Is it fair that foreign residents get residency spots in US hospitals?

SDN Members don't see this ad. (About Ads)

And how in the world are you going to determine who makes the best doctors and who is more qualified? Board scores? Grades? Exclude all the DO students because we couldn't make it into MD programs? I don't see a logical way of figuring out who the most talented is. Especially when there is little consistency between medical education in the US vs other countries. Many american medical grads get limited time to study for boards while FMGs can take years studying for step 1 if they need/want to. Obviously one will likely do better. How can you compare the two when they are at different baselines? It is one thing to compare two applicants from the same system, but when comparing two applicants with completely different backgrounds and circumstances you can't just look at numbers and there is nothing else real obvious to state which will make a better physician.

Originally Posted by sylvanthus

And how in the world are you going to determine who makes the best doctors and who is more qualified? Board scores? Grades? Exclude all the DO students because we couldn't make it into MD programs? I don't see a logical way of figuring out who the most talented is. Especially when there is little consistency between medical education in the US vs other countries. Many american medical grads get limited time to study for boards while FMGs can take years studying for step 1 if they need/want to. Obviously one will likely do better. How can you compare the two when they are at different baselines? It is one thing to compare two applicants from the same system, but when comparing two applicants with completely different backgrounds and circumstances you can't just look at numbers and there is nothing else real obvious to state which will make a better physician.

Yes, they get more time. But you try taking the boards in Mandarin. See if extra time is all that much of a net plus.

And while US students get less time, our curriculum is more or less geared towards it, even in schools that don't emphasize the boards much.

You may disagree with USMLE scores and research and other criteria to select candidates, but that's what residencies use, and if that's the standard, I've no problem with a better qualified FMG taking that spot over me.


And to really answer what makes a better physician - that study showed that FMGs overall have lower mortality rates than American graduates - so clearly whatever criteria we're using to select FMGs, we're getting a better quality of physician than the one we educate here.

The odds are tipped in our favor and you guys are advocating for that to be reversed? That seems self destructive. You guys deserve it if a carib beats you out for a residency spot.

Originally Posted by Lokhtar

Yes, they get more time. But you try taking the boards in Mandarin. See if extra time is all that much of a net plus.

And while US students get less time, our curriculum is more or less geared towards it, even in schools that don't emphasize the boards much.

You may disagree with USMLE scores and research and other criteria to select candidates, but that's what residencies use, and if that's the standard, I've no problem with a better qualified FMG taking that spot over me.


And to really answer what makes a better physician - that study showed that FMGs overall have lower mortality rates than American graduates - so clearly whatever criteria we're using to select FMGs, we're getting a better quality of physician than the one we educate here.

Ummm no, or did you not read the study? They looked at very limited diagnoses, CHF and Acute MI and only the CHF one had statistically significantly lower mortality rates and we're talking 3.4% vs 3.1%. Also, the study was retrospective and went off of hospital charts to try and determine who the "attending" was. Ya, somehow I don't think the study is completely legit or do you need to go back and look at which studies are the most valid? Do you also believe that NPs provide equivalent care to family medicine docs?

Also how does the fact that one diagnoses had statistically significantly lower mortality rates in this one flawed study, somehow balloon into becoming lower mortality rates "overall?" Thats one huge leap of logic.

Originally Posted by dr zaius

The odds are tipped in our favor and you guys are advocating for that to be reversed? That seems self destructive. You guys deserve it if a carib beats you out for a residency spot.

Meh if he or she is better than me, I can't blame the PD for picking them over me. I might have done better in undergrad but if they did better in med school - I know what would be more important to me if I were a PD.

fair? probably not, but there are lot of things in this world more unfair than FMGs beating out AMGs. i'm sure there are people who got denied from med school who would have made better doctors than some FMGs had they been given a chance.

FMG being in the same residency program as an AMG definitely gives them an advantage in terms of debt for sure.

program directors know that board scores and medical school name aren't the biggest factors in determining how good a doctor will be. therefore, they pick everyone above a certain threshold and decide who is best for their program. this screws over some AMGs, but solutions to the problem are even worse such as making FMGs take 6-figure loans until they have the same debt as AMGs or force program directors to always take AMGs even if it is worse for the residency program.

Originally Posted by PrideNeverDie

fair? probably not, but there are lot of things in this world more unfair than FMGs beating out AMGs. i'm sure there are people who got denied from med school who would have made better doctors than some FMGs had they been given a chance.

FMG being in the same residency program as an AMG definitely gives them an advantage in terms of debt for sure.

program directors know that board scores and medical school name aren't the biggest factors in determining how good a doctor will be. therefore, they pick everyone above a certain threshold and decide who is best for their program. this screws over some AMGs, but solutions to the problem are even worse such as making FMGs take 6-figure loans until they have the same debt as AMGs or force program directors to always take AMGs even if it is worse for the residency program.

Wouldn't the same also apply to AMGs?
I personally think the system is a bit unfair to FMGs. Sometimes they are better qualified than some of the AMGs... I thought this should be a meritocracy

Originally Posted by PrideNeverDie

FMG being in the same residency program as an AMG definitely gives them an advantage in terms of debt for sure.

what is the advantage once you're in the same residency program? How is having/not having debt or bills to pay change anything in the clinical setting? By that reasoning here's a few FMG disadvantages:
-not having any credit score.
-being ineligible for cheaper insurance policies due to J1 restriction

Additionally you're asuming FMGs dont have debts themselves. Moreso, plenty of them (us) maintain/help maintain people/families abroad to some extent.

Financial circumstances cannot be a criterion for selection anywhere, much less academic environmets, because that's where entitling one or another on the basis of debt/resources (or the lack thereof) impedes the "best and the brightest" from attaining better spots.

Further (a bit exaggerated reasoning): super succesful And academically excelling AMG owns company/stock and has enough income to pay thru med school debt free. How should he fare vs. avg(academically and economically) AMG, by your reasoning?

Why not? If they earn less than 10% of what a US attending earns yet still fork the $$$ to pay 4000 dollars to pay for all of the USMLE exams (not adding the expensive plane ticket to do Step 3 and 2 CS.. or the annoyance of getting a US tourist visa which is an ordeal as of itself). Good for them for their initiative. Plus the exams are in english, imagine doing an 8 hour oral exam in your non native language. I did a 4 hour oral exam once in my non native spanish and thought the exam was brutal enough.

I don't see why Americans are complaining, they have an excess of residency slots whereas most countries have more GP doctors than available residency seats. The mexican residency system has only a bit more than 1000 residency slots and over 25,000 applicants each year and the residency match scores are going up higher each year because the government has failed to keep on opening slots to meet demand yet urge the need of specialists (without really increasing specialist salaries that much). There's so few specialists in Mexico that they give special credentials and diplomas to GP's that have worked extensively in a specific service of a hospitals (mainly as IM or ER docs) to supply the urgency of specialists. Most of the 2000 municipalities in Mexico don't have any specialists, the few that do exist mostly live in less than 150 of the 2000 (mainly metropolitan Mexico City, Guadalajara and an ever decreasing amount of specialists in Monterrey). In a way, if you know where to work and live, a GP can outearn a specialist by a couple thousand MXN each month and work only 1/10th what they work.

Many mexican GDP's also choose to go to Spain because they also have a surplus of residency seats and the advantage that there is no language barrier but the US and Australia are still other popular choices for those that have the money and patience to do all of the board licensing exams. If the person that used the education returned to their home country, don't see it as a negative, see it as a positive because that person could change mexican health policy in a good way with better surgical techniques and suggest new drug guidelines. The advantage of being a specialist in Mexico is that they can get into bureaucratic positions more easily and change the system from within.

Originally Posted by sylvanthus

And how in the world are you going to determine who makes the best doctors and who is more qualified? Board scores? Grades? Exclude all the DO students because we couldn't make it into MD programs? I don't see a logical way of figuring out who the most talented is. Especially when there is little consistency between medical education in the US vs other countries. Many american medical grads get limited time to study for boards while FMGs can take years studying for step 1 if they need/want to. Obviously one will likely do better. How can you compare the two when they are at different baselines? It is one thing to compare two applicants from the same system, but when comparing two applicants with completely different backgrounds and circumstances you can't just look at numbers and there is nothing else real obvious to state which will make a better physician.

Dude your opinion on the criteria and metrics of what PDs think are important when recruiting mean jack squat. Different baselines? Do you know what standardized means? Do you know that not all med students start school at age 22? Some start when they are 30 years old. These folks and many others are called non-traditional students. They had more time to study for the MCAT, get more extracurriculars in, whatever. So what is your point about this "different baseline" nonsense? You should relax especially since this is something you cannot change and where your opinion doesn't matter, and if you wanna be real about it things are already way harder for FMGs so yea if you get "your spot" taken then too bad. I still can't get over your concept of it being "your spot." The arrogance is incredible.

Originally Posted by Wheatley

Dude your opinion on the criteria and metrics of what PDs think are important when recruiting mean jack squat. Different baselines? Do you know what standardized means? Do you know that not all med students start school at age 22? Some start when they are 30 years old. These folks and many others are called non-traditional students. They had more time to study for the MCAT, get more extracurriculars in, whatever. So what is your point about this "different baseline" nonsense? You should relax especially since this is something you cannot change and where your opinion doesn't matter, and if you wanna be real about it things are already way harder for FMGs so yea if you get "your spot" taken then too bad. I still can't get over your concept of it being "your spot." The arrogance is incredible.

I agree with the other guy that studying for 1 year for boards eliminates the idea of having a good standardized exam. If everyone knows that your score improves as you can do more qbanks and prepare better, obviously people with 52 weeks will be better prepared than someone with 5 weeks.

At the same time, I have no problem with IMGs getting into any residency. If they are good physicians, they should be allowed to play the game. Just like they do in sports.

Originally Posted by JackShephard MD

I agree with the other guy that studying for 1 year for boards eliminates the idea of having a good standardized exam. If everyone knows that your score improves as you can do more qbanks and prepare better, obviously people with 52 weeks will be better prepared than someone with 5 weeks.

At the same time, I have no problem with IMGs getting into any residency. If they are good physicians, they should be allowed to play the game. Just like they do in sports.

I second this man's statement.

Originally Posted by Wheatley

Dude your opinion on the criteria and metrics of what PDs think are important when recruiting mean jack squat. Different baselines? Do you know what standardized means? Do you know that not all med students start school at age 22? Some start when they are 30 years old. These folks and many others are called non-traditional students. They had more time to study for the MCAT, get more extracurriculars in, whatever. So what is your point about this "different baseline" nonsense? You should relax especially since this is something you cannot change and where your opinion doesn't matter, and if you wanna be real about it things are already way harder for FMGs so yea if you get "your spot" taken then too bad. I still can't get over your concept of it being "your spot." The arrogance is incredible.

I think you need to learn what the word standardized means. Do you seriously not realize that those people who have 400% more time to study for the exam will likely do better regardless if the exam is "standardized?" So yes "different baselines" is important in this regard.

Also, it is not arrogant to think that tax-payer dollars should go toward training american medical graduates before it goes to paying for IMGs. But, whatever, keep on with the personal attacks if it makes you sleep better at night. I would like to see you go to another country and essentially demand that they take you into their residency programs because you somehow believe it is "for the patients." Tell me how that works out.

They took errrrrrr jerrrrrbz

... i had too

Originally Posted by sylvanthus

I think you need to learn what the word standardized means. Do you seriously not realize that those people who have 400% more time to study for the exam will likely do better regardless if the exam is "standardized?" So yes "different baselines" is important in this regard.

Also, it is not arrogant to think that tax-payer dollars should go toward training american medical graduates before it goes to paying for IMGs. But, whatever, keep on with the personal attacks if it makes you sleep better at night. I would like to see you go to another country and essentially demand that they take you into their residency programs because you somehow believe it is "for the patients." Tell me how that works out.

This 400% more time argument is insane. You are so blinded by your own fear and insecurities that you cannot see that this argument is flawed. The med curriculum even in the US varies greatly from school to school, do you think some schools should get special treatment? Having less time for the boards doesn't excuse you from a lower score. It's not the best but its up to you to make it work. After all you chose that school to attend. But even beyond that it doesn't address my MCAT parallel. Some people take several years off from school and can study a few hours a day and do lots of problems. Do you have a problem with that too? Anyone reading your poor rationalization of how FMGs somehow have an upper hand, which you are trying and failing to use as a reason to discredit them can see your bias.

Other countries are not talent and brain magnets like the US is so they do not apply here. I'm sorry my straight talk hit so close to home for you that you took it as a personal attack which it was not, but we both know you are talking nonsense and I am right. We know I am right because at your residency interviews you will not be saying what you say so confidently on here: that they should let you in over an FMG who has better credentials because the FMG had more time to prepare for the test or that you pay taxes so you deserve the spot. You will not say this because it sounds ludicrous and it is clearly crying to any outside observers.

My board scores are more than adequate. I personally am not concerned but stand by my previous stance.

Glad i could open the **** vault.

If you're worried about FMGs taking your spot you probably have more important things to focus on, like academics.

I'm confused. It's been stated a bunch of times in this thread that the deck is clearly stacked in our favor (AMGs). So, what exactly is all the whining about? That we don't have enough of an advantage? How about instead of complaining about someone "stealing" a spot that you somehow feel entitled to, you just, you know, go earn it.

But aren't they going for no body else want? If is very hard medical admission and at India it is only four year after 12th. Lots of schools for M.B.B.S
Do they pass USMLE?

thats coz you prepare for step 1 from day 1 of your med school. All your med school exams and grades are in the formats for usmle. So you dont need special preparation. And regarding FMG's getting into residency, I dont think a american graduate has to worry about it. In my vast experience I have never seen/known a american medical graduate who has not gotten into residency....If there are any thats coz he is not fit enough to get into residency....

Originally Posted by taurean1982

thats coz you prepare for step 1 from day 1 of your med school.

You are exactly right. In every country that is not the United States of America, students are handed First-Aid for Step 1 on their first day of school (which they then study exclusively for the next 4-6 years), because no one ever wants to practice medicine in a country that is not United States of America. This is common knowledge.