The risks and benefits of doing residency in your home country before coming to the US for medical training

“Every decision brings with it some good, some bad, some lessons, and some luck.
The only thing that’s for sure is that indecision steals many years from many people who wind up wishing they’d just had the courage to leap.”– Doe Zantamata

 

Residency in your home country or no residency ? This would seem like an easy question to answer if your aim was to travel to the US eventually and practice medicine there, but it’s not as straightforward as you think.  There are some situations it might be better to get some sort of training in your home country before coming to the US,  but there are dangers of doing that which we will discuss below.

So in what situations is it better to do residency training before you come to the US ?

1.When you want to apply to competitive specialties: If you are interested in applying to a really competitive specialty that has a “backdoor” fellowship strategy (then it might be a good idea to do a residency in the specialty first so you can apply for that fellowship as your entry point to the US. (read the blog post about old medical graduates and fellowships)

2.If you need more time:  some IMGs want to jump in the first flight going to New York and never look back, but others have more complex situations that make taking a decision very difficult. For example:

• Some applicants have some family or marriage issues and can’t leave before they take care of them.
• Others could have financial or health considerations that will delay their travel.
• There are so many other issues that sometimes make it worth starting your residency where you are first then travel when some of these issues are resolved.

So if you need more time, try to get into residency training in your home country in the same specialty you will eventually apply to in the US.

3.Your resume is not competitive enough to match: This could be due to failed attempts or low scores on your USMLEs, being an older graduate, having other red flags which consistently affect your ability to match. In this case you could consider doing a residency in your home country or another country to make yourself more competitive and use the fellowship backdoor like mentioned before. However, this doesn’t work well with specialties where the fellowships are filled by board eligible/certified applicants from the US. Again you can read more about it in the related blog post about fellowships and older medical graduates

 

Well, why shouldn’t everyone do residency before coming to the US ?... Because there many risks , and here are a few of the more important ones.

1.Getting stuck in your comfort zone: The longer you wait back home as an IMG the harder it is to get up and move in a new direction. This is by the far the most important reason most old IMGs never make it to the US. They get too attached to their comfort zone and don’t have the energy and momentum to get up and change their whole life. They usually have a spouse and children, a similar minded friend group who validates all their fears about traveling at this point in their career, a job which pays them “ok” money, and a life they got used to even if not very exciting or rewarding. Having a mediocre job as a physician is worse than having a terrible job because it’s not bad enough to get up and make a change, they just complain about it and never do anything other than that.

2.Opportunity cost: Although the US is the “land of opportunities” and has a deficiency of medical providers due to its ever increasing population, matching in a residency program is generally getting harder each year. The more people around the world know how to make themselves more competitive for US programs, the more competitive the process will become.

3. Political and Economic factors: There are many unknown variables that come into play when applying to US training like getting a US visa, or like political turmoil and wars in the area you live in, or economic recessions causing devaluation of the currency of your country making the US pathway very expensive for you and your family.

4. Health and age of your parents:  If an IMG travels to start residency in their 20s there is a good chance their parents are in their 50s, so could be independent and not affected by the absence of their children at this phase of their life. However if you travel to start your training in the US in your 40s your parents are in their 70s and would probably need more help and have more health issues due to their advancing age.     

5. Becoming an old graduate: Waiting for 3-5 years after graduation makes you less competitive in the main residency match because generally most programs prefer younger applicants who are assumed to be more educable and less rigid in their training.

 

In conclusion, there is no right or wrong answer and the decision to do residency before coming to the US has to be tailored for each IMG applicant individually. Even as mentors when we give advice to younger applicants we have to understand everything about their circumstances before we give them our opinions.

This includes discussing with them their dreams, aspirations, fears, family dynamics, thoughts about marriage, financial situation, economic and political factors where they live and many more things, so that they make an informed decision on the most important career move of their life.   

 

“A ship in harbor is safe, but that is not what ships are built for.” -John A Shedd

 

M.Soliman