How will H4 EAD affect the residency process for visa requiring IMGs?

Its advantage time for H4 holders.

This article is to see what might transpire for the next couple of match cycles with the US government passing the rule where H4 visa holders(spouse of H1b) will be legally allowed to work in USA until their spouse gets green card. These people will be given EAD(employment authorization) card which basically means they can work anywhere without any restrictions(literally).

So what is the big fuss about it? The Department of state will start to roll out these EAD starting May 26. Applying for EAD will take about 3 months which means by September 15, 2015, most of H4 holders will have EAD and apply for ERAS mentioning that "They dont need visa sponsorship".

Here is where I think the trouble starts for applicants who wont be having H4 EAD. This will purely affect 1000s and 1000s of applicants who require either J1 or H1b to do residency here. These H4 EAD will be considered as equivalent to green card holders and american citizens and these applicants will be considered as US IMGs (visa requiring candidates are referred as non US IMGs). This will mean that a significant increase in their residency chances. It is well known fact that green card holders have a slight edge over visa requiring candidates in residency applications.

1. Some programs are exclusively for non visa requiring candidates ( UT austin, San antonio, aurora healthcare, few west coast programs).
2. Even in visa sponsoring IMG friendly programs, the fact that these EAD holders dont need visa may make those programs rank them higher because they dont have to spend for H1b or go through ECFMG hassles for J1. A typical H1 visa takes about 6000 USD for the program which is a huge amount.
3. Score requirements and research requirements are lighter for EAD holders than visa requiring candidates
4. These persons will hold competitive edge when they apply for fellowships too.

 Another advantage of this H4 EAD is that these applicants can go and do observerships, research appointments anywhere without the hassles of visa. They can stay in this country indefinitely and have no restrictions.

All this means that H4 holders have a very big advantage over visa requiring IMGs. My estimates is that there are at least 2000 H4 holders in this country who will be applying. Obviously not everyone will get residency in first go. I estimate that this will definitely affect the residency process at least for the next 2 residency cycles(match 2016 and match 2017). This does not mean doom for visa requiring IMGs. It means the better visa requiring candidates may be the ones who will match in their first application cycle. More and more visa requiring candidates may go unmatched in one cycle and need to strengthen CV to apply for next ones.

Why US government is doing all this to make life harder for visa requiring people? Well these H4 holders have been waiting for a long time for this EAD. They have been confined to home, ineligible to work anywhere while their husbands worked in large tech companies. This rule applies to all H1 holders regardless of their profession. US govt sees these h4 holders as ahead in the immigration process than the new comers.

Also to remember, not all H4 visa holders will be eligible to apply. In a long green card process, spouse of H4 holders should have crossed a certain stage in that process to be eligible for EAD.

My prediction may not pan out entirely the same way but I believe this will definitely be an issue for visa requiring candidates going forward. Until most of these h4 holders get their residency, it will be a tougher life for the other candidates.

So go back to your basics and prepare harder, score even higher, utilize time to do research and get good LORs. Good IMG candidates will always be in demand.

questions and comments -
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Good luck
Karthik

The Cost of a residency spot - Think about the bigger picture!!

Its not cheap, aint it?
Well residency spot in US doesn't come at a bargain price and it may reallyyyyy stretch your resources. This post is for people who are in their early stages of preparation for USMLE and step exams and also people who are applying this year.
Disclaimer: some expenses may vary depending on whom you speak, some may be old rates. Most of this is costs for IMG who did med school outside of US and Caribbean area.  The logic behind this post is to give a rough estimate. Conditions apply!!

Rough idea of the expenses you may incur

Step 1: 900$
Step 2 CK : 900$
Step 2 CS : 1250$
Step 3 : 850$


USMLE WORLD for all the steps: about 1000$
NBME exams: 400 to 600$
US Visa: 200$
Travel to US: 1200 to 1500$ per round trip ( one trip for electives, second trip for observership, research and last trip for your interviews)
Medical school verification and adminstrative procedure costs: 500 to 800$
Cost of staying in US: about 600 to 1300$ per month(depending on the city)

Interview season expenses:
cost of application: 3500$( for one specialty and applying 150 programs. This can hugely increase to around 5000$ which is what applicants have been spending of late)
Cost of travel for interviews: for 10 interviews, you can expect about 2000 to 3000$. also depends on the location of the program and where you set base in US for travel to interviews, mode of travel(bus vs amtrak vs air), whether program gives hotel accomodation, etc
cost of travel for CS: about 500$
Above costs are more or less mandatory.

There are other costs that happen from time to time:
Cost of applying for electives: 500 to 4000$ depending on the program
cost of observership: 1000 to 3000$ per month
other misc travel within US: 1000 to 2000$
phone bill when staying in US: 600$ per year
cost of extension of scheduling period of step exams: 50$ to 100$
recently popular CS preparation courses 1000$


there is much more to this list. USMLE really takes a toll on your bank balance. So be prepared for the expenses that you are bound to do.

The verdict: prepare for expenses from a minimum of 25000 to 40000$ for a residency spot.

Why this post is important is because of people's mindset about miscellaneous expenses during this whole process. Take for example, you are nearing your Uworld subscription end date but you postpone your exam by 1 month and will need to renew or extend by 1 month which costs like 100$. Many of us think it is a waste of cost and you will be economical and not extend it. Only if you knew the bigger picture that the 100$ you invest in UWorld may save 1000s of dollars in future, you will be willing to take it.

The other thing that people ponder over is this: you schedule a 3 month period for step 1 or ck and you extend it by 3 months because you are still in med school and not finish preparations. But even at the end of the extended eligibility, you still dont feel like you are prepared adequately. YOU SHOULD IDEALLY FORFEIT THE APPLICATION AND REAPPLY AND SPEND 900$. Though this sounds absurd, people dont realize the cost of a poor step 1 or CK score on their entire application. As seen above, the cost of applying for just one interview season touches 10000$. A poor score may make you reapply the next year with one year of travel, accomodation, next season application which can total to 15000-20000$.  This 900 should look small cost to you(which sadly never happens) but people keep doing the mistake of attempting the exam without fully feeling prepared.

Skip your thoughts about minor costs of residency process. Buy the best study materials, Buy an extended UW subscription, do more NBMEs. Don take the step exams lightly. A good step score can potentially save 20000$ A good step score by itself can make your residency process a breeze. Not only you get more interviews but also quality of the programs will be better with better scores(>250)

Though there are 15 things in a residency application, step 1 score still is the top determinant in that packet.

HOW TO SECURE A VOLUNTARY RESEARCH SPOT?

A difficult question with no single best answer. Research has played a significant part in this year's match, as far as I know of. almost everyone with research experience have gotten good number of IVs, some at significantly better programs. Its time to concentrate on securing a research spot but the bigger question, how to ask for a research position?

Me and some of my friends who are doing research got these enormous number of emails from strangers to recommend them for a research spot. It shouldnt have come to this because there are lots of opportunities out there, waiting for you. As a complete stranger, it would be impossible for us to refer you. It is YOU who have to secure a spot. Though seems tough, it is not impossible. many of us have done it.
and many of you dont seem to understand the meaning of contact. contact is someone who knows you either personally or professionally. Only a referral from a contact will be helpful rather than us.


The best way to secure a spot is definitely to go through contact. It has high success rate and most often works.

there is this majority guys like me with no good contacts. This article will concentrate on how to ask for a position in person rather than email.

Our good friend Dr.Droider has covered the topic as to how to request position by email. Here is the link to his webpage that describes it

http://www.mleresidencytips.com/2012/05/sample-letter-asking-for-research.html


Many of you might have relatives in US and you would like to stay in their home and do research in a nearby university. Here is what you can do

1. browse online and find all the medical universities near the place you prefer

2. browse through the departments that you want to work with. You can find smaller details about research in a particular department in their residency or fellowship website. Eg: if you want to know the research interests of attendings in mayo clinic, you browse their fellowship website and learn about the attendings, dept, current projects

3. Dress formally and take a copy of the things below:

a. your current complete CV
b. personal statement, directed towards an academic career
c. copy of usmle scores
d. ecfmg certificate
e. any unwaived LORs that you submitted for residency
f. your abstracts or publications from previous research work
g. cover letter- stating who you are and what you are looking for
h. letter from your relative telling details about their residence and that they welcome you to stay with them during the research appointment(helps them believe that you will indeed stay in that town or city without any financial constraints and wont expect pay)
i. your full contact information including email written on courier cover 

take atleast 5 sets of these documents, put them in separate courier covers.

4. go and find the research coordinator of the dept. they usually sit in a common desk and it is easy to find them. they dont need any appointment to meet. drop in one of these covers with her, explaining about your research interest, what sort of projects you want to work with, which attending in dept is active in research all that.. MAKE SURE YOU TELL THEM THAT YOU ARE OKAY WITH ANY VISA AND YOU ABSOLUTELY DEFINITELY WONT EXPECT ANY PAY!!  this is very important..

similarly drop in other packets in other universities or departments. 

get the email address of the research coordinator. If you dont hear back from her in a week, email her in a very polite manner. This way things may work much easier.

Thing or two about emailing people.
You have to try really really hard to make the attending to reply to your email. You have only 10 seconds before the attending deletes your email. So dont keep talking about I am bla bla bla I did med school in bla bla bla, I am from bla bla bla.. just aim and shoot within first four lines. Only if you impress within four lines, they are gonna read the rest of the email and look into your CV

You have to email atleast 200 people to get a spot. Usual reply rate is only 5 per 100. Some will just reply that we dont have spots. majority wont even reply. so don lose hope and keep trying hard.

I am not an expert in securing a paying research position, so if you have doubts regarding that I wont be the best person to answer them 

drop in your questions in the comments section
All the best
Karthik Ragu
IM resident physician- univ illinois college of medicine peoria, IL