Things to think and consider about before taking the USMLE

Are you one of the IMGs who are dreaming the American residency dream?

Here's something to think about: Taking the USMLE is not as simple as taking your local board exams; the process is not as easy or quick, and the effort needed for the exam will probably exceed your expectations.

This is what I want all IMGs to understand:

1] Be emotionally prepared when you take the USMLE.

From my experience, this is probably the most important thing to do prior to reviewing for Step 1. Condition yourself that you're will to sacrifice at least two or three years of your time to review for all the USMLE steps. Accept the fact that most of your classmates from med school will have already probably obtained their diplomate in their specialty of choice, while you are still reviewing and still studying for the US boards. Above all, know your own limits. Ask yourself this question: "Can I obtain a score that is competitive enough for both IMGs and AMGs? Can I get a grade more than 240?" If you answer "no", then start considering/rethinking your options very, very seriously.

2] Know your "enemy".

Learn more about the USMLE and the US protocol for residency programs. Ask the people you know who already took the exam and get their feedback. If you don't have any one to ask to or if nobody wanted to help you (like in my case, unfortunately), do your own research. Google it, join forums and other websites that cater to IMGs and their USMLE needs. Read the official instructions in the official USMLE, ECFMG and NBME websites. Don't leave your gun/s behind when going to the battle.

3] Anticipate a "large investment".

The USMLE does not come cheap. It's not loose change in your pockets. Here is the breakdown of expenses (as of 2009, see ECFMG for more details):
Step 1 = $845 (inclusive of international fees, may be higher or lower depending on the country)
Step 2 CK = $845 (inclusive of international fees, may be higher or lower depending on the country)
Step 2 CS = $1200 + air fare, board and lodging, other travel expenses, food expenses
Step 3 = $695 (may be higher or lower depending on the state) + air fare, board and lodging, other travel expenses, food expenses

The amount only goes higher should you decide to enroll in Kaplan. Check out their website by clicking here to know the cost of review... Another expense would be the Matching using ERAS, which will usually cost at least $1,000.

A short-cut to all these expenses: have at least $20,000 to $40,000 or more ready for spending. The amount may go higher or lower depending on your options.

4] The case of AMGs and IMGs.

Accept the fact that every year more and more IMGs apply to US programs. Acknowledge the fact that more and more AMGs are also graduating and applying to the same US programs that IMGs are applying. Accept the fact that no matter how the program will say that they do not discriminate between these two populations, there is bound to be some bias in recruiting new residents. It's common sense: AMGs know the American system better, most of them don't need any visa sponsorship, and their LORs/MSPEs are "more credible" than IMGs. US programs prefer US graduates. It's up to the IMGs how much they will and can gamble to compete with the AMGs.

*Note: I'm not bashing anyone!!! I'm just being realistic!!! I'll further elaborate about the foreign LOR/MSPE credibility in my next post!

5] America is the land of milk and honey - but getting one's self to stay there will never be easy.

Yes, America is a melting pot of all races from all over the world. Among countries with Caucasian origin, America also has less discrimination to the non-white races. Getting a US visa for a visit to Disneyland or Universal Studios is one thing, and staying in the US either for work or for good is another.

As we all know, one way of staying in the US that allows a foreigner to have some "freedom" with their social/business/family options is the H1B visa. H1B visa is also known as the "working visa"; however, this is not just "plain working visa" - this visa is given to foreigners with specialized form of work, e.g., doctors, specialty nurses, nuclear physicists, teachers, architects, engineers, etc. Unless there is an employer willing to shell out a part of their earnings to sponsor someone with an H1B visa, foreigners like me are left with other less inviting options like J1 visa (Exchange Visitor Sponsorship, 7-year limit) or F1 (student) visa. And because of visa problems, IMGs are less opted by the US programs to avoid trouble with the government. This is the reason why there are many US states that will say "We do not offer any visa sponsorship, must be US citizen, green card holders or permanent residents".

I hope that this post will help IMGs who are taking or will take the USMLE exam. I am just sharing my personal experience, and this is NOT what all IMGs went through during their USMLE journey. Experiences will differ from one graduate to the other, and not all experiences are similar. Please weigh the benefits and risks if you were to consider applying the content of this blog.

What are your experiences with the USMLE? Was is good or bad? What made you decide to do the USMLE instead of having the residency in your own country? Leave a comment below, blog about it and/or discuss it with fellow IMGs!

Hope that I've helped somewhat. Peace out, girl scout!

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Tags: about, before, confused, experience, usmle

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Comment by nitika bansal on February 11, 2012 at 12:37am

Hello dr rah!! USMLE surely isnt a cakewalk n u have very well written about the difficulties an IMG generally  faces. congratulations on ur MD.

Comment by Anastasia on May 4, 2010 at 4:06am
hello.You make me worried.What then are the chances for IMG?
Comment by anusharp on January 2, 2010 at 9:16am sure helps to know this stuff !
Comment by vikas on September 12, 2009 at 12:00pm
very beautifully summarized the tough journey. take care DR.RAH..... APPRECIATED
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