Dr. SHS. adult neurologist and a clinical neurophysiologist in Pakistan, secured direct fellowship position.
My path has been different from the usual path that International Medical Graduates (IMGs) take but this path is something, which not many people are aware of. I am sharing my experience with my fellow IMGs and USMLE aspirants so that they have a better understanding of this whole process and they do not repeat the same mistakes which I did. My story and struggles may help and inspire others in achieving their dreams. Also, read about USMLE preparation.
I graduated from medical school in Pakistan in 2011 (quite an old graduate, I know).
In Pakistan, we have to do a one-year mandatory internship before receiving the full license to practice medicine.
I completed my Internship in 2012. Passed Step 1 in early 2014 with a score of 261.
Step 2 CK in 2015 with a score of 266 followed by step 2 CS, which I gave in Houston, Texas, and passed with flying colors.
I applied to residency, basically just with my scores, and got just a couple interview invites. I was disappointed and eventually have not appeared in the interviews at that time. I got the ECFMG certification.
Keeping my US dream aside, I pursued my training in Internal Medicine in Pakistan, followed by core training in neurology, which I completed in 2019. I passed my neurology exit exam in 2020. In Pakistan (and in many other countries), you need to pass the exit exam (similar to the US Boards) to get a degree and work as a consultant. In the meantime, I pursued a two-year fellowship training in clinical neurophysiology at Aga Khan University, which ended in December 2021.
During my residency and fellowship, I did some research work and published around 15 papers in different national and international journals. When I was doing my fellowship, one of my colleagues from cardiology got a fellowship in cardiology imaging in the US. This gave me a much-needed spark that I should also look for fellowship opportunities in the US.
I asked my colleagues and schoolmates, who were working in the US. I also approached my senior neurologists in the US that allowed me to join their WhatsApp group where I communicated with many Pakistani neurologists working in the US, who I never knew before. I also searched on different websites (including Reddit and various USMLE forums). After all the research, I came to know that fellowship opportunity is available if you have completed your core residency in your home country but having an ECFMG-certification is a requirement. Step-3 is not mandatory but most of the programs do ask for Step 3 and it is better to pass your Step 3 if you want to maximize your fellowship opportunities. Now some fellowships are easier to get, for instance, nephrology or non-ACGME accredited fellowships, which remain unfilled as compared to some other fellowships, e.g. interventional cardiology, where the competition among the US residents and trainees is high. Another thing that greatly helped my colleagues is a clinical experience (observership/electives) in the same program. They worked there, made social contacts, and it helped them in getting the fellowship. So once you have done your homework and have shortlisted your programs where you can match realistically, a brief clinical experience in that institution and department is essential in securing a fellowship spot.
How fellowship is different from residency? And why this path is not usually followed? It is because of the fact that after the fellowship, you cannot practice in the US. To be eligible for US board certification and practice independently, you have to complete your residency (again) in the US. So this pathway is kind of a reverse one, where you are doing the fellowship first, followed by residency training. If you do not intend to repeat the residency, then after completing the fellowship, you have to go back to your home country. Uncommonly, but it is possible that your faculty during the fellowship is so much impressed from your work and happy with your performance that they may ask for some special exemptions for you to work in their institute without doing a US residency, even with this exemption your options are limited and you cannot work outside the institute that has asked for the exemption.
Some fellowship specialties enter into a fellowship match (similar to the NRMP residency match). Some specialties participate in the San Francisco (SF) match, while other fellowships do not participate in any program and you have to email the Program Directors individually. For example, if we talk about the fellowships in neurology, the movement disorder fellowship enters the SF match and it is a non-ACGME program. The neuromuscular fellowship has its matching program, only limited to the single super-specialty, while most of the fellowships do not take part in any match program.
Taking advantage of my ECFMG certification, I applied to 20 movement disorder fellowship programs, was interviewed by six programs, and got selected at the University of Virginia at Charlottesville. I am not alone who is getting selected for a US fellowship after completing a residency in their home country. In the last two years, following seniors and colleagues from my institute have also joined the fellowship programs after residency in Pakistan: A cardiology colleague was selected for a fellowship in cardiac imaging; A neurosurgeon was selected for a fellowship in pediatric neurosurgery; A senior of mine, an orthopedic surgeon, completed his fellowship in orthopedic oncology;
The point is: If you couldn't match for the US residency or you did not apply for the US residency and instead completed your residency in your home country, you still have a chance to get a fellowship and pursue your dream of training in the USA.