By Steven Kao, MD and Marco Ertreo, MD

Please tell us a little about your pathway to the field of medicine and then interventional radiology. What was your life like back home? What prompted you to come?

Growing up with parents who were both doctors was a huge influence, but I decided to choose medicine after my father passed away after a motor vehicle accident while I was in high school. During my pre-graduate internship and while rotating in the emergency department, I assessed a patient involved in a similar accident that my father had suffered, but with one difference: this patient was saved by an interventional radiology procedure. That was the moment I decided to pursue a career in IR.

What was your life like back home? What prompted you to come to the US for training?

After I resigned my former radiology residency in 2016, I had the great fortune to work as an interventional radiology first assistant while I was going through the process of the residency application in the US. I think as a Latin American physician, we possess a good balance between patient care in limited-resource scenarios and knowledge. I chose to come and pursue a medical residency in the US for the higher standards, incredible volume of patients, and practical training.

How long did the whole process to come to the US take? From when you finished medical school to matching.

I finished medical school in Mexico City in 2014. My interest in DR and IR started during my pre-graduation internship in 2012-2013. I then started a Radiology Residency program in 2015 in a private practice hospital, but quit in March of 2016. At this time, I started working as first assistant with a well known interventional radiologist physician in Mexico City, Jose Luis Rios-Reina, and have been in touch with him ever since.

I had already started studying for USMLE Step 1 during my residency in late 2015 and took it in June 2016. Step 2 CS followed in July 2016 and Step 2 CK in December 2016.

It’s at this point that I started applying for observerships – and when I say applying I mean calling or emailing directly coordinators. This worked well, as I spent 5 months rotating at different hospital across the United States. Observerships are hard to find, although are available if you look for them, even for graduated people like myself. Just try to respectfully reach out people – many times hospitals don’t have an “official” observership program on their websites but might arrange one for you if you contact them.

Where are you training now? What is your role in the RFS? What are some strengths that you have as an IMG in IR?

I have started my General Surgery internship at University of Texas Health at San Antonio. I have the luck of being an active contributing member of the International Outreach Committee of the RFS. IR can require physicians to be creative and, as a Mexican IMG pursuing a career in IR, many times I have struggled to work with the available resources and have had treat patients creatively. Personally, I have had the fortune to work with a well known IR in Mexico City, Jose Luis Rios-Reina. Since I left my former radiology program in Mexico City back in 2016, I have worked under his tutorship. We performed the first Y-90 treatment with glass microspheres in Latin America for hepatocellular carcinoma.

What are some challenges that you have face as an IMG going into IR? What was the process to match as a resident like?

The first important difference that I noticed during my path to a medical residency in the United States were the USMLE Step Exams, since it is a different way of teaching compared to medical education in Mexico. Second, depending on the specialty, the preference for US trained graduates over foreign ones. Third, particularly in my case, because I am already a medical school graduate and not a student, being able to have real hands-on rotations was very difficult. However, you can always look for good observerships.

Regarding my personal experience with the Match, I applied very broadly for the 2018 Match. In terms of numbers, I applied to 130 Diagnostic Radiology programs, 25-30 Integrated IR-DR, 60 General Surgery preliminary positions, 20 Internal Medicine preliminary positions and 10 Transitional programs. I ultimately ended up with 5 Diagnostic Radiology, 3 General Surgery and 2 Internal Medicine interviews.

How did you get recommendation letters? (Again, foreigners want to know this)

You can get a letter of recommendation from any person you would like to ask, although it is highly recommended to ask for LORs (Letter Of Recommendation) from US physicians that know you well and you are comfortable with. It is always best to upload the LOR as “sealed” – the physician uploads your LOR to your ERAS account and you cannot see it, hence be very sure that the person you are asking the letter has an excellent opinion of you.

What are some things you would like other IRs to know about IMGs?

I would like other IRs to know that we possess a great amount of medical knowledge plus a great instinct for patient treatment in terms of creativity and I think those features mean we can make unique contributions to IR as a field here in the United States.

How did you get a VISA?

I applied to programs that sponsor VISAs and then the program you match into will guide you from there.

Do you have any advice you would give to other IMGs pursuing a career in IR?

I recommend that they get involved in research projects, national and international societies, make connections, try to get IR or diagnostic radiology rotations in the United States but, the most important thing, is to always show an optimistic attitude every single day.

What do you think helped you in the match (research, networking, etc)? Can you give some examples?

I think my radiological background and the US rotations.

I met many people during the year of DR residency I did in Mexico City and at the International Radiology Congress in Mexico City 2016, I introduced myself with Johns Hopkins and Case Western radiologists who gave a lecture. This resulted in an observership at Johns Hopkins in 2017 and I am still in touch with them nowadays. During a vacation in New York City in 2015 I finally introduced myself in person to a Mexican Neurointerventionalist at Mount Sinai Hospital I had been in touch with since 2013 via email – I was able to do an observership there in 2017. My former program director in Mexico City knew an IR at UT San Antonio. I did a rotation there too in 2017. The IR I worked with in Mexico City had connections with UM Jackson Memorial. He contacted them and I did a rotation there in 2017 as well. My medical school has a partnership with Northwestern Memorial Hospital and I spent some time in Chicago too.