Guide to Observership search in US for IMGs

Sivabalan Narayanan
15 min readMay 17, 2019

Hi folks! After spending close to 3 months in observership search, we thought we should share my experiences so that others can benefit. Btw, I am not a medical student(I am a software engineer in silicon valley), but my wife is. She is a doctor from India and we are looking to apply for residency later this year (2018) :) Since she was fully occupied in her usmle steps, I thought I could help her out. So here is a compilation of how we went about.

Observership

Observership is a way to gain clinical experience in the United States which doesn’t allow you to have a hands on experience. This will essentially allow you to shadow a physician practicing in the country. Now, a lot of you will have a doubt if it’s okay to shadow someone from your own country. As far as I am concerned that is absolutely fine, as long as he/she is certified by the American Medical Board and is willing to allow you to shadow them.

Different types of observerships

Mostly observerships fall into two categories. Those that have official observership programs and those that don’t.

Official observership

Some programs have official observership programs which means that they have formal application process where in you can fill in application with some docs and the program/dept coordinator will take up your application. Some programs might have first come first serve basis, so that you need to apply as early as possible (like 4 to 6 months ahead, for eg: Cleveland Clinic). Some programs will have deadlines for each period and after the deadline they will consider all applicants and choose some of them based on the vacant spots.

A few programs might have an official obsie program but will require you to find a faculty sponsor, the way for which is described in detail below.

Non official observership

Most programs may not have any official observership program. Which means that, there is no formal application process and you have to find a faculty sponsor(doctor) to obtain a obsie spot. This is more time consuming and exhausting compared to first one, but this has its own advantages which I have listed below.

Note: Some program will have clear information in their site, that they do provide observerships, but first step is to find a faculty sponsor. But in some programs they may not have any information online, pertaining to observerships. In such cases, do send an email to elective coordinator or residency coordinator asking the right POC(Person of Contact) to enquire about observership if couldn’t find the POC for observership program.

P.S: I have seen cases where in, the coordinator will respond that they don’t offer any observership, but we know someone from our 2nd/3rd degree connection who has done observership in that program or currently doing. Our understanding is that, you need to know the doctor personally or via strong connections in order to be given a position. Emailing them may not cut it. Unfortunately, we won’t know what programs fall into this category and will be target list anyways.

Mediatories

There are agencies and other mediatories who would assist in getting you an observerships at some cost (min 2000 bucks). We didn’t explore that option since we didn’t see very good programs being offered via such agencies and we felt like we should have control over where we wanna do the observership and not just take something that is assigned for us. I have heard you might be assigned with some community hospital program which you haven’t heard of only. But please don’t take my words much wrt these agencies (chances are that they might do a good job too), as we didn’t explore this option much.

Let me list the differences between the first two options

Note: Acronyms used in this section. OOP : Official observership program, NOOP: Non official observership program

Program Fees

OOP: Most official programs will have some fees associated with it. Somewhere around 500 to > 3000 bucks for a week obsie.

NOOP: Most non official observership program may not have fees associated with it. But I have seen programs requesting fees in this category too.

Application fee

OOP: For some programs, you have to pay application fee. So, you got to choose carefully. If you don’t get the offer, its gone.

NOOP: Since the first step is to find a faculty sponsor, you are sure to have a position when you proceed w/ next steps. Either there is no app fee, or its bundled with program fees. I mean, at least the fees you pay won’t go wasted like in other case.

Availability

OOP: Since its officially offered, they will have fixed no. of spots for every month in some depts as per each programs policy. Some of them is FCFS and some have deadlines. So it’s better to apply early, just that you have to pay in most cases.

NOOP: Since you have to reach out to doctors directly, availability is very scanty and finding right doctor at the right time depends on our luck. Some doctors might have openings, but may not align w/ our timelines.

Finding a faculty sponsor

OOP: Mostly coordinated by the program coordinator. So, we don’t need to find one by ourselves. But in some cases, we might have to find one here too.

NOOP: As mentioned above, this will be first step here and it’s our responsibility to find one.

LOR

OOP: In my opinion( from what I heard from my sources), even they accept to give LOR, mostly it will be templatized since they have way too many folks coming in for observerships from time to time. Getting a personal one is very tough, but not entirely impossible. Depends from program to program and depends on the doctor you work with and the efforts you put in.

NOOP: Assuming, the doctor whom you work with agrees to give you an LOR, it will be personalized since you are the only one working for him/her. So, its any day better than the other option.

Time and efforts required

OOP: Compared to the other option, time and efforts required here is less, since its just about applying and paying the fees.

NOOP: This is very time consuming and exhausting. Finding the right doctor at the right time is hard to get it right. Mostly no one responds which is totally understandable from their busy schedule. In some cases, finding the email Ids of doctor is not straightforward. So, be prepared to spend at least 2 to 3 hours per program(assuming you are reaching out to 50+ doctors per program).

What’s best for you

It mostly boils down to a) how much time you have to spend in observership search?

b) When do you plan to do observership? (1 month from now, or 6 months from now) and

c) How much money you are willing to shell out for your observership.

For eg,

Case 1:

You are a an IMG, looking to apply for residency later this year by september. You have given your step 1(feb end) , step 2 cs. You have step 2 ck scheduled by July end and you are looking for observership for the month of August. As your step scores are the most imp in residency application, you don’t want to jeopardise your chances. So better not to spend too much time in searching a faculty sponsor. You’d rather be better off paying some extra bucks if you can afford and going w/ official ones so that you can have peace of mind by securing a spot and have a fully focused step 2 ck preparation.

Case 2:

You are an IMG, who is done w/ step 1 and step 2 ck by May. You have 3 months before you apply for your residency in september. You could spend entire June month for your observership search to find a spot in July and August. Since you can spend your entire time in searching for observership, you could afford to spend more time reaching out to doctors directly.

Duration of observership

Typical observership duration is 4 weeks. But sometimes you are given more options too. But in general, I have read not to do more than 3 months of observership (good enough to gain the required letters). If you have more time, try to find research opportunities.

Requirements for applying

I will try to list most common requirements, but again each program might have some specific requirements for their program.

  • Need to be a Medical graduate (if you are a student, obviously go for electives).
  • TOEFL might be a requirement in some programs. Chances are that it will be waived if you have given any step exam.
  • B1/B2 visa. If you are in H4, you are good with that. But if you are going to apply for a visa, do ensure that you have sufficient time to go about applying for visa before your observership start.
  • Vaccination : PPD, MMR, varicella, Hep B
  • LOR from your medical school in some cases.
  • Some places like Cleveland Clinic might even require ECFMG certificate.

When to start applying

I have gone over this w/ some example scenarios above. So adding on to the same, it all depends on your timeline. For official ones, prepare to apply 4 to 6 months ahead. For faculty sponsor types, apply at least 2 months ahead. If you know someone personally, these time frames doesn’t matter much.

Best way to reach out

For official programs, contact info will be right there in the same page. But for non official programs, as I have mentioned before, some programs may not have any info wrt observership. So, you have to reach out to elective coordinator/residency coordinator to find the program policy for observership and right point of contact (POC). Sometimes, if they don’t respond in a few days(4 to 5 days), don’t hesitate to give them a call. Very likely they have too many emails from out of network email domains and may not respond to such requests. WRT observership search in general, I would highly recommend to use your contacts before jumping into the wild ocean. Please please contact your seniors and connections who are currently doing residency or who graduated from residency recently. Don’t be hesitant if you haven’t talked to them before. Also, if they don’t respond, do not feel inferior that they are not willing to help. Everyone in medical field is so so busy and very likely they might have forgotten to respond to you. Please do send a gentle reminder after 3 to 4 days if they don’t respond. But don’t pester them after twice or thrice if they don’t seem interested to help you out.

List of programs offering Observerships for IMGs

We couldn’t find a good source as such in general. Some programs we reached out are based on info from our connections. We did come across these two links that has a list that offer obsie for IMGs. By any means, this is not a comprehensive list, but just to give you some head start.

https://im-for-imgs.com/2012/01/03/observerships/

https://forum.facmedicine.com/threads/35-us-medical-schools-that-accept-imgs-for-electives-and-observerships-2018.33086/

Notes: We haven’t verified that all programs listed does offer observerships to IMGs. In Fact we did hear from some of the programs that they don’t offer. But if you are looking for some list to get started, these lists might be handy.

Document your progress!

I can’t stress this enough. I had to remind my wife time and again about documenting our progress. Please prepare a document as to what programs you are reaching out, whom you have reached out to, what’s their policy and sort of. Here is the template that we used during our search and it did help us a lot to know where we were and what’s to be done next.

Program Name, City

Source from which we got to this program

Do they offer observership for IMGs

Requirements (ECFMG certified/hard deadlines, need to be a physician, etc)

Cost

LOR info (friendly/not known/do not give)

Observership coordinator/Email faculty directly

Coordinator email id(s) to reach out incase obsie is coordinated by one person and their position

Date at which we have emailed the coordinator or doctors(to assist in follow ups)

Link to document that has the list of doctors to reach out to (to find faculty sponsor)

Link to program site that talks about obsie program

Link to program site to find doctors

We maintained an excel with these info all through out our search. This helped us track our progress from time to time. Please don’t ignore to make entries that don’t offer observerships for IMGs(if it was in your target list when you get started). Bcoz, after 2 weeks you might forget the policy for some program and again do the research for another 30 mins to 1 hour to find out that we are not eligible to apply for some X program. For some programs, it is not easy to find out their policy regarding observership. More details in next section. In Fact we realized the importance of this after experiencing it by ourselves by duplicating the efforts for very few programs. So do document and avoid duplicating the efforts. Even in general, this document will help you track those programs for which you have sent emails and awaiting responses, so that we can send a follow up email after a week.

Google keywords

For some programs, simple google search would fetch the direct link to the observership program page and all info will be clearly laid out there. But for some programs, we had a tough time to find info on observership. So, we had to use many different keywords for our search. Few key phrases that we used during our search. Lets say we are trying to reach out to “Univ of X”.

“Univ of X observership”

“Univ of X observership for IMG”

“Univ of X observership for FMG”

“Univ of X observership for international medical”

“Univ of X observership for foreign medical”

“Univ of X Internal Medicine observership”

Same as above(FMG, etc) with “Dept” you are looking for

“Univ of X observer program”

“Univ of X international observer program”

How to structure your email

One of the important component in reaching out for observership is how you structure your email. Let me illustrate you a simple example.

Email 1

Hi Sir,

I am an international graduate from India (college name) graduated in 2016. I am interested in applying for observership program in IM dept in your program for 1 month anytime during the months of June/July 2017. I have attached my resume along with this email for your consideration. Let me know if you need any further information.

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

Email 2

// Your background info

This is <your name> reaching out for an observership/shadowing opportunity. I hail from India and graduated in <year of graduation>from <College name>. I am currently in the process of getting ECFMG certified (finished Step 1 and Step 2 CS<replace as per your requirement>). I will be applying to <your choice of residency> this September. I am currently in H4 (with EAD) visa here in US. <Call out your visa if you feel you might have an edge over others. If not, better to ignore it. This might make a huge diff especially for research reach out>

I came across this <link to site page that talks about observership> which talks about the process involved in applying for an observership. First step is to find a faculty sponsor and hence I am writing to you asking if you can sponsor me if you have a position to offer.

//Talk about any experiences you have in US, which dept you are interested in, your availability, your electives/observership/externship detail if any. Tell them why you are interested in doing an obsie. Ask them politely if there are any steps that need to be done for doing the same and if they could help you out in any other way possible with regards to this.

I am attaching my CV and Personal statement for your reference. Let me know if you need further information.

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

Hope you would have got an idea of what I am trying to convey with these two email templates. We used something like the 2nd one. Wrt residing city, since we are in US, we thought that would imply we don’t need a visa and hence its an easy choice for them to take us in.

First email is very concise and does convey the information. But we felt that 2nd one has all the required elements to highlight from our side. Do add details about the program, department you are interested in, your experiences especially in US, your visa (if you feel that might give an upper hand) in your email. Since its tailor made (to some extent) and not just copy paste to N no of programs, it gives a sense of efforts we have put in to reach out to them. Even a simple effort we have put in to compile an email talks about how meticulous, planned and detail oriented we are. So, please try to emphasize and bolden any phrases that you feel might give you an upper hand compared to others who are trying for the same position.

How to find faculty sponsor for a program

Finding faculty sponsor is one of the most time consuming process. For some programs, finding the doctors and their email ids are straight forward. But for most programs, email ids may not given in the doctor’s profile. For such cases, during initial days, we had a tough time finding email Ids for the doctors. One strategy is to find the coordinator email id and curate the doctors email ids. Find the pattern of the coordinator email id(eg: firstname.lastname@program.edu or first letter of first name_lastname@program.edu) and curate the email id of doctors you are trying to reach. This did solve us for some programs. But for few programs, email id of coordinator was very common and not specific to any one person (like im-coordinator@program.edu). So, we again hit a roadblock for these programs. That’s when found a trick from one of our contacts. Trick is to find some researcher in the same program that you are targeting. Find the research publications they have published in pubmed and locate their email ids. Once you have their email ids, use the same strategy as before to curate the email ids for doctors you wanna reach out to. Bear in mind that since we try to come up with Email IDs, most of the emails might bounce back being the wrong ones. We can’t do much about it but to move on.

Follow ups

Please do keep in mind that all doctors and coordinators are always busy with their schedule (esply doctors). So, if you don’t get any responses, don’t get disappointed. Its bound to happen and be prepared to face it. Do send a gentle reminder email after a week or 10 days. But don’t pester them with emails every week. Twice is more than enough. We had 2% response rates w/o any follow ups, but around 5 to 6 % response rates w/ follow ups. Even though most of them are negative, at least we got responses. Some of them responded that they don’t have any position, but have reached out to others in their dept. At least we felt good compared to no response. And believe me, a lot of people out there are really willing to help.

Things to clarify before you take up an offer

I know that most of us may not be in a position to demand anything from observership. But if your major intention to do obsie is to get an LOR, get appropriate info on that end. Do check for LOR policy. Some programs do have a policy of not giving any LORs. Maybe you don’t want to apply for such programs if that matters to you. So don’t hesitate to check their LOR policy before accepting the offer. If you are in a waiting stage after applying, do ask them when can you expect the results and what are your chances of getting the position. May be if there is a fierce competition, do accept the offer if you are offered. If not, in case you are trying at other places, you can ask them for few days to accept the offer. Do phase your applications for diff programs such that, your dream programs are earlier in your search compared to others. So that once you got a position in your dream program, you can stop your search. After you exhaust your dream programs, you can go all in for the rest of the programs.

Tools to assist

Many of our contacts suggested us to email doctors around 9:30 to 11 in the morning time any week day, when trying for observerships, as the chances of them reading your email is higher. So we had to use two tools to assist us. One is email scheduler. Obviously you can’t be compiling and sending emails by 9:30 am on a weekday if you are working full time. So, the previous night or the previous weekend night, I used to compile all the emails that needs to be sent out the next day or next week and schedule it appropriately to be sent out by 9:30 am on some weekday. Another tool that we used is mail merge in gmail. For those who are not familiar w/ mail merge, its a feature which helps you send bulk emails. You can define an email template with some words that can be tailor made for each TO address. You can list all TO addressed in an excel along with the words to replace the tailor made words (like department, program, doctor name) in the email. You can prepare all these the previous night or previous weekend night and its just a matter of hitting send by the time of interest to you. We used both these at different occasions during our search.

Conclusion

I have compiled all the information we gathered and used throughout our obsie search. Since we had a tough time finding resources during our hunt, we thought we should contribute back to the community. Hope you find these helpful. All the best in your observership search!

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