospital or programs that you will be applying to. Should you have the very good fortune to be matched, most residency programs start on the first of July. Residents usually opt to take Step 3 after the first year of training.
According to the Bulletin of Information, among those who are eligible to take the exam are medicalstudents who are officially enrolled in, or are graduates of, a medical school outside the US and Canada who meet the eligibility criteria of the ECFMG. Before you read further, check first if your school is eligible: http://imed.faimer.org. If it’s not on the list, check with your medical school, preferably at the Dean’s.
You are? Onward, then. The whole process is complicated, technical, statistically bleak, and not for the unmotivated. Parang love. Chos. Unlike love, though, you can actually prepare yourself for it by reading. Read not just your reviewers, but also familiarise yourself with the whole examination process. The 2014 Bulletin of Information should be one of the first things you should read, but I suppose it’s better to leave no stone unturned. These three websites should be your new best friends:
The USMLE is expensive. Let’s not sugarcoat it. The returns will be more than enough, of course, but understand that the risk is very high. Here’s an estimate of much a friend spent on Step 1 (as of November 2013).
This total could go up if you decide to include other reviewers or if you decide to review in big name centers like Kaplan. It’s harder to provide an estimate for Steps 2 and 3, because the process will be different for each individual. To give you an idea, aside from the exam fees, you’ll have to factor in expenses for visa application, airfare, hotels, and other living expenses. If you have friends or relatives you could stay with, then that’s going to decrease your expenses significantly.
Once you have a financial plan (and the corresponding resources), start applying for your exam permit and studying like a deranged person. In the Philippines, the testing centre is located in the Ateneo Graduate School (130 HV Dela Costa St., Salcedo Village, Makati).
In summary, these are the steps you should accomplish:
- Prepare your self, your family, and your resources.
- Apply for, study for, take, and pass USMLE Step 1.
- Apply for, study for, take, and pass USMLE Step 2 CK.
- Apply for, study for, take, and pass USMLE Step 2 CS (must be done in the US).
- Be ECFMG-certified, ideally before July of application year.
- Apply for and accomplish observership rotations while waiting for the start of matching season.
- Submit application in ERAS.
- Interview season: Wait for interview invitations, then travel around the country presenting your best (or least haggard) self.
- Ranking and submission of rank order list: Rank your top five training programs. If any of the top five that you chose also chose you, that’s when you are matched. It’s sort of like an OKCupid for doctors and hospitals.
- Results/ match day 🙂
Just like reviewing for the Philippine boards, don’t reinvent the wheel. If you know someone who’s been through the process, ask. It’s often a fast way to learn. In the next entry, I’ll be posting an interview of sorts with my friend who was successfully matched, as well as a brief explanation of why I opted to train in the Philippines. Until then, peace and more peace.