Post-Graduate Residency training in Pakistan and USA: Benefits and risks.

Post-Graduate Residency training in Pakistan and USA: Benefits and risks.

(Dr. Faran Ahmad, King Edward Medical University, 2004-10)

Over the years, post graduate training programs have such a drastic downfall in Pakistan that our young medical graduates are in genuine panic. Their future is at stake while our so called leadership is blindly indulged in power politics. Firstly, the entrance exam to post graduate training, FCPS-1 is such an ambiguous and futile exam that it’s the fate which helps you pass it. Secondly, even if you pass that famous FCPS-1 exam, chances of getting a training spot under a serious and dedicated supervisor are totally dismal. Our Supervisors are lot more busy in their private clinics and money making tactics that they don’t even prefer or consider their post graduate trainees. You are lucky if your supervisor is caring enough that he knows your name and credentials.

 Now, here comes the most important question: What should a fresh graduate do? This question needs serious consideration. There is no generalized answer. If you have selected medical profession to end up as a competent and professionally skilled doctor, you should seriously consider post graduate training abroad. If you are not affording the finance or your family obligations are not favorable enough to do so, then again listen to yourself. What you actually planned at first place? A “good doctor” or “a money making machine”. In current state of affairs, if you have plans of becoming a proficient doctor while remaining in Pakistan, then I fear chances are not more than 5-10%. You can only pray and depend upon your fortune to join that “5% club” in at least a dozen of years. And if you selected medical profession to become money making machine, then I must tell you that you have been ill-advised primarily. You start earning a good and healthy amount to run a family in your late 30s to early 40s. Get ready for financial support from your family and long duty hours in private clinics till your hair start graying.  There are no more paid slots for post graduate trainees and those trainees who have passed PPSC (Punjab Public service commission) interview selection process they have already received job termination letters. During this money making struggle, passing a post graduate exam is no less than a marvel.

Post graduate training in USA is challenging but gratifying. Better outcomes need great efforts. Path of success is full of ups and downs but when success is explicit, even challenges become exciting. Based on your personal preferences if you plan your future in USA, it needs preparation from your graduation years. Consider standard and recommended USMLE books to prepare your professional exams. Take your parents under confidence and keep on updating them about your career plans. Try to remain in contact with your senior fellows in US hospitals so that they may arrange elective rotations for you in the hospitals where they work. Try to score as much as you can on USMLE. Take your time. If you have sound scores, you are always suitable candidate. Don’t get distressed by visa issues; apply for it with complete application. Consult your senior visa holder fellows. You will get visa for sure, except in less than 5% cases where processing takes some time.

 Residency training in USA is not just a professional track; it’s a life time decision that needs an appropriate planning. Once you have determined to follow this path, let me tell you that your each and every decision is connected with your US career plans. Few of our young fellow doctors follow mob psychology and go for USMLE, but later on they face family life crisis. So, keeping your family on board regarding your career plans is of prime importance. You are the one, who will appropriately clarify the facts to your family and if properly explained, surely they will be supporting enough.

 Meanwhile, let me share some essential and good to know facts:

Ø  >By the time you are done with your USMLE, you are academically way ahead of your fellows as you have studied the basic medical concepts to such an extent that passing any exam is no more difficult.  Jobs follow proficient doctors.

Ø  >The Clinical Skills (CS) exam of USMLE series grooms your communication skills to such an extent that you become capable enough to gain a patient’s confidence. This increases your personal patient density. I am sorry to say that post graduate trainees in our country have meager communication skills, because they have never been trained on those lines.

Ø  >With a complete US residency application (ERAS CV), there is no doubt that one will get into residency training in the end.

Ø  >Once you complete your residency training and pass the board exam (they have 90%+ board exam pass rate on average, not like 7% pass rate of FCPS II; another eye-opener), you become a dynamic, multifaceted, up-to-date and highly professional doctor who can work anywhere in the world, even back in Pakistan.

   >Always keep a back-up plan. “Burn the boats” is a famous quote but in medical profession this means “cutting your legs”. Take your home country post graduate entrance exams as soon as you are done with your step 1. Passing an exam never harms. I know many US medical residents who passed their FCPS-1, MRCP-1 etc along with USMLE. 

>  Remain in touch and up-to –date. Start preparing for USMLE from your graduation years.

Ø  >“Enjoy” taking USMLE. You are updating your medical knowledge. Focus on each and every step while you are mastering it. Remain process oriented.

Ø  >Score well. Gain at least 3 months US clinical experience before applying for residency, hence time accordingly. Timing matters.

Ø  >Develop strong networking with your colleagues who are currently residents in various US hospitals.

>Ø  Finally, be positive; think positive and you will get the positive results, Insha’Allah. Positive thinking is secret of success.

   Don’t Do’s:

Ø  >Half hearten exam attempts are more risky than no attempts. So, take your exams when you are fully geared up and confident. It’s a one-time chance.

Ø  >Avoid the people who try to demoralize or confront your future plans. This pathway is already very challenging and testing. There is no space for such demoralizing elements. Leave them with their views.

 And to conclude, life is not all about US residency training. If Allah has some better strategy for you than residency training in USA, be acceptable and pleased. Move ahead with your career goals. There is no full stop for a competent person. Options are always there. Continue with post graduate training in your home country and your USMLE based knowledge will easily distinguish you from other fellows. Keep on taking exams and updating your medical knowledge. Otherwise, you can continue with general practice in recognized national institutions i.e. Military medial core, federal departments etc. And if you are ready, then academic career in medical colleges is welcoming you to hunt your professional goals as a teaching medical doctor.

                                     By:    (Dr. Faran Ahmad, King Edward Medical University, 2004-10)


  1. Very neatly and well informed writing. I would like to ask one question: I am giving FCPS II paediatric surgery exam this year. I am Kemcol and trained from The Children's hospital Lahore. How can i start USMLE pathway after FCPS in paediatric surgery?

  2. with every passing year after graduation, chances of Interview invitations of ECFMG certificate(step1+step 2 Ck+ CS) holder decreases. Once you are a part of residency training in Pakistan, until unless you get a Degree that additional clinical experience will only Help you if You have good scores on USMLE and only if you Apply for residency in relevant field. Meanwhile for US residency , it is US clinical experience that counts.
    Try to score 240s on USMLE, you can compete well.!!

  3. Very well written article and sound advice for young grads and undergrads.
    A quote from our great teacher, Prof Faisal Masoud " There is always a place at the top; all you have to do is ... reach there ! "
    A small correction: it's Army Medical Corps ... :-)

  4. Its a bit late to begin with, I advise you to pass USMLE exam series ,and go for fellowship spot in pediatrics rather than doing residency in pediatrics again in US. They offer that as well.

  5. Hassan Tariq BhattiApril 27, 2014 at 8:00 AM

    yes sir i agree,no sub to hardwork though cpsp needs reform


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