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Hi guys!
Would like some advice and guidance on the best way to achieve my lifelong goal of landing a neurosurgical residency in the States. Full disclaimer, being a FMG, I understand that the odds are stacked against me; but frankly neurosurgery is the only career that I can see myself doing for the long run, so I would really appreciate any and all comments that y'all could give me!
I'm currently in third year of med school (out of five), with a Step 1 score of 267. No pubs yet, but am working on that as of now. I lack a green card, and have no feasible way of obtaining one for the foreseeable future. I don't mind working anywhere in the States, so long as I match, and I plan to stay in the US to work even after I complete my GME.
However, my biggest problem right now is that I'm not sure whether I'll be able to get a sub-I/ elective rotation in the States. This is primarily due to my institution scheduling a non-final year slot for elective rotations, whereas almost all the US institutions (except for 3) that I've contacted require international students to be in their final year. I'm willing to defer a semester just to qualify for sub-Is, though, if there is no other way.
My question is, for someone in my situation, what would be the best course of action? If those three institutions wind up not accepting me for sub-Is, should I defer a semester just to qualify for sub-Is? Or should I graduate first, and attempt to make up for the lack of USCE via observer-ships (during my med school years) and via the various pre-residency programs (after graduation)?
If it's the latter, which type of pre-residency program* (e.g. research fellowships with a PI, clinical pre-residency fellowships, or a PGY-1 preliminary year in Gen Surg if I'm offered/ SOAP into one) should I go for, if my intension is to eventually match into neurosurgery? I'd have no problem working for 2-3 years in such a position, but I think that 1-2 years for an unpaid research position would be the most that my finances would allow.
Thanks in advance for taking the time to read through my long-ass post, and I would be very grateful indeed if any of you could help me answer my questions! 
* I understand that these are not strictly pre-residency programs, but I'm at a loss as to what to call them otherwise.
You will probably not match without publications, good LORs (preferably one of them from your research mentor supporting your application) and completing the rest of your USMLE steps with similar high scores. In this case, a few sub-I's now at the expense of delaying a semester would not be the best way of investing your limited resources (time, effort and money), since you will need 1-2 or even 3 years of research to get enough publications to be a competitive candidate, and in addition, you are a fresh grad and do not have the neurosurgical experience that some FMGs have (if they did residency abroad).
Most research fellowships would start paying you in 6-12 months if you show that you are an indispensable asset to their team: publications, meetings, grants, patents, etc. It is easier to negotiate this if it is laid down on the table as an option prior to starting the job.
I would say get whatever sub-i's or observerships that you can get without delaying your med school graduation. Work on getting a research fellowship position with an influential mentor. Work hard and publish a lot with your mentor. Ace the rest of your USMLEs. Your publications can also get you a green card even before you match, which will really help your match process.
Your last options should be pre-residency fellowships (almost no time for research, and only increases your chances in your current institution, if you have no publications to impress other institutions), or pre-lim year (almost no benefit regarding matching in neurosurgery, avoid at all costs).
Don't apply this coming match if you don't have the prerequisites to be a competitive candidate.
Is it doable? Yes
Will it be easy? No
Is it worth it? Definitely
Hope this helps. Good luck!
Senior resident (originally a FMG)
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(04-18-2020, 05:27 PM)Guest Wrote: You will probably not match without publications, good LORs (preferably one of them from your research mentor supporting your application) and completing the rest of your USMLE steps with similar high scores. In this case, a few sub-I's now at the expense of delaying a semester would not be the best way of investing your limited resources (time, effort and money), since you will need 1-2 or even 3 years of research to get enough publications to be a competitive candidate, and in addition, you are a fresh grad and do not have the neurosurgical experience that some FMGs have (if they did residency abroad).
Most research fellowships would start paying you in 6-12 months if you show that you are an indispensable asset to their team: publications, meetings, grants, patents, etc. It is easier to negotiate this if it is laid down on the table as an option prior to starting the job.
I would say get whatever sub-i's or observerships that you can get without delaying your med school graduation. Work on getting a research fellowship position with an influential mentor. Work hard and publish a lot with your mentor. Ace the rest of your USMLEs. Your publications can also get you a green card even before you match, which will really help your match process.
Your last options should be pre-residency fellowships (almost no time for research, and only increases your chances in your current institution, if you have no publications to impress other institutions), or pre-lim year (almost no benefit regarding matching in neurosurgery, avoid at all costs).
Don't apply this coming match if you don't have the prerequisites to be a competitive candidate.
Is it doable? Yes
Will it be easy? No
Is it worth it? Definitely
Hope this helps. Good luck!
Senior resident (originally a FMG)
Thank you so much for your detailed and well-thought out answer! I really appreciate your advice, and I'll be incorporating it into my prep for Step 2 and beyond.
Just a quick follow-up question though, would you consider emailing the research faculty of various institutions to be a good way to look for/ pursue the aforementioned research fellowships (aside from those positions that are clearly advertised on university websites)? If there is a better way that you know of, please do let me know!
Once again, thank you so much for your help!
(04-18-2020, 02:00 PM)dienbienphu Wrote: Hi guys!
Would like some advice and guidance on the best way to achieve my lifelong goal of landing a neurosurgical residency in the States. Full disclaimer, being a FMG, I understand that the odds are stacked against me; but frankly neurosurgery is the only career that I can see myself doing for the long run, so I would really appreciate any and all comments that y'all could give me!
I'm currently in third year of med school (out of five), with a Step 1 score of 267. No pubs yet, but am working on that as of now. I lack a green card, and have no feasible way of obtaining one for the foreseeable future. I don't mind working anywhere in the States, so long as I match, and I plan to stay in the US to work even after I complete my GME.
However, my biggest problem right now is that I'm not sure whether I'll be able to get a sub-I/ elective rotation in the States. This is primarily due to my institution scheduling a non-final year slot for elective rotations, whereas almost all the US institutions (except for 3) that I've contacted require international students to be in their final year. I'm willing to defer a semester just to qualify for sub-Is, though, if there is no other way.
My question is, for someone in my situation, what would be the best course of action? If those three institutions wind up not accepting me for sub-Is, should I defer a semester just to qualify for sub-Is? Or should I graduate first, and attempt to make up for the lack of USCE via observer-ships (during my med school years) and via the various pre-residency programs (after graduation)?
If it's the latter, which type of pre-residency program* (e.g. research fellowships with a PI, clinical pre-residency fellowships, or a PGY-1 preliminary year in Gen Surg if I'm offered/ SOAP into one) should I go for, if my intension is to eventually match into neurosurgery? I'd have no problem working for 2-3 years in such a position, but I think that 1-2 years for an unpaid research position would be the most that my finances would allow.
Thanks in advance for taking the time to read through my long-ass post, and I would be very grateful indeed if any of you could help me answer my questions!
* I understand that these are not strictly pre-residency programs, but I'm at a loss as to what to call them otherwise.
You also need to consider your visa options. Neurosurgery residency is 7 years. The maximum time on a J-1 visa is 7 years, while the maximum time on a H-1B (IF you can get the institution to sponsor it, given the extra $$ and time needed for it) is 6 years. Make sure you do not run into these issues.
Emailing faculty with your research interest and why you are interested in their work is fine. Mass emailing using generic emails is not.
Email has to be tailored to that specific neurosurgeon and their work. Make your emails brief, and to the point. Personal contact, prior knowledge, or common friends (for example mentors in your institution who know the neurosurgeon here) are more likely to get you a response.
(04-19-2020, 01:10 PM)Guest Wrote: Emailing faculty with your research interest and why you are interested in their work is fine. Mass emailing using generic emails is not.
Email has to be tailored to that specific neurosurgeon and their work. Make your emails brief, and to the point. Personal contact, prior knowledge, or common friends (for example mentors in your institution who know the neurosurgeon here) are more likely to get you a response.
How do you mention personal contact/common friends in an email?
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