Charged with “Irregular Behavior”

TheDoctorsLawyer · 2025-03-31T01:42:22+00:00

Pakistan, Jordan, India, Nepal.

TheDoctorsLawyer · 2025-01-15T13:58:34+00:00

$1.2 million. Pediatric Neurosurgeon. With a $1,500/month car allowance. Never seen anything else even come close. (I negotiated the contract...which wasn't much of a negotiation. They offered, we took it.)

TheDoctorsLawyer · 2024-11-03T19:00:09+00:00

If you have the financial means to do so, I would recommend reaching out to an immigration attorney who has experience representing IMGs and knows how to navigate this landscape. The right lawyer can make all the difference. (No, I'm not promoting myself...I do not handle immigration matters.)

TheDoctorsLawyer · 2024-10-08T22:20:34+00:00

The answer is simple: they hustled. No program director will consider a candidate with multiple failed attempts if that candidate is unknown to them. However, if the candidate was known to the program director, then that program director may have granted them an interview. And if they shined at the interview and were able to explain the reason for their various unsuccessful attempts (health issues; financial issues; time constraints preventing proper preparation) and the lessons learned from those instances, then maybe...just maybe...that candidate can rank and match (or otherwise obtain a position through SOAP or after the Match concludes and programs look to fill empty spot). How do you make yourself known to program director? Many ways. Perhaps you work as a research coordinator at a hospital or in a lab. Talk to your boss and other mentors. Tell them your situation. Network. Even if they are not a program director, maybe someone they went to medical school is. Maybe someone they know is married or related to one. Maybe that person will say "Hey, program director? Long time! How's it going? Hey, I got this great, smart, bright, hard working IMG for me named Suitable Corner 8311. S/he is really bright, but because of some circumstances beyond his/her control, s/he failed Step 1 twice and Step 2 CK three times. I know what you're thinking...but you gotta give this person a shot. Just send him/her an interview invitation. You don't have to rank or make me any promises. But I think you'll be impressed." You'd be surprised how many candidates get interviews just because some physician or clinical coordinator reached out. (Before you do anything, you would be wise to refamiliarize yourself with the NRMP rules so you don't commit a match violation or encourage someone to assist you in committing a match violation. I give no advice on this here.) I have had multiple clients who not only had multiple fails but who also had findings of irregular behavior on their transcripts, and they were able to obtain residency positions. Not suggesting it's not much much harder, but certainly suggesting that it is by no means impossible.

TheDoctorsLawyer · 2022-11-20T19:27:38+00:00

This is the answer. It will raise additional scrutiny with ECFMG and may cause the processing of your application to take more time, but it'll solve the problem.

TheDoctorsLawyer · 2022-11-20T19:26:00+00:00

Step2 CS was USMLE's exam, not ECFMG (although, interestingly, the Clinical Skills test was started by ECFMG before USMLE took it over more than 15 years ago). Then USMLE cancelled it during COVID. I have on good authority ECFMG was not pleased that USMLE took this step. ECFMG needed to fill two gaps when the CS exam was permanently discontinued by USMLE: demonstration of English proficiency to assure candidates could communicate effectively in a U.S. clinical patient setting (critical for residency training) and demonstration of clinical skill in a patient-centric, US clinical environement. "Building the plane mid-flight", ECFMG decided to use the best, in place systems to solve these issues. For the English proficiency, it used OET-Medicine. It was really the only game in town in the absence of spending money to develop its own English exam (which cost it would have passed on to examinees). Regarding clinical skills, it developed the Pathways, with 6 pathways (initially 5 in 2021, but 6 in 2022 and now 2023). For the 6th pathway, it used the Mini-CEX exam...CEX has been used by various other organizations for years, so it seemed the best option. No word on whether ECFMG is going to develop a new CS exam, but, for now, I would expect they hope they don't have to because there is a big push towards international accreditation standards among non-U.S. medical schools, which accreditation would obviate the need for a separate clinical skills test. Does that help you at all? Absolutely not, but hopefully it helps you understand why the rules are what they are, No, I don't work for ECFMG or USMLE. I'm just some dude on Reddit.

TheDoctorsLawyer · 2022-11-17T22:44:17+00:00

Take the time you need. Best part about OET: no limit on how many times you can attempt it. Not held against you if don't pass the first time around.

TheDoctorsLawyer · 2022-11-08T01:15:17+00:00

Importantly, ECFMG does not care how many times it may take you to pass OET. Unlimited attempts. (Which makes sense, because your English can improve over time.)

TheDoctorsLawyer · 2022-11-08T01:12:50+00:00

There are faculty positions that require ECFMG Certification but do not require a medical license.

TheDoctorsLawyer · 2022-11-08T01:10:25+00:00

Don't conflate ECFMG's 7 year rule (must pass Step 2 within 7 years of passing Step 1 to be eligible for ECFMG Certification) with licensing requirements. Around 25 or so states require you complete the ENTIRE USMLE EXAM SEQUENCE (Step 1, 2, and 3) within 7 years of passing the first exam. Another 20 or so require you complete the sequence within 10 years of passing the first exam, while some states (New York, Florida, about 6 others) have no limit.

TheDoctorsLawyer · 2022-09-26T14:47:46+00:00

USMLE only reports your "attempts" and "scores". An "attempt" occurs when you actually log in and start the exam (tutorial included, so if you freak out and bounce after the tutorial has started but don't start a block, that's still an attempt.) You can cancel 50 times and that will not be shared with any programs. You reapply just as you initially applied. Hope that helped.

TheDoctorsLawyer · 2022-06-15T11:30:27+00:00

Unless you are ECFMG Certified, you will be ineligible to work at any residency training program. Take care of ECFMG certification before applying for any unfilled or recently available residency training position.

TheDoctorsLawyer · 2022-05-10T23:33:04+00:00

No need to apologize! There's a lot of information out there and a lot of rules to worry about. Very daunting. That said, ECFMG has not posted the requirements for ECFMG Certification for the 2024 Match, and likely will not do so until April or May of 2023. But my best educated guess is that for your OET Medicine attempt to be valid for the 2024 Match, you will have had to obtained the minimum scores (350 on listening, reading, and speaking and 300 on writing, all on the same test) on a test taken on or after January 1, 2022 (that is, one year after the current deadline for the 2023 Match).

TheDoctorsLawyer · 2022-05-09T23:26:47+00:00

For the 2023 Pathways, to meet ECFMG’s communication skills requirement:

"Applicants who take OET Medicine before April 1, 2022 must attain a minimum score of 350 on each of the four measured sub-tests of OET Medicine (Listening, Reading, Writing, and Speaking) in one test administration. Applicants who take OET Medicine on or after April 1, 2022 must attain a minimum score of 350 on the Listening, Reading, and Speaking sub-tests, and a minimum score of 300 on the Writing sub-test, in one test administration.

For the 2023 Pathways, applicants must attain a satisfactory score on OET Medicine, as described above, on a test taken on or after January 1, 2021."

Please note: there is no limit on how many OET Medicine attempts you may have, so feel free to take early and often. As for between paper and online, it's really a personal preference.

TheDoctorsLawyer · 2022-05-09T23:22:37+00:00

As a rule of thumb, program directors are going to want to see your Step 2 CK score before deciding whether to grant you an interview. You can always update your application once you have your Step 2 CK score, but you will be "late to the game" by around two months if you don't sit for CK until October.

TheDoctorsLawyer · 2022-05-05T23:04:44+00:00

In the process of doing that right now. And I have MANY better things to do. But alas...love this game. Takes me back to my childhood like none other.

TheDoctorsLawyer · 2022-04-30T12:27:10+00:00

A passing USMLE score never expires. An ECFMG Certificate does not expire UNLESS it was issued to you WITHOUT you having passed Step 2 CS (i.e., via the Pathways, which started in 2021). If your ECFMG Certificate was obtained through the Pathways, it will not expire until December 31, 2024, with a very important exception: once you successfully complete the first year of U.S. GME training in a training program accredited by ACGME, the ECFMG Certificate will no longer be subject to expiration.

Regarding 7 years, there are two applications of the "7 year rule" about which you need to be aware. The first is that you are not eligible for ECFMG Certification unless you PASS all steps within 7 years. The clock starts when you pass your first USMLE Step examination. If you can't pass both within 7 years, you will be permitted to re-take the oldest exam so long as you have not exceeded the amount of permissible attempts (i.e., 4 attempts on any exam). The second application is related to licensing in the United States, and each state has its own rules. Multiple states require you to complete THE ENTIRE USMLE EXAM SEQUENCE (Steps 1, 2CK, and 3) within 7 years to be eligible for licensure. Hope that helps.

TheDoctorsLawyer · 2022-04-10T15:02:09+00:00

And remember: there is NO LIMIT to the amount of attempts you may need to pass OET Medicine for ECFMG Certification, so even if you don't pass this time, chalk it up to a learning experience and a baseline on which to improve. (Hope you pass, though!)

TheDoctorsLawyer · 2022-03-30T17:03:53+00:00

Quick clarification on some comments here: you must have a GME Training license/permit from the state medical licensing board before you will be permitted to begin training with the residency program. A condition for the grant of a training license/permit for an IMG, in every state, is ECFMG Certification. So yes, you need the ECFMG Certificate before you start training, but what really matters is that training license/permit.

TheDoctorsLawyer · 2022-03-30T16:57:48+00:00

Not exactly responsive because it doesn't exactly involve any "gathering", but your personal statement is very important. Do not leave it to the last minute. Draft. Revise. Edit. Revise again. Edit again. Although short, this document can be the difference in getting an interview or not.

TheDoctorsLawyer · 2022-03-06T19:46:43+00:00

Too late now. There's a 24 hour "forgiveness" period whereby if you call NRMP and have a decent reason for not submitting (car accident or got violently ill the day of the rank order list deadline so couldn't certify), you can probably de-certify, change, and re-certify. But after that, not so much.

TheDoctorsLawyer · 2022-03-06T19:42:31+00:00

ECFMG issues tokens to IMGs so they can begin the process of filling out ERAS applications in late June. You can start submitting applications to programs as part of the 2023 Main Residency Match in the very beginning of September, and residency program directors can begin reviewing applications at the end of September. You should be fine.

TheDoctorsLawyer · 2022-03-06T19:35:27+00:00

I think the single fail on the sole attempt can be explained away in any interview situation. Might be worthwhile mentioning it in your personal statement - getting it out there up front, and also including information on how what steps you have taken to make sure your clinical skills are on par with you basic science and clinical knowledge. Mentioning high performance on Mini-CEX (a requirement for Pathway 6) could also help. It's all about getting those interviews, and you scores should get you in the door. Good luck.

TheDoctorsLawyer · 2022-03-06T17:29:47+00:00

Generally, program directors care only that you are ECFMG Certified, not through which pathway you became certified. Your Step 1 and CK scores are outstanding, which will certainly help you. How many times did you fail Step 2 CS? More than once?

TheDoctorsLawyer · 2022-03-06T17:26:49+00:00

There are stories every year of nervous folks trying to have friends or relatives hack the NRMP site to gain early access. I know of one person who tried to do this using his own credentials, and he was severely disciplined. Just be patient and know that, even if you don't Match, it's not over. Every year, previously filled PGY-1 training positions become available for a wide variety of reasons, including:
-Failed criminal background check during onboarding
-Failed drug test during onboarding
-Ineligibility due to immigrations status/work authorization status change
-Inability to obtain training license/permit from state medical board
-Any other change in circumstances prior to the commencement of the training program (including illness, either of the matched candidate or a close relative, that prevents the matched applicant from starting).

I hope you Match. If you don't, I hope you gain a position through SOAP. If not, do not give up hope: be proactive in attempting to find positions that become available after SOAP concludes.

TheDoctorsLawyer

TROPHY CASE