Resident salary rise in 2008

The American Association of Medical Colleges (AAMC) released survey results on what Medical residents across the US were paid for the 2008-2009 academic year and here are the mean figures:

* 1st Year (PGY1 / Intern ): $46,000

* 2nd Year (PGY2): $48,000

* 3rd Year (PGY3): $50,000

* 4th Year (PGY4): $52,000/-

* 5th Year (PGY5): $54,100/-

* 6th Year (PGY6): $56,500/-


Which roughly imply about a 3% increase over the last year.

Full salary survery report can be downlooaded from here:

So this is what a Residency Paycheck Looks like

Well - It isn't really a scan of the paycheck up there, rather the paystub - and like you see, it isn't an amount to boast about ;-) ...but no matter how small, any first payments of labor are always cherished, aren't they ?

What you see is a typical two-week pay and the taxes for a typical resident. Here's summarizing:

Two-week gross:
$1925.00
Taxes:
Federal Income Tax: $234.33
Federal Medicare Tax: $27.91
Federal Social Security Tax: $119.35

Biweekly Take Home Pay:
Around $1543.00

Monthly Take Home Pay:
$3086.00

And here's what my approximate Monthly expenses look like at this point, in a not-too-big-but-decent Midwestern city:

Rent with Gas/Electricity/Car Garage: $600 : 1-bedroom apt
Car Payments: $400
Internet: $20
Cell Phone: $20
Food: $100
Hanging Out, Movies, Car Gas, etc. etc.: $100

Do keep in mind that both - the pay and the expenses, are highly variable depending on state, city and then area within that city...

Residents are not paid hourly, rather a get a fixed biweekly sum. If you divide the stipend earned by the actual total hours worked in a year, with the calls and all, that would be around a measly 5 to 6 dollars an hour.

Many residency programs are indulged in legal battles against the IRS to win back the taxes for their previous residents and exempt current residents, after the University of Minnesota won a case in 1998 when a federal court ruled that that residents are students working towards a degree and not 'workers' and therefore not tax-liable. Eventually, some programs who 'qualify' would have that advantage of lowered taxes - specially the university programs....(another advantage of doing residencies at University programs ? ) Read details on that here.

Iserson’s Getting into a Residency

There are a lot of things you should do for your interview, and Iserson’s Getting into a Residency covers all of them.
I read an excellent article here and I think it is worth reading it...

USMLE and residency

Introduction of the new work permit laws in the United Kingdom may mean that training opportunities have become tougher for international medical graduates. These sudden changes have left many doctors feeling anxious and uncertain about their medical careers. For this reason, further training in the United States, via a residency programme, is being considered a more favourable and secure option. The exam and selection process for a residency programme may seem long and arduous and discourage candidates. We aim to highlight how to make the process as smooth as possible, enhancing your chances of getting the residency programme of choice.

Why USMLE
All doctors wishing to practise in the United States have to take the United States Medical Licensing Exam (USMLE), irrespective of whether they are US graduates or international medical graduates. International medical graduates may take the USMLE to apply for a residency programme, research programme, or work in a superspecialised area. Once you have passed the USMLE and have been certified with the Educational Commission for Foreign Medical Graduates (ECFMG), there is no distinction between international medical graduates and US graduates when applying for programmes.

Whats is residency?
Residency is a period of training (equivalent to senior house officer level) an individual has to do after graduating from (US) medical school. It lasts three to eight years, depending on the specialty. For licensure in the United States you have to complete residency training and step 3 and have ECFMG certification. After this you can apply for a fellowship (equivalent to specialist training).

What is USMLE?
The USMLE has several steps: step 1, step 2 clinical knowledge and clinical skills, and step 3.

Step 1 is an eight hour multiple choice exam and tests basic medical sciences such as anatomy, physiology, biochemistry, and microbiology and their clinical applications. It is a computed exam and it can be taken in several parts of the world, including the United Kingdom.

Step 2 clinical knowledge is a nine hour exam and tests the clinical specialties such as internal medicine, surgery, obstetrics and gynaecology, and psychiatry. This is also a multiple choice computed exam, and it can be taken in several parts of the world including the United Kingdom.

Step 2 clinical skills tests an individual's clinical skills and ability to communicate with patients and can be taken only in the United States. Participants must register for the exam before 1 July and take the exam by 31 December to qualify for a residency starting the next year.

Step 3 tests the clinical management of patients and is administered only in the United States. The programme will normally specify if step 3 should be taken before or during residency.

The step 1 and step 2 exams may be taken in any order. To register for the exams go to www.ecfmg.org for steps 1 and 2 and www.fsmb.org for step 3. All associated costs are listed on the application form.

USMLE Scores
Scoring highly in the USMLE step 1 and step 2 clinical knowledge exams makes the difference between getting a cutting edge residency programme and an average one. In general, scoring 75 percentile (60% to 70%) is enough to pass step 1 and step 2 clinical knowledge, but may not be enough to get into a residency programme. Exams cannot be retaken to improve a score once an individual has passed. You should aim for percentiles in the late 80s and early 90s for an internal medicine residency and late 90s for a surgical residency.

USMLE Preparation
Preparation times range from three to six months for step 1 and step 2 clinical knowledge and one to two months for step 2 clinical skills. It is worth starting study by January 2007 for a residency starting in July 2008. Generally residency programmes like candidates to have less than five years' experience after graduation, so starting the USMLE process soon after graduation is advantageous. However, this varies from programme to programme and scores on the USMLE are particularly important, as are further degrees such as membership of the Royal College of Physicians and strength of the application.


How to apply for residency programme
Before applying for a residency programme you have to be ECFMG certified. This requires your medical degree, medical school transcripts, and step 1 and step 2 clinical knowledge and clinical skills scores.Then you need to enrol in the National Resident Matching Program and apply for a residency programme using the Electronic Residency Application Service. There is no limit to the number of programmes you can apply for, but each application has to be paid for. Programmes rank candidates and in turn candidates rank programmes through the matching programme, essentially leading to a "match." The matching programme main match is defined as "an impartial venue for matching applicants' preferences for residency positions with program directors' preferences for applicants." Matching takes place in March, and both the candidate and the programme are legally bound to the outcome of the match. Residency programmes prefer candidates who have some US hospital experience, so enrolling for an elective in the United States may be something worth thinking about. A letter of recommendation from a US consultant is high on the list for a residency match, but letters from UK consultants may be the next best thing. A detailed personal statement is also required.

Timeline
Ideally a candidate should spend about two years preparing for residency. However, this depends on the individual and in some cases preparation can be achieved in a year. The following guide is for candidates wishing to start a residency in July 2008²:

• Begin study for step 1 and step 2 clinical knowledge in January 2007 (January 2006 at the earliest and March 2007 at the latest)
  
• Step 2 clinical skills should be applied for before 1 July and taken before 31 December 2007
  
• Complete step 1 and step 2 clinical knowledge exams by August 2007
  
• Consider attending observerships in the United States before submitting an application for residency as this is a bonus point on your curriculum vitae
  
• Submit residency application by October 2007 as interviews are generally held in November or December
  
• Scores for step 1 and both steps 2 should be submitted by December 2007 at the latest
  
• Rank programmes in February 2008
  
• Match in March 2008
  
• Residency starts in July 2008.
  

You should allow enough time for getting letters of recommendation from referees. You may also need to get advice on writing a personal statement and interview preparation. If you are not called for interview it is highly unlikely that you will be offered a residency position.

Matching
There are three opportunities to match. The main event is the match in March. After this there is a post-match scramble, where a list of unfilled vacancies from the match is posted on the Electronic Residency Application Service and unmatched candidates have an opportunity to obtain a position. Lastly, www.findaresident.com also posts unfilled positions.

Preparing in UK
You can obtain USMLE videos and notes from this site:
http://www.usmlestep.com/

INTERNAL MEDICINE RESIDENCY PROGRAMS
IMG Friendly Residency

Carraway Methodist Medical Center : Selection Criteria

Montgomery Internal Medicine Residency Program: IMG Criteria
Visa: H1b + J1

University of Alabama, Birmingham : Application Criteria
Visa: J1 + H1b (Case-by-case)
Prematches: No

Residency World - Cardiology

Residency world - Cardiology

This is another popular and competitive IM subspecialty. It also is considered one of the three most procedural subspecialties in IM (sharing the honor with GI and Pulmonary/critical care). Cardiology is a 3 year fellowship, with at least 2 years of required clinical training time. The rest of the fellowship can be spent in research or additional clinical time. The clinical practice of cardiology is highly varied, and it allows for a large number of areas of subspecialization. Cardiologists can do angiograms, angioplasties (with interventional training), right heart catheterization, echocardiograms, manage heart failure, coronary artery disease, hypertension, treat arrhythmias, treat pre- and post- heart transplant patients, and manage adult patients with congenital heart disease, just to name a few. Some cardiologists will choose to do further subspecialty training. After cardiology fellowship, graduates can do a 1-year fellowship in interventional cardiology, where they get trained in such things as angioplasties, coronary artery stenting, valvuloplasty, and even things like pulmonary artery stenting. Another certified fellowship that cardiology grads can do is a 1-year fellowship in cardiac electrophysiology, where fellows are trained in pacemaker placement and interrogation, intracardiac defibrillator placements, cardiac resynchronization therapy, and VT/VF and afib/flutter ablation techniques, among other procedures.

Source: http://www.usmlestep.com

Which IM subspecialties are more competitive to get into then others?

Which IM subspecialties are more competitive to get into then others?

Right now, most people agree with the following order of competitiveness:

Most Competitive:
Cardiology
Gastroenterology
Allergy and Immunology

Moderately Competitive:
Pulmonary
Nephrology
Hematology/Oncology

Mildly Competitive:
Infectious Diseases
Endocrinology
Rheumatology
Geriatric Medicine

Mayo 2005 IM - What is inside?

This is 29 DVD disks:
The following topics are covered in Mayo Internal Medicine Videos:


How to Prepare for the ABIM Certification and Maintenance of Certification Examination
Amit K. Ghosh, MD
Hematology — Anemias
Thomas M. Habermann, MD
Hematology — Malignancies
Thomas M. Habermann, MD
Preventive Medicine
Sally J. Trippel, MD, MPH
Psychiatry
Bruce Sutor, MD
Cardiology — Mechanisms, Diagnosis & Therapies for CV Arrhythmia’s
Peter A. Brady, MD
Cardiology — CAD/MI
Abhiram Prasad, MD
Geriatrics
Darryl S. Chutka, MD
Neurology — Part I & II
Brian A. Crum, MD
Nephrology — Part I & II
Robert C. Albright, Jr., DO
Cardiology — Arrhythmia EKG’s/Clinical Syndromes
Peter A. Brady, MD
Cardiac Physical Exam
Kyle W. Klarich, MD
Cardiology — Systematic & Congenital Heart Disease
Kyle W. Klarich, MD
Gastroenterology — Liver
John J. Poterucha, MD
Pulmonary — Signs & Symptoms, COPD, Pulmonary Functions, Cystic Fybrosis, and Sleep Disordered Breathing
John G. Park, MD
Pulmonary — Diffuse Lung Disease, Occupational Lung Disease
Timothy R. Aksamit, MD
Infectious Diseases — Bacterial & Mycobacterial Pathogens
Larry M. Baddour, MD, FACP
Pulmonary — Pulmonary Infections
Charles F. Thomas, Jr., MD
Hypertension
Gary L. Schwartz, MD
Chest X-Rays
John G. Park, MD
Pulmonary — Neoplasms, Pulmonary Embolism, Vasculitis
Karen L. Swanson, DO
Allergic Diseases
Gerald W. Volcheck, MD
Gastroenterology — Part I & II
Robert E. Sedlack, MD
Gastroenterology — Colon & Pancreas
Thomas R. Viggiano, MD
Infectious Diseases — Fungi, Viruses, Parasites & Other Pathogens
Abinash Virk, MD
Infectious Diseases — Clinical Syndromes
Robert Orenstein, DO
Infectious Diseases — Antimicrobial Agents
Irene G. Sia, MD
Infectious Diseases — HIV Infection
Zelalem Temesgen, MD
General Internal Medicine
Scott C. Litin, MD
Topics in Perioperative Management
Margaret Beliveau-Ficalora, MD
Nephrology — Glomerular Disease
Fernando C. Fervenza, MD, PhD
Nephrology — Dialysis/Acute Renal Failure
Amy W. Williams, MD
Oncology — Part I & II
Timothy J. Moynihan, MD
Rheumatology — Part I & II
William W. Ginsburg, MD
Dermatology
Lisa A. Drage, MD
Women’s Health Issues
Lynne T. Shuster, MD
Images in Internal Medicine
John B. Bundrick, MD
Rheumatology — Part I & II
Clement J. Michet, Jr., MD
Hematology — Part I & II
Thomas M. Habermann, MD
Non-Internal Medicine for the Internist: Urology, ENT, Ophthalmology
Alan K. Duncan, MD
Critical Care Medicine
Otis B. Rickman, DO
Thyroid & Parathyroid
Bryan McIver, MBChB, PhD
Diabetes & Hypoglycemia
Bryan McIver, MBChB, PhD
Genetics
Virginia V. Michels, MD
Pituitary & Adrenal Medulla
Bryan McIver, MBChB, PhD
Adrenal Cortex & Gonads
Bryan McIver, MBChB, PhD
Medical Ethics
C. Christopher Hook, MD
Vascular Medicine
Peter C. Spittell, MD
Cardiology CHF/Cardiomyopathies
Barry L. Karon, MD

Want to get them all?
Click here to get Mayo IM Videos

Mayo 2005 Internal Medicine Videos

Mayo Clinic Internal Medicine Board Review is an intensive program designed to help candidates apply the 'finishing touch' to their preparations for the American Board of Internal Medicine (ABIM) certification and maintenance of certification examinations. For the practicing physician, it also provides a comprehensive overview of all areas in Internal Medicine. All course faculty are affiliated with Mayo Clinic and Mayo Clinic College of Medicine and have had extensive experience in training candidates for various certification examinations. This course is an extension of Mayo’s highly successful and popular tradition of annual board reviews for Mayo Clinic residents and fellows.

ABIM Internal Medicine boards - 10 Tips

* When & How to study for ABIM exam: During your medical residency, schedule time to study for the ABIM Internal medicine boards. The third year (PGY 3) of your residency should be your main time of preparation. Reading alone is usually a bad strategy and often depressing. You may not be able to retain much of the ABIM material that you reviewed alone either. Try to form a study group with other PGY 3 residents who will be taking the same ABIM Internal medicine boards. This will boost every ones morale and give a common sense of purpose. Set a mutually agreeable time for the discussions. The best time to study in a group is over the weekend when none of you have residency obligations. Spending three or four hours every weekend (once a week) is enough to stay focused. Understand what you are studying and the reasons for it. Keep asking yourself the question “why?” and “why not?”

* Study groups: It is crucial that you keep your study group small and stay focused on your ABIM Internal medicine board exam goals. An ideal number would be three or four residents. More than four residents would be counter-productive. Try to have a schedule and read ahead of the planned discussion. By preparing ahead, you will save time, cover more topics and retain more from the discussion. The study group will work best if all participants follow the same board review material. However, different ABIM board review material could also work to your advantage. A good plan is to discuss your ABIM Internal medicine board review study material (Medstudy / Mayo clinic review etc) for the first two hours and then solve multiple choice questions (MKSAP) for the next two hours. Solving multiple-choice questions in groups and discussing each option in detail is vital in developing your thought process and sharpening your clinical decision making skills. You will realize the usefulness of the study group and thank your colleagues when you sit for the actual ABIM Internal medicine boards.

* What to study for ABIM exam: Decide on the ABIM Internal medicine board review material you wish to study from. We have reviewed some commonly used material in this website. The important thing is to choose what works best for you. Choose one ABIM board review textbook and stick to it. It is far more advantageous to revise the same material several times than reading several different materials and getting confused. You must concentrate on solving MKSAP or Medstudy questions at least 50 % of your preparation time.

* Create and devote time to prepare for your ABIM boards. Remember, medical residency is the best time to prepare for the boards. Once your residency is completed, you are thrown out into the real world. If you are starting a fellowship, you will not find much time to study. If you are starting a job as a new physician, your first month will be busy learning the intricate details of medical practice and the paperwork that comes with it. You will most likely, end up designating ten days for study just prior to the exams and as we all know that never works out. So once again, residency is the best time to study. You will not find that kind of quality time after your residency.

* Prepare a schedule to study for ABIM Internal medicine board exams and hang it in a prominent place. You will make several changes to this over time. Plan to revise the ABIM Internal medicine board review material that you have chosen several times (minimum twice). Stay focused throughout the third year of your residency. By middle of the third year, your ABIM Internal medicine board review preparation must be at its peak. If you have not yet formed a study group, now is your last chance.

* Solve questions similar to ABIM exam content: Don’t try to read the ABIM Internal medicine board review material from “cover to cover”. You will not retain much. The best way to prepare is to solve questions, then read the explanation and then look up additional information related to each of the choices (options). This really improves your understanding of the question, familiarizes you with the “teaching principle” and the “testing objective” of that question (which may be repeated in the actual ABIM Internal medicine board exam), and gives you an opportunity to learn about all the other choices and how they differ from the correct answer. Ideally you should be solving MKSAP questions in your second year of residency (PGY 2). If this is not the case, you must definitely begin doing the MKSAP questions by the start of your third year of residency (PGY 3).

* Pictures & Images: Pictures of skin disorders, X-rays and other images given in board questions are generally easy ones to score points. Looking at the image first, before reading the question, usually helps spot the abnormality. Reading the ABIM question’s stem after that will help you put the pieces of the puzzle in place.

* ABIM answering strategies: When reading long multiple choice questions, it may be useful to first read the actual “lead line” of the ABIM Internal medicine board exam question. Once you understand what the question is asking, you can stay focused and look for clues in the long stem of the ABIM exam question. This strategy will also save you time. Several residents have found this strategy useful. As you read through the question, you may also find it useful to underline the key facts and abnormal findings. Once you have gone through the choices, it will be easy to look at the underlined abnormalities and try to “connect the dots”.

* Zebras: Use exam “techniques” to your advantage. Look for target words in ABIM Internal medicine board exam questions. These are referred to as “zebras”. For example in an ABIM exam question, if you see the word “anosmia”, think Kallmann’s syndrome. If you see the phrase “scar on left abdomen”, think splenectomy and look for encapsulated organisms causing sepsis. If the patient is from the Ohio or Mississippi river valleys, think histoplasmosis (CXR calcifications).

* ABIM exam day: Do not study the day before the ABIM Internal medicine boards or in-between the ABIM exam sessions. Discussing the ABIM exam questions with other residents may upset you and adversely affect your performance in the next session. Remember, “What is done, is done”. So don’t cry over spilt milk. Rather, stay focused and conserve your energy for the next ABIM board exam session.

Top Residency Programs

US News Ranking are the standard reference for rankings used to assess schools and residency programs in the United States.


The Top THREE Residency Programs in Internal Medicine (2006 US News Report)

1. Johns Hopkins University
2. Harvard Medical School
3. University Of California - San Francisco

The Top THREE Residency Programs in Family Medicine (2006 US News Report)

1. University of Washington : Website
2. University of North Carolina-Chapell Hill
3. University of Missouri-Columbia, University of Wisconsin-Madison

The Top THREE Residency Programs in Pediatrics (2006 US News Report)

1. Harvard University
2. University of Pennsylvania
3 . Johns Hopkins University