In this blog, I am going to share my experience on how to apply for US fellowships here (I had applied in 2012-13).
1. Clearing the USMLE (United States Medical Licensing Examination) is a must to be able to work in any clinical fellowship. Try deciding whether to give the USMLE as early as possible to save you time. This however is easier said than done, and I myself had given the steps only after my MD got over (during my bond year). You usually have to apply one or two years earlier than the fellowship date (so in case you are applying now, you will be applying most likely for the 2019 or perhaps even the 2020 fellowship, unless there is an urgent vacancy). I thus had to wait an extra year after the bond before my fellowship started. Having said that, I do not regret the extra year of waiting, because I was able to refine my interpretation skills here in India in that time and make a better impact in my fellowship.
2. Clearing the MLE is more a matter of time (and expenditure) than of anything else; anyone who was able to secure a radiology seat in the competitive Indian NEET scenario will perform well in the MLE. It took me four months during the bond (evenings were pretty free to study) to give Step 1, another two months for Step 2 CK, and a month for Step 2 CS. I had read First Aid and Kaplan notes along with usmleworld for Step 1 (Kaplan notes were not very useful retrospectively). Step 2 CK preparation was predominantly usmleworld, and a little bit from First Aid, and Step 2 CS was a lot of hands on practice with another colleague giving the exam with me. It is a good idea to give Step 3 as most programs now want it as well. I had clubbed giving Step 3 along with my fellowship interviews and most programs were fine with it, but times may have changed now and you might want to confirm this. The only thing I read for Step 3 was half of usmleworld, and it was enough (its pretty similar to Step 2 CK).
3. Step 2 CS can be given in whichever order (you do not have to finish Steps 1 and 2 CK to give it). You should pick up the dates as per your convenience but early enough such that you do not have to keep waiting for the results very long.
4. Once you finish your final Step, there is usually a 4-8 weeks lag for your result to come out. Use this time to get your CV, SOP and LORs ready.
5. The neuroradiology, IR and breast imaging fellowships follow a centralized system of application called NRMP match (http://www.nrmp.org/fellowships/radiology-match/); thus for these two fellowships you can upload your papers online and select all the programs you wish to apply to on one website. This makes it rather convenient! I had not applied via the match so I cannot comment much on this route.
6. The other fellowships do not however have a centralized match. Hence you have to email and apply individually to each and every program you are interested in. The email should be sent to the fellowship program coordinator; it should be a short application with all relevant documents attached. I have attached a screenshot of the email I used to send as an example.
7. So as not to miss any program, I first created an excel sheet with all different fellowship programs and the emails of the program coordinators. This is easier said than done as there is no standard list of hospitals available on one site for radiology fellowships, unless you have paid for the NRMP match access. I first went to the FREIDA online website (https://www.ama-assn.org/life-career/search-ama-residency-fellowship-database) which has a list of all residency programs with associated hospitals. I then went to each and every hospital website, went to their radiology section, into the education/fellowship programs, read whether there is any vacancy and for which year, and then saved the corresponding email address to the excel sheet. You can of course borrow such an Excel sheet from a friend (if recent) and cross-check subsequently If there is a shorter route, someone please do comment on it or email the same to me so that I can put it up!
8. I then emailed every program coordinator of a fellowship I was interested in applying. I converted all rejects into red font color (or you can delete them from the excel sheet), kept all the ones who did not reply as yellow, and similarly color coded those who said that they had a vacancy and are considering my application as green.
9. Remember that program coordinators are humans and they often miss out on replying to emails or to following up. So it is your job to resend the application if there is no response (around 50% will not respond till the end or will say that the program needs only board certified candidates). Similarly, if someone says that they can consider your application only later (which means that they are waiting for US board-certified radiologists to apply as of now, and will consider your application if a vacancy remains later), then you must send the reminder emails!
10. Once you have applied everywhere you wanted to, you just have to wait. Usually responses trickle in slowly, particularly if you have applied early. I had only one positive response for a month, but then ended up getting interview calls from six places eventually.
11. An interview call is the successful culmination of all your hard work. What happens subsequently often depends on how well you give your interview, your body language, how good a fit you seem for the program, and often a little bit of luck (there is a vacancy which needs to be urgently filled etc). Your CV still matters for sure in deciding between different candidates.
12. Some universities (like the University of Washington Medical Center) offer the four year pathway upfront, whereas in others, you have to work your way through securing individual fellowships. It is important to be clear if you are interested in the four year pathway, as this may entail scheduling four days of interviews with different subspecialty departments. There is no reason to hide this anyway, as people are usually willing to help or at least be frank whether the four year is a possibility or not.
13. There are other routes of entering the system as well. You can apply for a research fellow position at one of the big hospitals (it may be a paid or an unpaid position), and then impress people with your hard work to make a successful application the following year. You can also apply for a residency program match (repeat the radiology residency in the US; this may be preferred by many over the uncertainties of a four year pathway as this guarantees board certification). And there are people who have successfully done a primary radiology residency in the US as well (having directly gone to the US after MBBS); these will invariably need research experience in the US with a mentor.
Hopefully this write-up helps you clarify some of the steps you need to undertake in applying for an American fellowship.
– Akshay Baheti
PS: You can check our other blogs on training abroad in our section ‘Beyond the Shores’.