AIPG or MLE??
Well when i got stuck between Indian Pre-PGs n USMLE
, i thought i was alone, but with time i've come to realise that there are many docs like me who're in this dilemma, whether to go for AIPG (by this mean indian Pre-PGs) or USMLE
.
I met a lot of seniors and friends and took their advice and in this process I've gathered a lot of info regarding varying aspects of this eternal question AIPG or MLE??
So in this thread I’ve tried i've tried to compile whatever info i have, including my own views regarding aforesaid aspect. Of course i've used facts and views from other relevant posts as well. I request all to add whatever info is deficient here..
In keeping with the tradition of RxPG, any additions, suggestions, comments are welcome. That would help us get a broad view of the realities we face and help lot of us to decide, whats the right course for us.
But remember, these are my own views and I’ve penned them down just to help out people like me. I may be wrong at a point and I apologise in advance for that.
Lets start with the first and basic question, that is which one is better..
We'll take factor by factor...
1. Home advantage- [tex]With AIPG you have an advantage of home country, being close to family - Its very hard to spend years abroad and many students become home sick becos you don't find many people with our culture. Students, too much attached to their families might find it very difficult there when u celebrate diwali/holi/Eid alone. But then Indians abroad do form their own little groups and celebrate all festivals together.[/tex]
2. There is a risk of being treated as 2nd citizens at the USA. [tex]But then regional, caste n creed considerations do exist in india too n sumtimes are grave enough. I know people who had to leave their PG seats when limits of discrimination were crossed. So its not a very strong factor.[/tex]
3. Risks - [tex]In AIPG, Selection means a seat n If u get a seat, u will surely complete a PG. But clearing MLE even up to Step 2 CS doesn't guarantee a residency slot. You may return bare handed or may have to compromise with a branch you don't like, for the whole life.[/tex]
4. Expenditure - [tex]At least in the short run, expenditure for AIPGs runs only in few thousands. But for MLE it is in the tune of 5-8 lacs (details later). But again in the long run MLE people earn lot lot more than their indian counterparts. So it can be considered to be an investement.[/tex]
5. Visa? Mera no aayega?? - [tex]This is the most critical factor for MLE. You may be denied visa even after getting 99 in both steps, that too for no reason at all. The situation these days is pretty rosy, but we gotta remember the fact that its very very unpredictable. 12 months or so from now when we apply, what the situation may turn out to be, only god knows. So never decide solely on the fact 'My senior got the visa, so will i'. Same is true for vice-versa.[/tex]
6. Working conditions - [tex]MLE definitely scores over AIPG on this aspect. You'll get very good working conditions even at the lowest ranked program at US. No need to comment on the situation in india. Still i'd like to remind you here you'll be faced with lack of infrastructure n lab facilities, poor clientelle, general bias AGAINST medical community, Very frustrating payscales, broken/malfunctioning instruments, filthy hospitals. Conditions in private setup are better but then most people prefer govt jobs. In private sector you earn well only as a consultant, buts it would be 7-10 years at least before you get a consultant job at a good hospital.[/tex]
A distinct disadvantage in US is that you have to be thouroughly professional. Any laxity and you are always at the risk for litigations (specially true in surgical branches). You should be willing to give best service to the patient there cos pts there are well educated and well informed. Don’t forget that the number of litigations in India is on a sharp rise. Every other day you can read about patients, relatives, local politicians storming and mobbing the hospitals on small so called lapses. Episodes of manhandling of docs is also increasingly common.
7. Earnings - Do i need to elaborate??? In the US, even during residency (in the tune of $45k per annumn) you earn more than most of us wud earn here 5 years post-PG. Its very frustrating when during PG you're given 6K and you have to look towards your parents for support. After PG, you're offered 8k/14k/20k at private hospitals. Or if you do SRship it runs from 15k-25k at the max.
Post residency payscales in the US are in the tune of $ 1 lac plus p.a.
8. Job satisfaction - Well its very subjective and variable. But most people who are in the field agree that it’s highly frustrating in majority of India. According to them Few reasons why:
* Yours pt has more faith in local quack/compounder than you
* Pt Compliance is very poor due to illiteracy , poverty etc. But the blame of failure of treatment will always be on you.
* If you prescribe an investigation it’s always unnecessary in pts view
* Indian pts are highly reluctant to pay your meagre consultation fees
* Even after specialising you have to work as a GP becos of lack of facilites you can't make specific diagnosis or perform big procedures (barring big centres)
* Payscales are not commensurate with the quality of your qualification and work
There are hundreds more. In summary, here you feel incapable of applying the hard earned knowledge properly leading to dissatisfaction.
While in US, you get paid well, plus ample facilities at most hospitals n lietrate pts. who don’t worry about expenses (also due to health insurance) allow you to try to provide the best treatment according to your judgement.
9. MCI Recognition - MCI doesn't recognise PG from US, so you would be counted as an MBBS in govt setup, even after residency from US. So your scope in india is restricted to private hospitals. Its a good option but competition among US returned docs is increasing day by day, so it myt not be a cakewalk on return from US.
10. Time spent - Well its a big issue at hand. Definitely here you have a chance to get into PG early concurrently with your batchmates. While if you go for MLE, you myt be delayed by 2 years. By the time you’ll join your residency your friends myt be in final year PG. But i look at it differently, In india we myt start the race early but what'll be the situation only 5-6 years from now. With the kind of earnings in US you'll have accumulated more money than your friends here, even after deducting what you'd spend for MLE.
Careerwise, as far as i know, a fresh PG from US wil get at pays least equal to, if not more, than an Indian PG after doing SRship for 5 years, of course only in private hospitals.
11. Choice of branch – Well if you are hell bent on surgical branches, reconsider your decision for MLE cos its tough to get them (not impossible mind it). To get them you need very high scores, good LORs (Letters of Recommendation), USCE (US Clinical Experience), some research background etc. Even if you take surgical branch, you might be a bit discriminated (not in all programs), plus Asians are more at risk for litigations. I know a senior who left surgery within 2 months due to aforesaid reasons.
12. Exam itself – Well MLE is definitely easier than AIPG. MLE study material is:
* Significantly Less exhuastive
* Less ambigous
* Clinically oriented
* More of conceptual
* Hence involves less cramming
So, if u find cramming difficult, love clinical cases, have spent more time at wards than at your study table, you are more likely to love studying for MLE.
13. Indian PG + prep for MLE simultaneously??It requires a lot of patience for MLE aspirants specially cos lot of risks are involved at multiple points. Plus its very very tough to prepare for AIPGE
and MLE simultaneously, both myt get spoiled cos remember, in MLE scores are very very important n you can't improve scores once you’ve cleared a step.
Yes, starting PG and then preparing 4 MLE is possible and many people do it but it is associated with following difficulties:
* You gotta prepare for AIPG if you don’t get selected this year, which means 1 additional year.
* During PG its hard to find time to study, of course depends on branch and college
* You won't be able to join any coaching if reqd.
* A small disadvantage is that a few programs prefer recent medical graduates or at least who have passed within past 2 years. This incurs a loss of at least a few more programs which u can apply for.[/tex]
Thanks for reading till the end...er... i mean if you are still awake...
Now lets take various issues in a bit more detail. I’ll start with finances cos they appear to be very important for most of us.
How much money needed?
A rough rough estimate
step 1- 40k
step 2-40k
step 2 CS- 55k
step 3 - 35k
Study material - 30k (excluding coaching)
Online mock tests - 6-12k per step
Airfares - 50k (economy class for one round trip), double if u plan 2 come back to india in between
Applications for residency - 60 k
Coaching at Kaplan for 1 step – 60k (not very sure for individual steps)
Commuting within US for interviews, exams etc – 50k
Sundry (like ISD calls, visits to us consulate, booze etc. ) – 40k
Stay in US for 6 months - 200k (If u know sumone, at whose place you can stay, it myt be much less cos it forms the major chunk of living expenses)
Attorney fees H1B visa processing – about 60k
Total (excluding coaching, online mock tests, H1B attorney fees) = approx. 6 lacs INR
These all expenses are valid if you clear everything in one attempt, otherwise add accordingly.
But remember this is just an investment if you get a residency. You can cover the money in 1-1.5 years.
How much time?
Well that’s pretty subjective again. Still I’ll outline average suggested time frames for a good preparation. These are based on average of 6-8 hours of thorough studies a day (adjust according to your schedule)
Step 1 – 5-7 months
Step 2 CK - 4-6 months
Step 2 CS - 45-60 days
Step 3 - 2 months (I’m not very sure about this)
Now this totals to 15-18 months. But you gotta know a few facts:
* To be able to apply to max no of residency positions you should have cleared all steps (Upto Step 2 CS) by mid-september.
* Interviews are conducted around Jan-Feb period. So its no use even if you complete your steps in Feb or April for that matter. You’ll have to wait till next year’s match. This is the dilemma for many like me who have decided at this point. We can’t be eligible for the match of 2007. We’ll have to wait till 2008, which IS a long time..
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No. of Residency seats?
I’m giving approx. numbers:
In USA during past years:
No of US medical graduates per year – 14,500
No of residency slots per year – 22,500
Hence about 8,000 slots are there to be filled by IMGs (International Medical Graduates). But mind it Indians are not the only ones applying!!
No of IMGs who got residency after clearing MLE – 55%
No of students (including us graduates) who got residency(MLE score > 75) = 75%
No of students (including us graduates) who got residency(MLE score > 90) = 90%
Scope after Residency?
Well if get to stay in US, its great. You earn good, life’s good. If you have to come back to India you still earn more than your Indian counterparts of same batch. MCI does recognise US PG but we r not considered for govt. jobs. But mind it its getting tougher these days even for US returned PGs to get good jobs since we are restricted only to private sector.
But since US PG is recognized all over world, you can head towards other countries. Believe me if you are prepared for that the scope is great.
Books to study for Step 1:
1. First Aid - the mother of all preparations
2. Kaplan notes - (Add extra material to it)
3. Anatomy
: High Yield (HY) for neuro, embryo, histo and gross
4. Physiology
: BRS physio – Add extra points to Kaplan
5. Biochemistry
: Lippincott
6. Pharmacology
: Lippinott
7. Microbiology
: Jawetz
8. Pathology
: BRS with points on Kaplan
9. Webpath/Pathguy for slides
10. Behavioral Sciences: BRS is ok
11. Biostats: NMS
12. Q book kaplans +/- NMS series
And above all, a good discussion at our beloved RxPG!!
I’ll post more if I find remember more. You guys can post any queries you may have here. Good luck to all. God bless us all. Amen!!
Visa of Step 2 CS???
Toughest question! First I’ll talk about visa for Step 2 CS. Its usually the biggest hurdle. You can be denied visa even after getting 99 in both steps without any obvious reasons. It depends totally on luck. I won’t go deep in technical details. Usually when you apply for a visa, you are given B1/B2 (which one of the two I don’t know ) tourist visa which can be given for month to many years multiple entry. All depends on your luck. But the factor which is most important in getting a visa is your ability to convince the Visa Officer (VO) that you will surely come back to India once your purpose is achieved)
The VO believes that every visa applicant is a potential immigrant unless convinced otherwise. The arguments in favour of the fact that you’ll come back may be:
- Your or your parents’ fixed assests in India
- If you are the only son, it’s a plus point
- If you are married and your wife stays back in India. Plus point if you have a child.
- If you have your own hospital, or have a contract with a hospital that you’ll come back and serve it.
- During interview convince the VO that you are attached to your family and culture and wanna come back
- Liquid assests (your own or your parents’). In the tune of many lakhs.
Still if denied, you can reapply. Don’t loose hope. Most of the MLE aspirants do get a visa sooner or later.
If you’ve come back to India after CS, getting a visa for residency interviews is relatively easy.
Visa for Residency??
It is commonly of two types, J1 and H1B.
J1 - Exchange visitor visa- You need to clear upto Step 2 CS.
- Most programs (70-80%) prefer J1 visa
- Sponsored by ECFMG
- You need to come back to India for 2 years (mandatory) after completing your residency. There is a talk of increasing this mandatory period to 5 years. So this is not for people who badly wanna stay in US.
- There are certain conditions in which J1 waiver (ie. No need to serve in India for 2 years) can be obtained. But it is very tough.
H1B- You need to clear step 3
- Few programs offer H1 cos it has to sponsored by employer itself. They are unwilling to do so much paperwork and bear the attorney costs.
- It is easier to get it converted into green card.
- The H1 cap that we hear about doesn’t apply to docs.
- If you are aiming for this visa the number of programs that you will have as your options will be less.
GRE
route:
- You clear GRE
and take up courses like Masters in Public health for 2 years or so (some say 1 year??!!, not sure) Give MLE while in US
- You get an F1 visa
- Normally you have to pay for your course which entails a expenditure of around 7-10 lakhs
- There are aids/scholarships etc available but not for all, you’ll have to try hard for them
- Plus 2 years more before you can get residency.
Well friends, I'm sharing my views on few more topics that have been requested by many of you friends.
Factors that determine getting a residency slot:
Well that’s pretty subjective again. At times guys with lower scores have gotten better residency slots than those with higher scores. Still I'll list all the factors that go into determining the probability of getting a residency slot.
1. MLE scores:[tex] This is the single most important factor for an IMG at least. The higher the scores the better are the chances. Now there is a confusion over step 1 or 2 scores which are better. General perception is that Step 1 scores are more important. But I'd like to tell you about a study on this factor.[/tex]
This study concluded that Step 2 scores had higher predictive value for getting good slots than step 1. The predictive value was not affected when step 1 and 2 combined scores were taken into account. This implies Step 2 scores have the maximum predictive value for getting residency, irrespective of step 1 scores. Few people might contradict this but this is what the study says. Here is an extract from that study…
Quote:
About a month after the completion of the 2004 Residency Match, Kaplan surveyed a set of students who had taken USMLE
preparation courses with us over the past year. Students [tex] were asked whether or not they had secured a residency position, and for some information about themselves, such as USMLE
scores, USMLE
failures[/tex], the date on which each USMLE
Step was passed, the number of programs to which they had applied, their year of graduation from medical school, and whether they were permanent residents of the U.S. or not.
By far, the best predictor of getting a residency position was the USMLE
Step 2 score! Good Step 1 scores were also positively related to getting a residency, but STEP 2 scores mattered MORE!
When both Step 1 and Step 2 scores are placed in a stepwise regression analysis to predict the chance of getting into a residency, once Step 2 is entered into the model, there is no predictive capacity left for Step 1. This means that adding a Step 1 score to the model does not give a better prediction. A Step 2 score, by itself, gives the best prediction. Using just Step 2 scores as a predictor, we are able to derive a model that correctly classified 75% of those who did and did not get a residency position.
2. Research: The funda in US is "PUBLISH or PERISH". Research oriented docs are very highly rated. They expect you to be inclined to do research. If you have published research papers, you definitely have an edge. If you don’t have your own papers, any association to any research (like research assistantship) is also plus point cos that shows your interest in research.
3. USCE (US Clinical Experience): This is again a very important factor. Rather many programs shortlist only those candidates who have some USCE. It can be observership (where you only watch docs treating patients, not involved in any way in patient management), [tex]externships (You get hands-on experience). Plus if you are targeting a specific program, it’s better to do such externships at that hospital, cos that would increase[/tex] their chances of taking into their program. But these are tough to get and you need some sort of contacts for that.
Remember USCE is getting more important with every passing year.
4. LORs: These count a lot specially if written by US doc (which is possible only if you do an externship under him). Still a well written Dean's letter and LORs by professor's from your medical school helps.
5. Visa status: Many programs prefer green card holders, cos they don't want to get into visa hassles. Most programs prefer J1, lesser no offer H1B (visa issues already discussed). Bottom-line is they prefer a candidate with minimum visa hassles.
6. Contacts: well [tex]they work everywhere. If you know a big shot[/tex] in the same university, he might coerce the PD into taking you.
7. Interview itself: Never forget the importance of a good interview. PDs at US want an all round personality..[tex] pleasant, confident, witty with good communication skills. Many guys get a seat over others with higher scores just becos they can have an impact on their PD during interview. General interview rules do apply to [/tex]residency interviews. Start brushing up your communication skills from today itself.
8. Program selection: There are certain programs termed IMG friendly. If you apply to them, there are higher chances of getting a seat. Plus assessing your own status and factors and being realistic in applying to right programs increases your chances.
9. Co-curricular activities: As I [tex]said they just don't want a dumb book worm. I've been told, if your CV contains other stars, like sports and other co-curricular activities, [/tex]it’s a plus point.
10. Others: Like Teaching experience, some audit experience, previous PG in India, MPH etc. may help you a bit.
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As always, suggestions/queries/comments are welcome from all..
Sorry guys when i started i never knew it would becum so huge post. Hope it helps at least sum. Otherwise i be awarded with "The LULLABY of all times" award..
That was loads of great information AshB. All compiled together on this thread.Kudos to you.
Id like to say that its very very important to keep in mind the post PG scenario in both countries.
The post PG scenario in India is BAD!Even if U hve a post graduate ( these days super speciality counts), from a premiere institute, life after pg is tough, very tough and u may be payed in peanuts after slogging for hrs.
Unless u have a home setup, medical practice (especially good ethical practice) has become very very difficult in India.
Preparation wise Id say both MLE and aipge require the same slogging though MLE may be an easy exam.
U R RITE DANA . THESE DAYS IT IS VERY TOUGH AFTER PG ESP WEN THEY R INTRODUCING COMPULSORY SERVICE AFTER PG ( ATLEAST FOR 3-4 YEARS )AND ALSO AS U SAID NOT EVEN PG IS ENUF THESE DAYS U NEED SUPER SPECIALITY FOR THRIVING THIS COMPETIEIVE WORLD. ALL WE GET DEFINETLY IS PEANUTS !
AND EVEN IF U COME AFTER RESIDENCY BACK TO INDIA U CAN JOIN A PRIVATE HOSPITAL SETUP AND I THINK NOT BAD ABT IT
Thanks dana and sravya, i hope this post serves its purpose, ie. to give a broad but good idea to starters.
N dana, i think this post-PG scenario is d biggest reason why students like me are taking up MLE, inspite of d fact that i love my country. It is very very very frustrating, is all i can say...
i think this is a very gud effort. The biggest dilemma that we med graduates face these days is betn aipge and international exams!
And its very very difficult to completely ignore aipge and not even try for it.
Its a decision hard to make and needs a lot of introspection.
About preparing for both aipge and MLE id say that its a huge bet. u may end up losing both ways or else if ur one of those lucky ones...u may crack both the exams.
At the end of the day its a personal decision. But a decision tat needs a lot of gud and correct advise.
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