Every medical student, during their medical school time comes around this question of whether to go for Indian PG or USMLE. A lot of us swap several times, between these two completely different paths. The earlier you decide between these two options, the better it is for you in the long term.

The only deciding factor according to me is: “How badly do you want to settle in USA”. This may seem illogical to you at this time but in the long term, it matters, because it’s not everyone’s cup of tea to spend their life away from home and family.

Some students think that the Indian postgraduate entrance exam is extremely difficult and with all the reservations going on in India, it will be much easier to get a PG seat in USA. This is a huge misconception, because unlike Indian PG, in which you just give an exam and get the seat of your choice, USMLE is way more different.

The best thing, which a lot of my colleagues did, to make sure that USMLE is the right path for them is doing clinical electives in their internship before giving USMLE. By doing so, you are not investing much before deciding and you get to see all pros and cons.

During your elective rotation for 3-4 months, you will familiarize with the US health care system, the American culture, living situation, the food you are going to eat and behavior of people towards you. This will help you make a good judgment because these things matter in the long term – whether you will be able to sustain yourself in a completely different country, miles away from your home, amidst a different culture, away from the delicious home-made food.

A lot of doctors face stressful situations during their initial years of residency just because they start feeling homesick and their performance decreases, so make an early judgment about your blending into the atmosphere of USA.

After all the hard work, with four stressful exams, lots of invested money, time away from home, the unpredictable interview season and finally, the match day hot seat. It’s rewarding in the end. There are lots of advantages of getting trained in USA as a resident.

• The residency program in USA is unified with central board authority (Graduate medical education accreditation), that means that your training will be uniform like all the other residents in the country. They make sure that every resident who is getting on board, is certified as a physician/surgeon and equal in every aspect of their training. For surgery, it means certain number of cases in a year, certain amount of hours spent in certain aspects of training. As a matter of fact, these regulatory bodies won’t even give residency training authorizations to programs which are not qualified enough, they send their residents to places other than their hospital to get training in sections that is lacking in their own hospital, like surgical residency programs send their residents to different hospitals for burns, transplant, pediatric surgery, trauma training if they don’t have enough cases in their own hospital. So that you are a well-trained doctor after the end of residency.

• We all know that only less than half of the protocols that we read from our textbooks are being practically followed in our setting because of financial and resource constraints. Our government is not at fault for this. It is because of the huge population of India that all the novel strategies cannot be used in government set ups of our hospitals. Even though these facilities are available in private hospitals, in India most of the Indian PG students are being trained in government hospitals. Due to the advancement of technology and financial strength in the US healthcare system, you get trained with the latest technology available for a particular disease. For example; all prostate cancers are being operated robotically in the entire USA.

• The standard of living: Finally, the last but the most important thing is that the living conditions in USA are far better. After your residency, you get to live a satisfying life that you’ve always dreamt of. You can spend your holidays on some beach in California or you can roam on the streets of Manhattan. You get to drive the luxurious cars you’ve always wanted and live in the beautiful home you’ve always seen in the movies.

USMLE preparation vs. Indian PG exam preparation:

Both these career paths are completely different from each other so it’s better to decide early in your journey which path you want to run on. They differ in the following ways:

• Exam content: While Indian PG has a single exam that tests your ability to learn all the subjects that ever existed, a night before the exam, USMLE makes much more sense as it tests your knowledge of basic science subjects (Anatomy, Biochemistry, Physiology, Microbiology, Pharmacology, Pathology and Behavioral Sciences). In USMLE step 1 and advance clinical subjects (Medicine, Obstetrics and Gynecology, Surgery, Pediatrics). In USMLE step 2, Clinical Knowledge and then test your practical clinical skills via USMLE step 2, Clinical skills.
• Exam day: Unlike Indian PG, which is on a fixed day in a year and if you get sick in that particular week, you have to wait for another year, USMLE gives you the flexibility of selecting your exam day, according your comfort and rescheduling your exam in case you are not ready.
• Results: In Indian PG, you get your result and then according to your rank, you get to select the specialty and the college wherefrom you want to do your residency. I have seen my friends who always wanted to be surgeons, ended up taking radiology after getting higher rank in Indian PG and later regretting their decision. USMLE, on the other hand, makes you think before even starting which specialty you want to tread on. Because you can build your CV for one specialty at a time and stick to your decision. That makes you work towards that specialty and it makes you sure on whether or not you are passionate about it.

Investment comparison 

Fee structure for USMLE step 1, step 2 CS & CK, step 3 and AIPG*

• USMLE step 1: 865$
• USMLE step 2Ck: 865$
• USMLE step 2 Cs: 1505$
• USMLE step 3: 815$
• AIPG: 60$

*this is the current fees status (May 2015). It may be subjected to change*

• Attempts:  If you don’t get a rank in the Indian PG exam, you can attempt again the next year, but if you get a low score in one of the USMLE exams, you can’t attempt for the next 7 years. So, unless you are sure about your preparation, don’t write the exam.

• Security: Once you are done with your Indian PG exam with a good rank, you are in. But in USMLE, there is no assurance or guarantee of any kind that if you pass the exam even with good scores, you will get the residency spot. I have seen people with double 99 and passed USMLE step 2cs in first attempt, going unmatched. So it’s the overall assessment. You can’t just close yourself in a room and prepare for these exams. You need to be good overall including your communication skills, personality and confidence.

Also read,

The best iOS app for USMLE preparation – Dailyrounds.

Top 10 medical apps for doctors in Google playstore.

Six things you can do in college before USMLE step 1 preparation

USMLE WORLD: Ideal strategy and don’ts for your USMLE preparation

Neuroglia Health Private Limited.

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