Matching general surgery residency:


Hello everyone. This is probably a long overdue post. I have noticed that a LOT of people tend to just give up their dream specialty and try to get into IM/Psych/Peds etc. preferring US Vs. their preferred specialty. There seems to be a lot of ignorance about whether or not you can match into a competitive field.

Basically the answer is yes. IMGs match routinely into all the crazy fields including orthopedics and neurosurgery. You have to be invariably stellar – the point being, if you are really good, it is possible.

To those seeking guidance about matching General Surgery, I’m going to explain the two possible strategies to get there. I am an IMG who matched categorical surgery in a good program without doing a prelim year and through the whole interview process, this is what I came to realize:

(Please don’t ask me ‘credentials’ - I would prefer not to reveal my identity and I hope people can respect that. Basically, I checked most of the boxes of what I have described below. The information that follows should tell you what exactly you need in your pursuit. And to people who can recognize my identity from this post, a kind request not to defeat my purpose of using a different account)

  1. Straight categorical (without doing years of research/ prelim year prior to applying) -
    Have a PERFECT and EXCEPTIONAL application.

By PERFECT - it means EVERYTHING! Right from your medical school (people say medical school outside US has no value, what you accomplish in your medical school doesn’t matter etc.) But these are mostly people who just postulate. Bottom line, medical school of origin, your achievements in medical school, CLASS rank (YES for an IMG) is important.

Step scores-
Goes without saying - now here is the catch - people ask what’s a good score? Well, bitter truth - it is high if you want a straight categorical - again bitter truth 240s and 250s are pretty AVERAGE IMG scores for an applicant to General Surgery. For an institution to consider you for a categorical position straight in General Surgery, you’re going to need one score to typically cross the 70 mark (preferably step 1 in 260s and step 2 showing a jump above that) - because you are basically replacing a local graduate which means you have to be way beyond or exceptional - now before a bunch of people start yelling examples to me of people who matched with lower scores - those people VERY LIKELY spent at least a year or two in research. (The ‘huge amount of research pathway’ into straight categorical is an alternative into categorical when you don’t meet the 'PERFECT APPLICATION ’ criteria - these people typically end up having 10-15 publications with similar numbers of presentations having dedicated a couple years to research). (Please don’t cite NRMP averages on average scores because that data is heavily confounded).

Electives -
ATLEAST 3-4 in good places. (Observership in Surgery typically have low value).Have seen a lot of posts asking ‘Oh does Harvard give LOR? Does Mayo give LOR? Does Cleveland give LOR?’ The hidden answer - each and every place has academically proficient people obtaining LORs on a regular basis - why does anyone even ask this question? It’s your performance. If someone tells you they didn’t get a letter, always keep in mind the possibility that they just weren’t good enough.

Letters of recommendation -
You have to STRONG letters - that’s what you ask for when you ask the person to write you a letter - AND these have to be from renowned people - not just random people from small places. It would be ideal to have one of the letters from a General Surgery PD at a big place - how do you get that? When you apply for an elective and get accepted, email the coordinator and make a request to be with the PD for the month. Things won’t just happen if you sit on the pelvis and watch! You have to be proactive and MAKE things happen!

Another golden point with LORs – When a program says on the website – 3 LOR – ONLY UPLOAD 3. Then in October when sending your email expressing interest – state that you have added an LOR from Dr……, Professor of Surgery, ….(name of institution) in support of your application. (and add your 4th letter)
Don’t upload all 4 LORs and waste this opportunity – unless the program website states MINIMUM of 3 in which case, go ahead straight with 4.

Personal statement-
One of the coordinators at a program I interviewed at told me- PS is what I use to filter applications- there are so many people with scores above 250. PS matters! It’s YOUR story. Don’t get other people to write it for you. Don’t read sample PS before writing yours – subconsciously that is going to create a bias when you write yours. People suggested that my PS should get approval from residents/faculty etc I know, but I didn’t take this advice - depends on your confidence - write a strong one - you are selling yourself - rules of business- NEVER UNDERSELL! Regarding professional agencies for this purpose, honestly if you back your English language proficiency, you don’t need it.

The PERFECT application has no gap - so graduation in the year of application. You can always fill up gaps with whatever random stuff – research falls under the “heavy research pathway” – but sadly, even a few months IS considered a gap. Be prepared to answer the question on how your skill hasn’t deteriorated during this time – don’t ask others for answers, think honestly and work on it.

During the application season –

Don’t ask for LISTS of IMG friendly programs – DON’T USE THE commercial websites for lists! if you can’t even do your own homework by individually looking up every single program and figuring out which ones will consider you and which ones you want to go to, how do you expect to work hard as a resident? If doubtful, compare FREIDA with program website – resolve discrepancies by emailing the coordinator in August when they are reasonably free after the new interns have come in and the application is yet to start.

Email programs - you have paid 26$ and the only way they will pick up an IMG application is if you tell them you exist - a good way to do this - email your ECFMG certificate to the program saying that you just wanted to ensure a complete application - this shows you are proactive! Do this in early October - don’t do it in September and not in November (too late). There was a point of time when I was sending out 20 emails per day for about 15 days. I drafted several of these emails way before September 15th, so all I had to do on any given day was hit the send button.

Interview –
This is a really long discussion if we get into it. Easier said than done but better nail the interview. ‘The Successful Match’ book has some useful tips. Don’t copy the interview answers from that book but use the questions to frame your own. You have to prepare both generic answers and program specific answers. The preparation will take TONS of time and effort so start early. I spent the month of September dwelling over my answers and thinking of better and smarter ways to answer questions.

Another point – if you feel confident, and there is a ‘standard answer’ which people will offer to a particular question, try to make yours different. The way I prepared my answers was as follows – I would think of what most people would respond, then I would think of an answer completely different but gets the point across succinctly. It requires lots of practice – basically, don’t take the interview lightly.

Research your interviewers – don’t ask them – Oh what are the strengths of this program? What qualities do you look for in an applicant? – Personally, I feel this is a terrible question because your job is to convince them they are looking for you. I never asked that question to an interviewer. Ask your interviewer about the last paper he published – specifics of that – not just – Oh I read your wonderful paper. It was so amazing – then if he asks you the intricacies – BOOM! It will blow up beautifully. So tread carefully and smartly.

Update programs with whatever you accomplish during the time - most IMGs are in research during the application time or are just hanging around touring - there must be something academically moving in your life - maybe you got a paper accepted you submitted six months back etc. Make sure you update the programs (ALL PROGRAMS your applied to) - Emails are free of cost so make sure you utilize it. I would probably be a couple thousand dollars poorer had I been charged 1$ for each email.

Post interview write the thank you EMAIL - This is my view but others may disagree. The EMAIL beats the Thank you card! - reason is people can reply to the email while they can’t waste time to try and find your contact from a very nice card you send them. DO NOT delay the email - best time to send it is Post interview day 2 - just enough for the face to fade and for you to remind them - again I don’t want contests on this - it’s my opinion - you may differ.

Email your interests towards end of January - tell the one program your ranking #1 as such and others as to what you liked etc. Any email you write is extremely important so make sure no spelling errors and common mistakes (I emailed one program when I was sending my letters expressing interest in early October that I am very interested in joining the resident community of a different program due to copy pasting error - got their rejection in a couple of hours :-). So don’t mess up there – as an IMG you’re facing stiff odds already – cant afford to lose a program here and there.

  1. Heavy research pathway -
    If you want a straight categorical, do committed research for 2 years atleast and apply - not a guarantee - you may end up as a prelim - outcomes proportional to your research outputs and people you meet and greet at conferences, mentor support etc.

  2. Prelim pathway -
    Relatively easy pathway - when you’re a prelim, you’re not a liability to a program as if you’re not good enough, you’ll just end up changing specialty next year (forcefully). You need decent scores (240s/250s) (or just know somebody) and apply broadly - always assess the where the program sends its prelims after their prelim year before ranking them - you want to find out how many they keep/match categorical GS elsewhere etc.

Important point to note - if you match prelim, your profile ‘disappears’ - your scores don’t really matter anymore – also, you apply more selectively the next year - what I mean is your best chance to get categorical subsequently is at THAT same program so work hard and prove yourself. This is because some programs consider matching prelim as an unsuccessful match (bitter truth). Other programs when you apply as a prelim will simply ask you ‘Oh if you’re so good, why isn’t your program keeping you?’

Bottom line -
People say surgery for IMGs is impossible without prelim years/research years etc. Most people just express hearsay information without actually having first hand experience. The people who say 'You can’t ’ and 'You won’t ’ are the people who scared ‘You Will’. I had a person who told me ‘You should apply IM/Peds and just get into US. IMPOSSIBLE for surgery.’ – My reason for writing such an elaborate post is to explain that it is possible if you really want it. Make sure you don’t take bad advice as there is plenty out there!

Please don’t PM me – Just post any questions you have here so that everyone can see it and I will get to them in an as timely manner as possible.