Addendum: Reflections of a a medical student who went abroad for her MD

I have wanted to write a post about what it was like to be an IMG and the pros/cons of going off-shore for an MD for some time. Yes, officially I am done with this blog but for those future SGUers that may be reading later or lurking this post is for you...

My List of 10 Things to Consider:

1. SGU or another Caribbean medical school (but be careful because they are not all created equal) offers you a chance to earn your MD, a CHANCE to become a doctor. Getting accepted and going to SGU is by no means a guarantee that you will achieve your dream. I think this is an important point to make and for future and contemplative students to understand. I could tell you about a boy that came to SGU but left after a term because it was just too hard, I could tell you about a girl that left her fiancé to attend medical school and could not figure out how to be in a relationship with 1500 miles between her and her betroved. I know a student that left and is now in PA school. I personally know several people that despite graduating are unmatched and trying to figure out a way to secure residency in 2014. The say the hardest part of medical school is getting in. That may be true for US schools but I would not same the same for SGU.

2. Medical school is hard. You have to want it. And you have to be doing it for yourself. Otherwise, see above.

3. Even if you succeed and graduate, you MAY NOT MATCH. This is the truth and it is sucks. So if you have options, are young or simply don't want to be in this situation figure out how to get into a US Medical School. Go to DO school. Get into a medical masters program and try again. Being an IMG is a disadvantage and unfortunately this situation is only going to get worse.

4. You are one of many. The class sizes are large and growing each semester. There were 418 students at my white coat ceremony and another 86 that joined us second year from the Global Scholars Program in the UK. That means I am one of 500+ students in my term. The good- you can find your own click, study group, friends, out of 500+ this just happens. The bad-you never know everyone, you may rotate with fellow classmates that you never knew on the island. The professors and faculty will not know you unless you happen to do research (which is no small feat during the basic science years) or go to office hours incessantly. Individual attention is not going to be given to you so if you need small class sizes or personal help think twice before choosing SGU.

5. Your medical school only exists as an umbrella. Once you leave Grenada there is no campus, no SGU events or official student get togethers. You must seek out your own mentors and get advice on how to apply for which residency. For me this was not much of an issue as I was already decided that I would do Child Neuro and Dr. Boyfriend had gone through the whole process so I had support and mentors from my past research job, etc. For some students this was difficult and they struggled figuring out what they were going to do, what to apply for, how many program to apply to, etc. US medical schools tend to have academic advisors and small groups of students that meet throughout the four years and this type longitudinal support is lacking at SGU.

6. Medical school is DIY. I am sure that this is somewhat true for all medical schools but being an IMG in a class of 500+ students accentuates this aspect. There is no personalized instruction or mentoring. Sure you have an assigned faculty advisor but this is mainly lip service. I  was able to meet with mine a total of two times in two years.  One of the meetings was a lunch for all of the advisees. My advisor did not know my name. When I emailed him, his secretary responded. I had friends that had slightly more involved academic advisors but it really comes down to the fact that there are SO MANY students and that you are only on the island for two years. Resources are limited in this regards. Once I left the island I thought maybe I would find a clinical mentor but since I rotated at nine different hospitals and was continually moving this was a difficult proposition.

7. You have no medical center home.  I was continuously changing hospitals during my clinical years.  I rotated in county, state, community, private, and inner-city hospitals and saw a variety of patient populations. In doing so I learned different ways of accomplishing similar tasks. I believe this was a huge advantage and as I interviewed for residency I was able to apply my knowledge of different programs and know what I was looking for. Learning a new computer system or finding my way around the hospital was no longer a daunting task but simply part of each new rotation. Sure it was a pain to live out of a suitcase and move every 4-12 weeks but I liked the variety and exposure. For some, this is a disadvantage and there are work arounds.  Note, you can choose to stay in one area but if you do this then you are limited to some of the less desirable places to train, in my opinion. I think moving around gives you a more diverse education better chance to network, etc. This worked for me but it was not always ideal.

8. You get to live in a foreign county. This was good and bad. I loved the experience and enjoyed Grenada. Many of my classmates did not. I missed my grandmother's funeral. I missed many birthday parties, weddings and family Holidays. There was no option of going "home for the weekend". This means that I was freed from many social obligations but it also meant I missed out on those special family moments. I lived away from my husband for two years and we joked about our "marriage by skype" this worked for us, but it was difficult.

9.  You will most likely enter primary care or IM. This is simply a fact. If you desire to become a neurosurgeon or a dermatologist than SGU is not for you. Sure a token few in the top 5% of the class will match into a couple of highly competitive residencies but the vast majority (over 70%) are going into Family, IM and Pediatrics. Surgery, ER and anesthesia are possible but very competitive. This is the reality of becoming at IMG. (Note-I based my calculations on the 2013 match list with a denominator of approximately 700.)

10. You will be in debt (unless you are a trust fund kid or have independent wealth of course). This is really not unique to SGU as all private medical schools are expensive but living in a foreign country and having to move around during 3rd/4th year adds to the expense. My medical school debt is over $350,000. I just finished my exit loan counseling and my monthly loan payments will be over $2000 (which is the graduated 20 year plan.  Note, you do have the option to defer these loans during residency and accumulate more interest or pay based on salary but these options only apply to Federal Stafford loans not any Direct Plus or private loans you may have taken to subsidize expenses or apply to residency, etc.)  Also note #9. As a PCP you will not make the big bucks to pay off your loans so unless you do a loan forgiveness program you will most likely be paying off your education for a very long time. I never really thought of this aspect or spent too much time worrying about the debt that medical school requires as money was not my reason for choosing the field. Yet I now believe this topic is worth the mental exercise.

If you can be happy doing something else, do it. If not, well then choose carefully, have a plan and may luck be with you!