I think it's fair to say that USMLE scores are not the only marker off how good a physician one is/will be. There is no question that, on average, residents with higher USMLE scores have been "better" than those with lower ones. So, ignoring USMLE scores would be a mistake.
USMLE scores provide some insight into a future resident's performance. And, it can be very difficult to interpret medical training obtained outside the US. I have had US IMGs and/or DOs in my program who have trouble getting started, due to lack of relevant experience in medical school. On the other hand, I've had some which have been top performers. It's just really hard to tell the difference from their applications.
Also, from a foreign policy standpoint, other countries may not look kindly on us taking their best and brightest.
Thanks, I meant to say that USMLE scores are not the
only marker of one's abilities. I am not even suggesting that they should be ignored. I am just saying that they shouldn't be used as a definitive cut-off point for specialty training applications. As you yourself said, it is very difficult to tell from someone's application how their performance would be. So applications should be viewed in their entirety to see what someone is potentially bringing to the table.
The difficulty about interpreting medical training outside US, seems like an excuse to me. I have seen transcripts from some top US medical schools and mine looks quite similar in format, except for the University name, etc. I understand it might be difficult to compare non-English speaking schools' training, but ECFMG does a very thorough job of verifying the accuracy of an applicant's credentials, so once that has been done, then it should be taken as legit.
I also agree about the "brain-drain" phenomenon. However, people choose to stay in or leave their home countries for whatever reasons they might have. I think to sort this issue out from the American side, some sort of cap should be introduced on the number of applicants per cycle on ERAS. Looking at NRMP statistics, it seems like there are nearly 15,000 US seniors applying for a PGY1 position, leaving a potential shortfall of approximately 8,000 in the total PGY1 positions offered. So all non-US senior applicants together (US grads, Osteo, Canadian, 5th Pathway, all the various IMG/FMGs groups) should have a maximum of 10,000 applications allowed-first come, first accepted basis. Each program should also cap the number of applications received via ERAS based on their historical data. That still leaves enough in the pool to choose from for specialties, and does not give false hopes to people who don't stand a chance and the process does not make them bankrupt. The different specialties also would not be overwhelmed by the ridiculous number of applications, and would be able to scrutinize most of them sufficiently and efficiently to not base their decision on one 3-digit score. True, ERAS and ECFMG and NRMP would make less profit (I am not sure how "non-profit" these are), but wouldn't that be for the overall good?
Another system might be a point-based weightage system like in the UK (at least it used to be when I was there). Each category of achievement should be allotted points-say 10 points for Step-1 scores over 240, 8 for scores between 230-239, 5 for scores between 220-229, 10 points for each publication, 8 for each poster presentation, 6 for each talk/teaching responsibility/something similar, 10 points for each scholarship/award won, and so on. In the end, the top 20-30-however many highest-scoring applicants are invited to interviews. I believe this balances out the score v/s other achievements to some extent.
I believe that the preference of residency programs to AMGs over IMGs, notwithstanding the purported higher USMLE scores of IMGs, is understandable. But there has to be a way for the US, with its shortage of physicians, to utilize the skills and education of these ECFMG certified FMGs/IMGs (esp. US citizens and legal residents). This grp. of people is a resource of this country that should be utilized or put into good use.
I agree completely, and my potential suggestions above might be a step towards it.
The FMGs (foreign born and trained medical graduates, not US citizens that train offshore) that I know have taken their USMLE steps while juggling medical school exams in their home country and away rotations in the US or working full-time and/or often times dealing with family/financial issues- not really an ideal prerequisite to prepare for an exam whose format you are unfamiliar with and that you have not been trained for. My take on the whole thing is that there is a somehow "natural selection process" that only allows the most highly qualified FMGs to even make it to entering the match process.
I personally have applied for a very competitive specialty, and as an AMG I certainly would have received a much greater number of interviews (this fact has been confirmed to me by numerous residents and faculties in the field). However, I would not complain about the obstacles FMGs have to deal with, as mentioned by others, many things in your life just won't be fair. The resident education in the US is certainly superior to the systems in many other countries, and I cannot blame any PD for being cautious about hiring someone whose background they are unsure of simply because it would be impossible to be familiar with the quality of medical education in any given country. Nonetheless, it would be desirable for PD's to keep an open mind and give foreign candidates a chance if (based on their scores/LOR's/CV) they indeed promise to have the potential for being a great resident.
I completely agree with what you have said about the time available for preparation and financial issues, etc. However, I don't agree about the "natural selection process enabling one to
enter the matching process"-If that were indeed true, we wouldn't be hearing stories of people (almost always IMGs/FMGs) who end up in some malignant residency program, usually via scramble, and their life becomes a living hell. Anyone can enter the process-I think you mean that only the best succeed in matching where they want in the specialty they want.
Even then, as you yourself are experiencing, there is a bias, regardless of how good you are. And yes, even though there is no point in complaining about obstacles and life is not fair, etc., it would still be nice if programs actually say on their websites, or wherever else that they would rather give chance to an average AMG than an exceptional IMG. The so-called "political correctness" programs maintain gives false hopes to many IMGs who then spend money they can ill-afford on chasing some mirage.
I disagree about lack of familiarity with other medical education systems as an excuse, especially in this day and age. There are a lot of precedents for most countries and schools in the US healthcare system now. If anything, they should think that if someone coming from a presumably "inferior" system (to US) can do well in their own school as well as in the USMLEs, and be an overall well-rounded applicant, then their education must have been solid to begin with.
And, of course, I reiterate that PDs should have an open mind about candidates based on all their past achievements rather than one or two arbitrary things.
