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Do Advanced Graduate Degrees help International Medical Graduates Match Into Residency?

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Do Advanced Graduate Degrees help International Medical Graduates Match Into Residency?

Deciding whether to get an Advanced Graduate Degree is a serious consideration most International Medical Graduates ponder at one point or the other. This article aims to help IMGs decide whether the costs and commitment of pursuing advanced studies are necessary for the ultimate goal of matching into a medical or surgical residency in the US.

If you are an International Medical Graduate like me looking to land the much-coveted American medical residency position, you are probably acutely aware of the increasing competition among residency applicants for the limited spots available. You are probably getting anxiety attacks scrolling through online platforms like Reddit and Student Doctor Network – seeing applicants like yourself feverishly pursuing electives, looking for observerships, or clinical shadowing in general. Some even spend years conducting dedicated research, publishing and presenting a ton of research work at reputable scientific conferences. The competition is at such a level that residency applicants are exploring relatively unconventional avenues like Advanced Graduate Degrees (AGDs) as pathways to a US medical residency. Anything to set you apart from the next applicant, right?

However, residency application is expensive, so while it is essential to remain competitive, it is equally vital to examine different pursuits we take, such as Advanced Graduate Degrees, in the residency application process. Exploring the weight these pursuits hold in helping us secure the residency position we seek is also necessary.

Does an Advanced Graduate Degree increase your chances of matching into the residency of your choice?

The answer is not entirely clear. Certain criteria like a great STEP score, academic and curricular achievement, medical school status, US clinical experience, and Letters of Recommendation (LOR) have been indisputable predictors of a successful Match® process over the years. In recent years, successful residency applicants have highlighted the utility of dedicated research years in landing a competitive residency position in surgical specialties. As a result, applicants like myself are beginning to take dedicated research years in droves to increase their contact with clinical faculty, demonstrate scholarly acumen and project completion skills, as well as secure valuable LORs and clinical shadowing/observership time. With the discontinuation of Step 1 scores and dedicated research spots getting increasingly saturated, applicants are now seeking other ways to set themselves apart. It is reasonable to predict that qualifications and pursuits like Advanced Graduate Degrees, currently considered insignificant, will become more relevant as the years progress. With this in mind, I examine its utility for the match. However, not every medical graduate pursues an advanced graduate degree with the goal of using it as a transit to residency. Before we get ahead of ourselves, we should understand other reasons why medical graduates pursue Advanced Graduate degrees in the first place. To understand and adequately characterize this, I interviewed a host of International Medical Graduates (IMGs) who went on to pursue Advanced Graduate Degrees in the US before applying to residency. My impressions from these interviews are conveyed in the following section.

Reasons why International Medical Graduates Pursue Advanced Graduate Degrees

Most IMGs may pursue an additional degree to enhance their competence and standing in a specific field of interest. For instance, a medical graduate interested in neuroscience may choose to pursue a Ph.D. in Neuroscience. Similarly, an interest in global health may translate to a Master’s in Public Health (MPH). This has the additional benefit of successfully increasing the likelihood of pursuing an academic or research career in said field.

You also may have noticed that a majority of high-ranking professors and department chiefs in top-ranking academic institutions tend to bear advanced degrees. Although this is not a requirement, having an advanced graduate degree can help to gain recognition, credibility, and professional mobility. Indeed, there is additional time and financial commitment to obtain these degrees, but the gain in experience can help set you apart.

For those who want to pursue non-clinical careers, an AGD also provides an indispensable avenue and launchpad into non-clinical careers. For instance, in fields like global health, although not required, an n MPH gives physicians a significantly strong background to successfully launch a global health career with organizations like the WHO, UNICEF, and other major international NGOs.

An AGD program’s network-building potential is also nothing to be scoffed at. Networking is largely taken for granted, but an extensive, powerful, and resourceful network is a significant predictor of career success. AGDs grant scholars an opportunity to connect and work with a diverse group of professionals from medical and research career paths during their course of study. When leveraged correctly, these professional networks and connections can be beneficial in research opportunities, career advice, and mentorship opportunities which could significantly help build one’s professional influence.

Finally, moving from a different country to the US can be jarring culturally, especially for IMGs. The change in outlook, adaptation to a new way of life, and even a different system of medical practice can be overwhelming. Pursuing AGDs for a year or two offers you a buffer time to adapt and effectively adopt the new culture before entering a high-stakes – high-pressure residency environment where miscommunications and misunderstandings could mean a loss of human life.

Having highlighted the myriad reasons medical graduates may pursue AGDs, it is time to explore their utility for the match. Do AGDs increase your chances of matching into your desired medical specialty?

What does the Data say?

Examining the NRMP® 2022 report on characteristics of IMGs who matched versus those who did not, we quickly observe that Advanced Graduate Degrees may have a detrimental effect on the chances of IMGs getting matched. While the number of Ph.D. holders among IMGs was too small to make a significant conclusion, 61% of specialties had more unmatched US-IMGs with an advanced graduate degree. Even more alarming, 89% of charted specialties had more unmatched non-US IMGs with an advanced graduate degree. To summarize this, here is a quote from the report highlighting the supposed utility of Advanced Graduate Degrees:

The majority of specialties had a larger proportion of U.S. IMGs who did not match to their preferred specialty report a graduate degree than did their matched counterparts. The same is true among non-U.S. IMGs.

Interestingly, results in the literature paint a different picture from the NRMP data. For instance, a study by Barone and colleagues of plastic surgery residents published in 2018 revealed that 42% of IMGs in an integrated plastic surgery residency position held an advanced graduate degree. While this is not necessarily a smoking gun highlighting the utility of Advanced Graduate Degrees for the match, it suggests that AGDs may not necessarily impede matching successfully as the NRMP data suggests.

Concurrently, the NRMP data, when scrutinized more closely, reveals that the percentage of IMGs who have AGDs, specifically PhDs, and successfully matched to specialties like Neurosurgery, Orthopedic Surgery, and Anesthesiology was higher than their non-matched counterparts.

This may be because of the increased number of years post-med-school graduation required to obtain an Advanced Graduate Degree, and not the AGDs that may account for this disparity in match rates shown by the NRMP data.

Hence, Advanced Graduate Degrees do not hurt, but do they help?

The answer is more complex than it may seem and is incredibly nuanced. In short, as a line on your CV as an applicant, AGDs on their own do not appear to bear significant weight in landing a desirable residency spot. However, pursuing an advanced degree can provide valuable experience and resources that can enhance your CV and make your application process hassle-free.

1. Prevention or Compensation for Gap years:

When I spoke to numerous IMGs who undertook AGDs, I got the idea that a majority pursued further studies as an alternative to having a massive block of time unaccounted for or wholly spending said time preparing for the STEP exams. It is no secret that gap years, or “unaccounted for” years, are frowned upon by residency programs as they highlight a chunk of time being unproductive and away from academic, scholarly, or clinical activities. Whether or not applicants with gap years perform worse during residency than those without gap years is undetermined and is subject to investigation, but this is the reality of the application process. It is therefore expedient for IMGs to prevent significant blocks of unaccounted time in their CVs. Pursuing AGDs is a suitable avenue for this when direct residency application is impractical or not immediately possible after graduation.

2. Interaction with Clinical Faculty:

In addition to filling up gap years, Advanced Degrees grants you an opportunity to interact and work with clinical faculty. Top programs in fields like public health usually possess physicians with clinical practice as part of their faculty and instructors. It should be emphasized that the number of clinical faculty and their level of involvement depends on the size and rank of the program, i.e., top programs tend to have more clinical faculty. However, the utility of these clinical faculty depends on the specialty the IMG is shooting for. For instance, a surgery applicant will probably only meet a few surgical faculty while pursuing an MPH compared to an internal medicine applicant who is more likely to meet with more success on this front. Proactiveness and self-advocacy are highly encouraged. IMGs who pursue advanced degrees should actively reach out to clinical faculty enquiring about opportunities for clinical shadowing and collaboration on projects. This could help obtain recommendations from established faculties to boost your credentials during the application cycle. Possessing an institutional email also makes favorable responses from professors and faculty within or outside the institution more likely. Indeed, a history of working closely with faculty for 1-2 years would lead to a more relevant LOR speaking of your skills and abilities than one after 1 to 2 months of clinical observerships.

U.S. Clinical Experience

Our multi-specialty rotations ranging from hands-on to observerships will give your application the boost it needs!

3. Research, Publications, and Conference Presentations:

Advanced Graduate Degrees also grant opportunities to garner research skills, specifically quantitative and qualitative analytical skills. A myriad of projects in different areas of interest can be pursued under supervision and guidance by highly qualified faculty. Impressions from IMG interviewees suggest that highly motivated individuals can produce up to 3 peer-reviewed publications per year from these projects. Institutions also provide valuable resources and support for students to present research findings and abstracts at scientific conferences all over the country. Apart from adding a notch to your CV as an applicant, these conference presentations create a potent environment for networking and meeting like-minded individuals or potential mentors who may be invaluable during the match process. It should, however, be said that research output during an AGD depends on the specific discipline, the caliber and productivity of research faculty you are exposed to, and your ability to reach out and effectively leverage these resources. Research may also not be clinical, or related to public health, epidemiology, quality improvement in health services, etc., and the impact may be variable. In other words, the research and publications garnered during an advanced graduate degree depend on the discipline pursued and may not be directly clinical. Regardless, your capacity to begin and complete projects and strong scholarly acumen will be demonstrated by your publications during this period and will bode well for you during your residency application.

Research Course

The research course will teach you how to take a research project from idea to publication and in which I will share my 3-year experience of clinical research in which I had over 100 publications and 80 presentations.

4. Internships, Volunteering, and Real-world experiences:

During certain advanced graduate degrees, students can participate in various internships intended to grant competency and valuable real-world experience. These internship opportunities vary in nature but offer numerous novel challenges and avenues for the practical application of learned theoretical knowledge. Projects and initiatives you begin and complete during these internships will provide valuable CV highlights and interview fodder. These are useful experiences you can talk about during interviews that will highlight your level of productivity as an applicant. Students can also participate in volunteering opportunities during the course of these programs. Students can volunteer for various worthwhile causes during their programs, and apart from the apparent altruistic purpose of this endeavor (which should be your primary motivation wink wink), it has the added – totally incidental – advantage of looking good on your CV.

5. Adaptation and Acculturation:

Finally, IMGs can also pursue advanced degrees as a bridge to residency, taking the time to adapt to American culture. As mentioned earlier, moving to the US can be an intimidating and jarring experience for internationals, so having a watershed but productive time to adapt to the new culture and way of doing things can be an attractive alternative to jumping right into residency. Understanding interpersonal interactions are invaluable for the physician-patient relationship, will provide you with a sense of the nuances of American cultural expectations, and overall grants you a headway into seamless cultural integration. IMGs like myself come from a variety of backgrounds with different languages, and even when English is native, a plethora of accents. This period allows you to tackle language and communication barriers in a relatively low-pressure academic environment. Additionally, during residency, time for socialization and making new friends is limited. Hence, this period can be crucial for making friends and building a social support structure while navigating the stress of the path to residency, especially for IMGs who do not have any family in the states.

Pitfalls to look out for in pursuing Advanced Graduate Degrees

Having highlighted how pursuing AGDs may enrich your portfolio and improve your match chances, we must examine and emphasize ways that pursuing an AGD may impede the match.

Time

“There’s never quite enough time to do all the nothing we want to do” – Bill Watterson.

The obvious elephant in the room here is time! Depending on the length of time taken to acquire AGDs, a significant chasm may form between the year of medical school graduation and the year of residency application. An extended period of time post-medical school graduation, especially those of 5 years and more, does not bode well for the residency application process due to the increased tendency to be eliminated by program screening filters. This should therefore be considered when you are looking to pursue an AGD before residency application. Programs should be planned so that they are completed in a reasonable period of time, optimally three years or less, after graduation from medical school to remain competitive for the match.

Visa and Immigration

Furthermore, visa issues may be complicated. Students on an F1 visa usually relish switching to an H1B and getting started toward a green card and full immigration. To this point, it is essential to highlight that the number of residency programs willing to sponsor an H1B may be limited, and the number of hoops IMGs may have to jump through to get an H1B visa may represent significant barriers to a successful and hitch-free match process.

Cost and Financial Considerations

“People say that money is not the key to happiness, but I always figured that if you made enough money, you could get a key made” – Joan Rivers.

AGDs are also not cheap! Depending on the program, the cost of tuition for these degrees can easily run into >$50,000. Of course, scholarship opportunities are available, and institutions provide other cost-mitigating programs to their students to enable them to handle the brunt of the financial responsibility – but these are not guaranteed, and a majority of students still have to depend on support from family during the years of their advanced degree programs. Apart from tuition, the cost of living in the United States is not exactly cheap either. This has to be factored in during decision-making, making sure to account not only for the degree itself and the cost of living but also the cost of residency application.

 

Recommendations and Final Thoughts

In this vein, I recommend that unless your future career path necessitates that you pursue an AGD, IMGs consider alternatives like a postdoctoral research fellowship when merely looking to explore their field of interest further before beginning a residency. Highlighting the pros and cons of a postdoc is beyond this article’s scope. Still, it is a cheaper and more efficient way to get into a clinical environment, complete research projects, publish, present, network, and work closely with clinical faculty.

In conclusion, pursuing an advanced graduate degree is not the smoking gun to the residency of your dreams. However, it has its merits, and if leveraged efficiently, it offers experiences and resources to enrich your portfolio as a residency applicant and increase your chances of matching.

I hope this article has helped you reach a fully informed decision on whether or not to pursue an Advanced Graduate Degree. Ultimately, it is up to you to fashion your career, and prudent decision-making with the information this article provides will definitely lead you to success.

Chijioke Chukwudi, MD, is a postdoctoral fellow at Harvard Medical School, where he conducts research in general and cardiac surgery. He is passionate about providing resources and education aimed at helping IMGs match successfully. When he is not pipetting solutions or writing blogs, he also works on initiatives to provide ‘high-quality – low-cost’ healthcare resources to low and middle-income countries.  

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