Intro: You're listening to the Beyond the States podcast with Jenn Viemont. Did you know that you can go to Europe and get your entire degree taught in English for less than one year of tuition at many American schools? Jenn will take you on a deep dive into the many benefits and options around English-taught higher education in Europe, helping to make the possibility less foreign.
Jenn Viemont: Hi, guys. I'm Jenn Viemont, founder of Beyond the States and I'm so glad you're listening today. Because I'm going to talk about something, a question that I get a lot. This question is whether a degree from Europe is good in the US. So this usually means one of two things. Will it allow me to get into grad school? Or will it allow me to get a job?
We've had episodes already with more coming about the positive ways, studying abroad outside of your home country affects employment, due both to globalization and also the skills that students gain by studying abroad. It's always interesting to me, though, that people think this could be a hindrance to grad school. If you look at the International Student percentages for Master's Degree Programs in any US university, you're gonna see that degrees are accepted from accredited universities from around the world. In fact, there were more than 1 million international students studying at universities in the US during the 2019 to 2020 school year.
So I could spend an entire episode talking about the different types of accreditations, I'm just going to touch quickly on it today for the most important aspects. So in the US, the government doesn't give accreditation to universities itself, but instead approves various accrediting agencies, as does the Council for Higher Education. So these are often but not always regionally based, like the Middle States Commission on Higher Education or the WASC Accrediting Commission. And then there are also national accrediting agencies as well as specialized accrediting agencies for degrees, like, you know, law, nursing, medicine, and things like that. It's a pretty confusing process, because a school in the US can say it's accredited. But if it's not accredited by an approved agency, then it doesn't matter, then their accreditation really means nothing.
In most other countries, accreditation is granted by a governmental body, which is usually the Ministry of Education. Since public universities in Europe are heavily funded by taxes, the accreditation process is really quite thorough. And since there's only one accrediting agency per country, the Ministry of Education, the criteria used for accreditation is consistent. This is a type of accreditation we rely on for beyond the states, because this is what's going to matter. When you're seeking degree recognition. We really don't risk it when it comes to this. And I sometimes get emails from people asking about a school they found online that isn't in our database, the school may have given them a reason that they don't yet have national accreditation. And the reason behind it sounds compelling. Sometimes it's sketchy, sometimes it's not. It's just not something we're willing to risk. This type of accreditation is a deal breaker for us.
Okay. So as I mentioned, there's also degree recognition, which is connected but different. This is the process of getting your foreign degree accepted as valid by an employer, or a graduate school, or a licensure board. Most graduate schools will use credentialing agencies to do this. And this is why the National Accreditation is key, is it's a required component. Many employers will just look at accreditation, or they might already know the school if this is like a multinational company that recruits from around the world. Honestly, really, so many companies hire from around the world that see degrees from outside the US is not an issue. Some employers, so will use credentialing agencies for the process. Again, no big deal. If you went to a university that had this National Accreditation.
Then we get into careers that require Professor Professional Licensure. And this is a different matter entirely. These are things like you know, healthcare, education, psychology, law, and a handful of others. The most important thing to note about the careers that require licensure is that most, not all, but most are going to require a master's degree before licensure. So many of our members intend to work in Europe after graduating. But if you're sure you want to eventually work in the US in one of these careers, perhaps the solution is to get your Bachelor's in Europe and then coming back to get your Masters in the US which would then make the licensure process much easier. That said, though, there are extra hoops to jump through. Most of the careers have passed to licensure with an international diploma. The biggest obstacle can be the licensure exam, not because students who studied in Europe don't have the knowledge, but because the curriculum in Europe of course was not focused on preparing them for a US specific exam, so more self studies needed in order to pass those tests. Other hoops can be found on the licensure board connected to specific professions, I've looked at a number and it's pretty clear if you find the right link for how to pursue licensure with a foreign degree, it'll lay out whatever hoops or obstacles there are around that.
However, when we get to the health related fields, the obstacles increase. First of all, let's say you want to get your Bachelor's Degree in Europe and then go to med school in the US, this can be a problem. Many US medical schools require a degree from the US. And those that don't require you to have your Bachelor's Degree from the US require at least one year of coursework from an American or Canadian University. And usually these are the science classes. This is the case even if you were pre med at a top university in Europe, most of the health related programs in Europe, things like Veterinary Medicine, Pharmacy, Dentistry, and Medicine are combined programs. So in five or six years, depending on the field, you graduate with both your Bachelor's Degree and your Master's Degree. It's really integrated and combined, it's not like after three or four years, you could just leave with your bachelor's. It's also very focused from day one. So students really need to know 100% that this is what they want to study. So of these, Pharmacy is probably the easiest to come back to the states and practice with. You first take the foreign Pharmacy graduate equivalency exam, and then the national NAPLEX test. Like the other licensure, the biggest obstacle around this is just preparing for a national test. Veterinary Medicine isn't horrific either. It's pretty similar to the process for Pharmacy, it starts to get more difficult with Dentistry. Unless your degree came from a school accredited by the Commission on Dental Accreditation, which are only in the US and Canada, you have to complete an advanced standing program at CODA school. This is even if you are practicing dentistry in your home country, and I believe these are about two years. So even if you were a dentist in some other country, you have to come back here and and go to school basically, in order to be a dentist here.
Then we have becoming a doctor and the issues around becoming a doctor are the most common misconception. I can't tell you how many people think that you can't become a doctor if you get your degree abroad or that it's just about impossible. Now it is true, that students who get their MD In other countries have certain obstacles which we're going to talk about today. You have to get clinical experience, take the really expensive USMLEs and get your residency. Let me back up for a minute. When you get your medical degree abroad, you're called an IMG. This is International Medical Graduate. The term IMG says nothing about citizenship. So it's qualified with either US IMG for American students who get their degree outside of the US and non-US IMGs who aren't American citizen. Many of the residency obstacles are greatly decreased for US IMGs. Because of course, as an American, you don't have to have a visa and visa sponsorship to work in the country.
But people who tell you that you can't get a residency in the US, if you have a foreign degree are usually talking about the obstacles for foreign IMGs. Even the expensive hoops that IMGs have to jump through, end up costing more when it's not in your home country. And we're going to learn about many of these hoops today in the interview. I'm talking to Dr. Sinha today, and we continue talking after the interview ended. And we talked about the costs associated with going the US Route as an IMG.
What she noted, though, was that she was able to graduate medical school without debt, which made these expenses as well as the headaches more manageable. She also talked about friends she has who are Indian, but also US citizens, who went to medical school abroad to avoid the debt knowing that as US IMGs, the obstacles wouldn't be as significant. Honestly, it really makes sense. So like, let's look at UNC Chapel Hill. And again, I use this as an example often just because it's where I live. And we'll even just look at the more affordable in-state tuition.
So if you are in-state going to medical school, you're going to pay well actually, if you're in-state for your Bachelor's Degree, you're going to pay about 35,600 in just tuition for the entire four years, not that's not the annual rate of course, that's the tuition in full for the four years. Then for medical school in-state, you're gonna pay just over 35,000 a year for four years in-state totaling $140,616. So you're ready for residency in eight years, and you've paid $176,000 in just tuition costs. And remember, this is in state at a public university. So it's on the lower end of things. In continental Europe, there are 42, English taught programs in medicine. These take six years to complete, so you finish with your Bachelor's and Masters. They range in tuition from 1,900 euros to 20,000 euros per year with an average tuition of 10,150 euros. So that's right around 11,500 US dollars. So students who pursue this average tuition, let's just say, they're going to have their bachelor's and their MD for just $69,000. And they're going to have this two years earlier. So it's true that they are not going to have the non-science, non-medicine related gen ed classes and electives that aren't related to that that the UNC student had, but they're also paying $107,000 less, over that it's 107,216 less, and two years less of living expenses in that student. I would think there could be other ways to explore, you know, non medicine related academic interests with that amount of time and money savings. So I'm excited for you to hear the interview where I learned so much. I do want to emphasize that Dr. Sinha is talking about her experience as a non-US IMG. So just want to remind you that some of the obstacles she faced would not be as much of an issue for a US IMG. So let's take a quick break and come back with the interview.
Testimonial: Hey, guys. I'm Izzy from Wisconsin. I'm entering my third year of study at Maastricht University in the Netherlands. If you've been listening to the last few episodes of the podcast, you might think that Beyond the States is mostly for Dutch schools. There are a lot of members here particularly because other than Ireland, of course, the Netherlands has the greatest number of English-taught Bachelor's Degree programs. There are actually Beyond the States members in Sweden, Finland, Estonia, Austria, Germany, the Czech Republic, Hungary, Greece, Italy, and France, and Spain, and Belgium, and even Cyprus. Each country is different when it comes to their admission requirements, educational approaches, the types of universities, and types of programs they offer, and more. This is just one reason why Beyond the States is so helpful. They have information about all of these different countries and make it easy to understand and navigate them. I'm actually a dual citizen, and my parents grew up and started their higher education in Poland. They later moved to the US to finish their higher levels of education. Even though they have an understanding of these higher educations in the US, they didn't want me to be limited to just those options, especially since I'm eligible for EU tuition in all of Europe. Except for Ireland, of course. Our Beyond the States membership helped me learn about so many options all around Europe that would be a good fit for me. I would really encourage you to not limit your options to just one country. For example, when I was looking, I looked not only at the Netherlands, but also Portugal, Spain, Germany, and the Czech Republic. Beyond the States makes that easy to do, especially with their membership. Check the show notes or Service Page at beyondthestates.com for information on how to join.
Jenn Viemont: So there's a belief that it's impossible for students who study medicine in other countries to become practicing doctors in the United States. Today we're talking to Dr. Akriti Sinha -- I hope I said that right? Yes? Who is an International Medical Graduate, having gotten her medical degree in New Delhi, India. She's currently an attending physician at Virginia Department of Behavioral Health and Development Services in Williamsburg, an adjunct Professor of Psychiatry at University of Missouri Healthcare, and a clinical fellow at the McLean Center for Clinical Medical Ethics, University of Chicago. Wow, that's a lot. You're busy. Thank you so much for being here today, especially given how busy you clearly are.
Akriti Sinha: Well, thank you, Jennifer, for giving me this opportunity. I'm very privileged that you guys found me out somehow and, you know, invited me here.
Jenn Viemont: Well, I think you have a really important story to tell students and families because clearly, it's not impossible for International Medical Graduates. That's IMG, right International Medical Graduates to practice in the US, given that you've done so. I do know that there are extra hoops to jump through. And I was hoping we could talk about that today. So can you tell us a little bit about your path going from medical school in India to becoming a practicing doctor in the US?
Akriti Sinha: Yes. So it was a long path. It was a long, convoluted path. So a little bit about medical school in India, so I started my medical school when I was just 18. So right after I finished my high school, medical school in India is essentially a college, you don't do anything, you know, between medical school and your high school, unlike in the United States, where you go to your college, you do your Masters, you do maybe other things, and then eventually, you know, you start your medical school, most likely you're in your late 20s, or, you know, maybe mid 20s. There's no age barrier in the United States, which is fascinating to me. In India, you have to kind of make a decision pretty much at a very tender age, you know, by the time you're finishing your high school, you are, you know, either taking your entrance exams to enter into engineering or you know, law or whatever. There's no college, your graduate school is your college.
Jenn Viemont: So is that a combined Bachelor's and Master's degree program for medical school?
Akriti Sinha: It's interesting, because it's a Bachelor’s school. Well, the degree that I got after finishing my med school was MBBS, which is based on the British curriculum. So there are also Bachelor’s in Medicine and Bachelor’s in Surgery, which is MBBS. And after you do your medical school, you enter into post-graduation course, which in United States is residency, so only after I finished my residency in India or post-graduation in India, then I get my doctorate degree. Yes, which is MD or Doctorate in Medicine, or, you know, MS if you were a surgeon. So, it's interesting that here, if I were to complete my medical school, I'm already a doctorate because I've already completed my, you know, Bachelor's, or, you know, unmask whatever Master’s if you wanted to. In India, so MBBS is equivalent to MD, it’s because the course is the same, right? It's just that in the United States, there's no concept of MBBS, or Bachelor’s in Medicine or Bachelor’s in Surgery, right?
Anyways, I was close to 18, when I started my med school, and so kind of longer duration, of course, it's almost five and a half to six years, unlike four years here in the United States. It's, I think, very comprehensive, very thorough. And so when I started my med school, I always knew that I wanted to get my higher education in the United States, I just did not know why. Or I wouldn't say why. I knew why I wanted. I wanted to learn from the most brilliant minds, you know, when you're growing up in a country like India or South Asian countries, you look up to United States, you look up to, you know, Great Britain as pioneers in technology, in science, and medicine. And we have a great role to play here, for sure. But there's just so much research being performed here. There's just so much opportunity. And as somebody in her early 20s, I wanted to experience that, right. So as soon as I entered medical school, my first year, I was already navigating the process, how do I practice in the United States. And it did a lot of research. This was like in 2011, 2012, when I started the, you know, the groundwork, and I was going into the websites. And that's when I, of course asked around the other people, there was obviously some of my seniors who were already writing exams. And that's when I understood the process of pursuing residency in the United States. So basically, as you write all these exams, which is the United States Medical License Exams, USMLE, and that's a complete separate pathway from what I was pursuing in India, right. In India, I was trying to get my MBBS degree get my, you know, complete all the requirements for medical school to be able to practice in India. But along with that, I was already working towards the process to, you know, pursue residency in the United States.
Jenn Viemont: So, and I think the important obstacle to note here is that medical schools in the US are preparing their students for the USMLE, of course, a school in India or school anywhere else in the world. They're not going to be preparing their students for the US based tests. So you were studying for two completely different systems.
Akriti Sinha: Absolutely. And it's a lot of work and it requires so much perseverance, so much technique, so much planning. And I think the good thing about it is it's kind of flexible on you, when you want to do it. For me, I wanted to do it right away. As soon as I completed my requirements in India, I wanted to go ahead and start my residency in the United States. So I started it pretty much towards the end of my medical school. I was already studying for my USMLE exams, and I'm trying to apply for, you know, medical experience here. But a lot of doctors in other countries, they do it after they have completed their residency in their, you know, own country, they are probably practicing physician, you know, and that's one good thing about pursuing residency here is that as long as you have completed the requirements, which is which we show we're going to talk about, which is all the exams, USMLE, step one, step two, step three, and get accepted into residency program, it doesn't matter, you know, what you were doing before that?
Jenn Viemont: Interesting. So just in terms of the steps, you take the test, you get your transcripts verified, correct? And then whether you completed a residency in another country or not, unless it was Canada, you have to complete your residency in the US in order to become a practicing physician, correct?
Akriti Sinha: I think so. I cannot talk about Canada. But I know a lot of students, medical students in Canada also pursue residency here and they don't necessarily have residency.
Jenn Viemont: Okay. Okay. So why do you think that is? Why is it that the US requires, so you were talking about other people who might have already completed their residency in another country, they might be practicing doctors, they might have been practicing for many years, and then they come here, and they have to do this. Why do you think that is?
Akriti Sinha: Very strict. I think it's, I was told when I started it, I was told that it's the toughest exam that you will take in your life, and you don't take it once you take it three times. It's step one, step two, which is divided into two parts, which is clinical knowledge, and clinical skills, which has kind of, the clinical skill part has been eliminated because of the pandemic because it required standardized patients, and they have different ways to assess you in that. And then that is step three, which is your final exam.
I think the reason why they want it is they want it to be very standardized, they want to make sure that people who are going to practice here, even if they you know, the residency itself is very standardized in several years, like three to seven, eight years, along with fellowships if you want to. But even before that, they want to make sure that people who are deciding to be practicing here are like very thorough in their knowledge. I mean, that cannot be, I guess, duplicated by any other degree, no matter, you know, you could be the biggest researcher in your country. But if you have to take those exams, you have to prove, you have that you passed them very well, you know, a lot of times, our scores have to be higher than some of the American grads to place us before them. Because, and that's not a wrong thing. I mean, it's your country, right? You want your own students to have definitely a spot here. So for us to be able to bypass that and be considered as their equivalent, we, a lot of times have to prove our mettle to a much higher degree than them.
Jenn Viemont: So as residency, and this is something I don't know much about my knowledge is like limited to Grey's Anatomy and shows like that. But so are residencies offered completely based on test scores? Or because I've heard is very hard for students, whether they're American or not, if you have an international degree, even if you pass the USMLE that it can be really difficult to get a residency.
Akriti Sinha: Yes. So the tests are absolute necessity, there is nothing you cannot. Yeah, you have to take step one, step two, two parts, now one part and this step three. And then, because we are foreign grads and international medical graduates, we have to show proof of United States clinical experience. It's very, very highly coveted and expected from you. And the United States clinical experience. It's a very broad term, but it basically involves wherever field you want to practice, you have to have some kind of clinical experience. It could be clerkship electives, electives, essentially, what fourth year medical students do here, they can do it in their own program, they can go to other programs to increase the chances of matching. Elective is like, you know, if you want to be an Ophthalmologist, you want to do extra rotations there. For me, it was Psychiatry. So I wanted to do more, you know, rotations in Psychiatry, which I did in New York City in Miami. So that is clinical experience. You're basically meaning, you know, you're following the treatment team and you know, you're following an attending or a fellow. And you're just trying to see how the American Healthcare System works, which is very, very different from no matter, you know, which part of the world you come from, it is very different to you, for me, it was huge, usually different. And, yeah. So they want that. They want to see, and the more the better. You know, if you can spend four or five months, hopefully in different programs, doing that, that really speaks, and that gives you an edge.
Jenn Viemont: So this is something that a student who goes to American med school, they're going to have that as part of their degree. So was this hard for you? Is it hard, I guess I shouldn't just say for you, but in general, is getting this clinical experience before the residency, is that difficult to secure?
Akriti Sinha: It is very difficult. It is very difficult to secure. And mind you, I did this in 2015, 2016, because I matched in 2017. So this was the time when I was doing it, this was far from the past, you know, five or six years ago, and even then it was so difficult, I cannot even speak how people are doing it now. Everything shut down. So the biggest problem is, they don't know you, right? I did my med school from it’s like the Asia's largest hospital, in terms of how many people it sees as an outpatient basis, like VMMC Subdivision Hospital, which is in New Delhi. It's like Asia's largest, they don't know this, right? I mean, you know, and I don't expect them to know this. So it's a real big scramble to get an experience somehow, in their private companies who kind of can help you with that, but it's expensive, and it's not reliable. A lot of us kind of, you know, talk to some of a senior if they can help us, you know, talk to program directors, or talk to the production director if they can get us, but even then, because it still involves an external person to come to the hospital and talk to the patient, there's, you know, there's a lot of things that need to be considered.
So at least in I think, early 2000s, there were a lot more programs that will offer an external, like international students like Cornell was on top of that, Harvard Medical School. They had their own, you know, way, just for like US medical students, we were included in that category. It was expensive, a few thousand dollars for every month. But I think we, if there's a lot of competition, because if they have their own students or you know, other students from New York, I want to rotate in Cornell, then that can be difficult to get that. So you have to like apply in advance and all that. So yeah, sometimes those programs invite, you sometimes they don't invite you, you know, because you're not a local, and you're not a citizen. So there are hoops to cross there.
Jenn Viemont: Interesting. So I wonder if what that experience would be like for an American citizen who has their degree from another country? You know, if they're coming, because they wouldn't need the visa, right? So part of it is you needed them to sponsor you, so that you can have a visa correct.
Akriti Sinha: So most of these clinical rotations are done on a tourist visa.
Jenn Viemont: Okay, because you're only, it's only a few months.
Akriti Sinha: Right, right. But if you want to stay longer, or you want to get into research, kind of position, which I did with the University of Miami, then they require you to sponsor, you know, like your research visa or things like that. I mean, if you're a citizen, you can stay in the country, no matter how long you need to. And even if you're trying to find a position, or somebody you can shadow, or somebody who can, you know, staying here is not an issue. For us, the longest we can stay here on a tourist visa is six months, so you have to make the most out of it. During that time, you also had to take the Clinical Skills Exam, which are often in very specific centers in America. So yeah, it is a lot of planning and a lot of coordinating. Yes, yes.
Jenn Viemont: So you take the USMLE, the three parts, and you need to really kind of ace it because you're kind of coming at it from a disadvantage right. And you get your clinical experience in the US right? Through juggling a hospital slash university, who will set you up with these rotations that you pay for, while you're doing this, and then you can apply for residency to complete your residency for the matching?
Akriti Sinha: Yes, so I wanted to mention, so ECFMG, which is Educational Commission for Foreign Medical Graduates. So that's the Corporation, which are basically verifying all our transcripts and making sure that we are, you know, at par with our, with our AMGs grads, so they are keeping a record of all our steps, our scores, our transcripts, they have our you know MSP, like our, you know, medical school, papers, and the Dean's letter and stuff like that. So they are the ones who, so we have to be certified by the ECFMG before you can apply for residency.
Jenn Viemont: And you can't be certified until you take the tests, do your clinical rotation experience stuff, and then they'll certify you, and then you can go through the matching.
Akriti Sinha: Right, so we have to be ECFMG certified before you can start your residency.
Jenn Viemont: So how does matching work?
Akriti Sinha: Yes, so that's a very unique experience for me. Because nowhere in my life when I was in India, I was interviewed to get into medical school or you know, things like that. So the way the residency process or getting residency work, so it's a system, it's an electronic system, it's called ERAS, so Electronic Residency Application Services. And it opens up sometime in September, mid September. And that's where you enter your, you know, all your information, you create your portfolio, and through that you apply to programs. So for example, I wanted to do my residency in Psychiatry, you can apply to different programs, like you know, if you want to do not sure, maybe you can apply in Pediatrics, too, and all that, but your profile has to match what you're applying into, that's also very unique to the United States, like you need to sure, you need to be pretty sure about what you want to do with your life. You know?
Jenn Viemont: What you mean by your profile, like, if you're wanting to do Psychiatry, then those rotations, that clinical experience you had should not be Pediatrics. So it should be related somehow to Psychiatry,
Akriti Sinha: Right. So the exam score, which is basically kind of verified by the ECFMG, then my statement of purpose, right? So that has to speak to why I want to go into this field, I have to have three, at least three reference letters. So letters of recommendations, these are the people I interviewed, you know I shadowed, or I worked with, or I did research with, and they have to speak very, very highly of me. That's the requirement there too. And then Dean's letter from your med school, think those are the main things.
So all of this is entered into the ERAS. And through that also, I'm applying to the program. So this is the catch here because I'm an IMG, I already kind of have a disadvantage here. I try to apply to as many programs as I can to be selected by at least one.So there are like 120 Psychiatry residency programs in the United States, I'll try to apply to at least 80. Okay, compared to an AMG, who would probably apply to 20 or 25, only the places they absolutely want to go. Because every program you apply costs you. It's like 30-40 Dollars or something. Yes, so it can be very expensive. And did I tell you, sorry, I might have forgotten. So every step exam that you take is about $1,000?
Jenn Viemont: No? And I'm sure that getting your transcripts verified, and all that is not free, either.
Akriti Sinha: Oh, yeah. So every paperwork that goes through ECFMG, some amount of money, there's no doubt about it. But these exams are really, really, really expensive. So $1,000 for step one, $1,000 for step two, clinical knowledge $1,500, to step two CS which has been eliminated now, but I'm sure there's other alternative way which is probably quite expensive. And then step three is the last exam that can be taken during your residency, but normally it's taken by IMGs before we even do it, again, to increase our chances of matching. That's like again, gosh, that's probably also like $1,500 or something.
So it's expensive, so just exams themselves are, and then the process of applying into all these programs is overall can be up to 2000, $3,000.
So yeah, my goal was to match and I would apply to as many programs if I had a chance to be interviewed by them. Now, some programs, I know, I don't want to say I don't want to name them, but I know I won't have a chance. I won't. I know that they don't sponsor visas, even if they would put it on the website that we would sponsor your visas through the ECFMG, which is also the, you know, the same entity that verifies our transcripts, they also sponsor what's called J one visa, which is an exchange. They would say that, “hey, we will sponsor visa,” but they will probably never do that, right. It's a total of 80, 90 programs that can cost you about 3000, $4,000, just on applying. And if you get called from them, which is could be 1050. If you're really, really lucky, you might still get called from 10, or 15 people or programs, which is a good number. And it's variable. You know, sometimes people get called from one program and they match in that program. And sometimes people get call from 15 programs, and sometimes they don't match. It's very unfortunate. So the goal is to get as many interviews as possible. But it does get expensive in that.
Jenn Viemont: Yeah. So you apply to however many, and each of those places looks up your application and decides, okay, we want to interview her or no, we don't want to interview her. And then you have your interview. Is that usually in non-pandemic times, is that in person or is that virtual usually?
Akriti Sinha: It's all in person. Yeah, so September 15, is when the ERAS opens, so everybody starts. So it's active, right? Before that, you can work on your portfolio, and you get all the information there. But I think September 15, is when it gets active, and the programs can look at your information, and they can start sending you interviews already through their, you know, program coordinators. So my first interview, I got on September 19, which was amazing. So that was positive, right? I'm like, already in the game, I'm starting to prepare, right? I'm doing my booking my flights for that place. I'm trying to see if I can find a place where I can, you know, where I can stay. So yeah, so throughout October, November, December is when you're interviewing maybe only till early January. And that's after which, you know, then comes the decision time.
Jenn Viemont: And so the decision time, would you get an offer for more than one or only one.
Akriti Sinha: So the way it works, it's pretty transparent, and pretty streamlined. I could interview at 15 places, but I would eventually accept an offer at only one place. I cannot do it twice.
Jenn Viemont: Did you get an offer from more than one place?
Akriti Sinha: So that process is called a match. Okay, and so very thing of its own. So you don't get email, “Hey, can you accept.” It doesn't work like, right? So it's called NRMP. So that's another system. It's called National Resident Matching Process, Matching Program. And the way it works is that, hey, I interviewed at 10 places I go to their, you know, website, again, I create my account, I pay the fees, whatever. And then I rank the programs that I interviewed at so 1, 2, 3, 4, 5, based on my preference. And programs do the same thing. Right? So they interviewed about 100 people, right? Maybe 10 person for each spot. They had 10 spots for Psychiatry, they interviewed 100 people, and they would rank maybe 40 people. Maybe they didn't rank 100. But I don't know, I really don't know what they like, if they're really confident that they will no matter what happens, they will never have an empty spot. They might, you know, rank less people.
But there's some kind of algorithm that runs in like late February, early March. And based on my preference, they say that the applicants preference is considered to be more important. But based on my preference based on what or where program matched me. That's where somewhere, they meet and that's the place where I'm going to do my residency for several years, and sometimes it can work in my favor, and sometimes it cannot. And if there's no match, then you don't get a spot and then you're unmatched.
Jenn Viemont: And then what?
Akriti Sinha: And then you repeat the process next year.
Jenn Viemont: Oh, man! And you know, by repeating the process next year, do you have to take the test again?
Akriti Sinha: No, no, no. The test -- the good thing about these tests is that they are valid for seven years. Yes, they're valid for seven years so you don't take the test again, but you do, you know, apply to the programs again and your next, your new candidate, you maybe rewrite your statement, you know, maybe you try to strengthen your profile in the next few months.
There's not a lot of time though, because the match or the results of everything comes sometime in mid March. Mid September is the time when you start the process, and between March and September, you have to decide what you want to do, do you want to, you know, completely withdraw and go back to your country, because maybe your experience was not great, or you think that you were really close, and you know, you want to do it again. And the best case scenario is you match. And hopefully you match in your top three ranked program. And then you're stuck, you kind of start the process of working on your visa with the ECFMG, your, you know, with the program and start getting orientation, and all that process.
Jenn Viemont: Because if you've been there, if it's March, although maybe you've gone back to your home country by then, you're on a tourist visa still.
Akriti Sinha: Yes. Unless I was in a research visa at the time. But that was a unique, not everybody is in that.
Jenn Viemont: That complication, as well as of your visa if you're not a US citizen,
Akriti Sinha: Right. So most people return by the end of January, as soon as their interview season is over, they are gone by then. And they're essentially just waiting, you know, in March and for the results to open. And it's a very prideful experience, you know. So I think it's a Monday, second week or third week, second week of March is when on a Monday at this very specialized very specific time, you get the letter from NRMP. And you said, “Congratulations, you matched!” Or I don't know, match. And that is what you know, on Monday, on Friday, you get another email, for me it was email, for American grads, they open the letter in their respective medical schools, and it's called Match Day. And that's the envelope tells you where you match, which can be again, an amazing experience or the most disheartening experience, because if it's not somewhere you wanted to go. For me, it was all email because again, I'm not a grad here. Right. But it's a historical experience for a lot of people.
Jenn Viemont: Yeah. Wow. And so you matched your first time going through this?
Akriti Sinha: Yes. And I was lucky. I want to say that. Anybody who matches in the first time, they're talented, but they're also very lucky. Because I've seen very exceptional people, like, you know, super bright graduates from India, are the country’s with the highest scores, like amazing scores, that you don't even hear a lot of AMGs and have finished, you know, probably spent several months, if not few years, building up their clinical experience or research experience here. Or, you know, completing all the steps. Were getting astonishing letters, and sometimes they don't match.
Jenn Viemont: Wow, yeah. Well, you don't know. I'll find the stats for the show notes. So you don't know them off the top of your head. About the number of students with international diplomas who match their first year?
Akriti Sinha: Ah, not tell. So it's nowhere the data will tell you? About the attempts? Or IMGs, they won't tell you about the attempts, but they will tell you the percentage for different fields. So for example, I can talk about Psychiatry in my year, 2017. And I don't want to get into too much of, you know, specific fields. But Psychiatry has recently become a very difficult theme to match. In early 2000, this was one of the easier speciality to match for IMGs. Now, again, I'll tell you, I should have probably specified it earlier, surgical specialties are very difficult to match to in America. In India, it's a different story, like surgery is less. It's not that competitive. But in the United States, I guess, because of malpractice and all of those things. It's a difficult field to match into, not not just for IMGs, it's almost impossible for IMGs to match. Unless you again, you were probably very established surgeon in India and did a lot of work in United States, or you had some kind of an edge in some way. I don't know.
So most people who want to pursue residency are doing it in Internal Medicine, Psychiatry, Pediatrics, maybe Family Medicine. And so these are the fields that are more common. So non-surgical fields. And Psychiatry became pretty competitive more recently, because of just the advances, the lifestyle, the money, just how much mental illnesses and mental health, you know, became important.
I want to say only 9% in my year. 9% of IMGs, out of everybody who needed a visa. So like 9.9%, or something like that. So only one out of 10% turned can candidate, who needed a visa, and was an img matched in second.
Jenn Viemont: Wow. Do you know how many people who didn't need a visa matched?
Akriti Sinha: I wouldn't say a huge number 90%? Maybe? Yeah. Because most of these people are citizens, or they’re citizens who trained in, you know, Caribbeans or in Europe, but they pretty much match almost every time. Yeah.
Jenn Viemont: So is the obstacle for matching more the visa issue or more of where you had your undergraduate, right, and med school where you got your education or visa? What would you say the bigger obstacle is?
Akriti Sinha: I think it's the visa. I think it's really a visa like, for example, me being trained in some of, you know, one of the biggest medical school in the world. But I'm not a citizen compared to somebody who got trained in a non- United, you know, non-US school, but in Carribeans, or in Canada, maybe but is still a citizen will have a better edge, or higher chance of matching than me.
And when I got into the process, I think I was extremely optimistic. I was naive, right? I was naive. And I did not know a lot about immigration issues at that stage. And I was just doing what I was supposed to do. And I got lucky and it worked out for me, and it works out for a lot of people. I don't want to dishearten anyone, but be cognizant of the fact that immigration is a huge issue. And sparked visa sponsorship, it has become a difficult thing for a lot of programs. And even though ECFMG, as I mentioned, really advocates, because the overall the physician shortage is here, right? The reason why I matched, why I'm needed here is because we just cannot fill all those spots by us grads alone.
There are like 12,000 Internal Medicine spots. And there are not 12,000 AMGs who want that Internal Medicine spots, you know, they want other fields. And so a lot of IM spots have to go to, you know, people from different other countries. But the visa sponsorship becomes an issue, especially with the pandemic, I think, when the embassies were closed and the consulates were not functioning, it's a huge risk for program directors to take. Because even if they rank you, and you match, worst case scenario, you might not be able to start on time, you know?
Jenn Viemont: Interesting. So it sounds like part of the misconception that people might have is that the obstacle, certainly the obstacles are still there, if you get your degree in another country, you have to take that three part test and pay $1,000 each time, and you need to get your clinical experience, whether you're an American or non-American who gets your degree from another country. You still have those obstacles. And those are definitely big obstacles. So it sounds like those are, I mean, legit, but it sounds like the residency obstacle that might be where part of the myth is as it pertains to Americans getting their degrees elsewhere, that it's more of the test and clinical experience, then getting matched for residency for those who have US citizenship. Interesting.
Akriti Sinha: Yeah, it's easy. It's easier for them for sure. And I, again, I understand that, you know, Visa sponsorship is, is not something that only America deals with, you know, we deal with the Indian government itself has to allow me to leave. And there's a paperwork called Statement of Need, which I have to get from the Ministry of Health in India, which basically says that, “Hey, we are letting her go. So eventually she comes back and serves us.” And that's a part of what we call as exchange visitorship. If I don't, which I'm doing now, is basically I am serving one of the underserved or health physician shortage areas of the United States for three years, bypass that.
Jenn Viemont: Interesting. And which is the underserved population?
Akriti Sinha: It's very well defined by the HHS, which is Human Health Services here. And there can be just so many bigger universities, which are still underserved, because they're just serving, you know, they're serving people who are Medicaid, Medicare dependent, or you know, insured. But one of the classes, either I finished my residency or fellowship and go back to India, and don't work in the States for two years at least, or I stay here and serve one of those areas for three years. Only then I can continue to work in the United States.
Jenn Viemont: Wow. So you have to, so after your residency, those are your two choices. You jumped through all those hoops to get your residency? All those hoops, paid all that money to get your residency. And you can either go back to India after you complete your residency, or serve an underserved population or underserved area for three years. And then you'd be able, wow.
Akriti Sinha: So they definitely tried to get the most out of us. I mean, if I'm staying here, irrespective of whatever I sacrificed, I'm living here, I'm getting, you know, I have my own advantages by working here, right? I'm getting a good lifestyle here, I'm getting good money here, I feel like I'm part of a much bigger fraternity here and I have a bigger voice. And for the future, if I want to work in a health policy, and you know, preventative medicine or whatever, it's just so much easier when you are here in the United States. And I think that was one big reason I got here, but it's not easy, you know? It's not like you finish your residency and you're just, you know, yes. Yeah.
Jenn Viemont: Do you know, and you might not know this, if you don't, it's fine, is the US sort of the exception in terms of how hard they make it?
Akriti Sinha: It's good and bad here. I think this process is the most streamlined and most well known by people in other countries, it's very transparent, it's very well designed. There's just so much information to know when to talk to the ECFMG is an amazing, you know, organization that helps us in this process.
A lot of people have done it in the past. So a lot of us have our seniors from med schools we can talk to. The other options are, I guess, United Kingdom? They were more open in the past. I think it's a smaller country. Yeah, there are much less spots there. And I think there was a huge emigration of Indian doctors at some point. And they, I don't know the exact reason, but they stopped taking us in late 2000s, or something like that. And so United States became, like the stand alone country for a lot of, you know, Indian grads or other grads, to to focus on. And it's still I think, despite the pandemic, there's still people who are writing the exams, who are, you know, interviewing on Zoom, so everything is on Zoom now, so people are in India, they don't need to travel here.
Of course, there's a few travel ban, which is now just now being lifted. So for the past 18, 20 months, everything has been, you know, being done on Zoom. And I think this process gets much more difficult if things are being done on Zoom, because at least I was traveling, and I was trying to talk to these people in person, and see what I like and what I don't like about them or about the town or whatever. But no, you know, people have never been to wherever and they're ranking them because that's the mean to match. You know, there's so much at stake.
Jenn Viemont: Yeah. And there's a huge difference between Boston, Massachusetts, and you know, Bloomington, Illinois, you know, and if you haven't seen it, if you've never been to a town like Bloomington, Illinois, it's hard. It's gonna be hard to really gauge that. Yeah. Wow.
Well, this has been so informative. I can't even tell you I feel like my knowledge on this topic is preceded beyond Grey's Anatomy. Yeah, so ER back in the day.
Akriti Sinha: As much as I enjoy myself watching those shows, oh, God, it's so wrong.
Jenn Viemont: I know, I know. My daughter is interested in studying Criminology because of the show Criminal Minds. And I can't tell you how many articles I've sent her saying this is not an accurate representation of what you would do in the job.
Akriti Sinha: Or House MD or whatever. Yeah
Jenn Viemont: Exactly, exactly. So I appreciate ain't having a more realistic vision of how all this works. And I really appreciate you sharing your knowledge and your time with us.
Akriti Sinha: Thank you so much.
Jenn Viemont:Thank you.
Thanks so much for listening today, before we end up like to tell you about a Crunch Time Pack. So I only offered this twice a year. And it's for students who are going to be applying for the Fall of 22 and are feeling behind on the research. And it's a personalized and comprehensive package. It’s really hands on with me to make sure that you know, all the ducks are in a row.
So, the first thing that comes with it is a Best Fit List. This is a service we offer where I personally handpick three to five programs that fit the student's qualifications, budget, interests, preferences, all of that that they provide to me through a form that's emailed to you after ordering. It also includes a Line Jumper Pass, the turnaround time for the Best Fit List is often about three weeks or so because we get so many of them. And with the Line Jumper Pass, you'll get your Best Fit List just 10 days after submitting. It also comes after you get your Best Fit List back we'll have a one hour consultation. And we do this to formulate your admissions plan, and also answer any questions you might have.
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Because it's such a personalized service, I only accept five students at a time. So you're going to want to make sure to sign up really soon. If you're interested. You can find a link to this special and also more information about this episode in our show notes. And you'll find a ton of other information on our site, which is beyondthestates.com. You'll find blogs, some by me, others are written by our student ambassadors, they have both written and video blogs. You'll find links to our old podcast episodes that we did back in 2017, which is a great starting point. And you'll also learn more about our various services and our incredible community.
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