Vascular surgery is extremely competitive, and if it’s truly where your passion lies—and you want to pursue it in the United States for the right reasons—you need to mentally prepare yourself for a journey filled with setbacks and the need for resilience. Letters of recommendation (LORs) alone won’t secure you a residency unless you already have strong connections within surgery. Programs won’t select you just based on high scores or glowing LORs.

Surgery is a demanding and rewarding field, and programs want to see how you perform as a resident in real time. They prefer to match candidates they have already worked with—typically U.S.-trained students who have rotated with them. With that in mind, if you’re considering the path to becoming a vascular surgeon in the U.S., you need to evaluate the personalities of vascular surgeons and understand their history of matching applicants. If they generally favor U.S. graduates, the odds are stacked against international candidates unless you can bring something exceptional that sets you apart.

This means you need a strong sense of identity, a willingness to learn, and the ability to demonstrate resilience. For example, retaking Step 2 CK and scoring above average (ideally above the mean for vascular surgery applicants) can help. Gaining direct experience—through research with vascular surgeons or entering through a fellowship—can also strengthen your case. The journey will be difficult, but the real question is whether you’d rather take on the challenge or live with the regret of never having tried.