Is there any truth to this about the Caribbeans...

[caffeinemia]

Oh, I understand his post. Outliers = the norm = chances for me identical to a US MD or DO student.

I'm not sure I understand your post.

Exhibit II. Magical thinking.

Time to face the wall...

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Members don't see this ad.

 

[touchpause13]

That's the idea and why the government treats student loans as an asset. But we're only getting it back if we are getting it back.

Something like 1/3 of the total loans out there (all student loans, not med school) are in non-repayment, and IBR drops the payback rate down to less than the interest for a lot of loans that are in repayment.

You would think by now they would have realized that giving loans to these folks is a horrible investment...

 

[WingedOx]

You would think by now they would have realized that giving loans to these folks is a horrible investment...

Money talks. And DeVry has a lot of it.

 

[NYCdude]

John Oliver needs to do a bit on Caribbean schools, he's already taken a public dump on Devry.

 

[touchpause13]

John Oliver needs to do a bit on Caribbean schools, he's already taken a public dump on Devry.

I would love every second of that.

 

[Law2Doc]

L2Ds thing on rotations is exaggerated, but has a little truth to it. There are places in the bigger cities where you have peeps from SGu, Ross, auc in the same rotation. I'm not sure which school or hospital l2d went to, but it doesn't seem to be the absolute example. That hospital must be **** for students if that was the case.

Not exaggerated, and we had students from some of these exact offshore schools, doing what they were calling their core rotations. Was a great place to rotate as a resident but as an offshore student you had to be a lot more proactive than 99% of the offshore students I met to get anything out of it. Basically, unlike a US med school rotation, you could do very little and still pass and most people I met opted this route. And they might as well, because most PDs assume this is what the offshore rotations are like. But one word of caution -- even though they all had it pretty cushy, every student I ever worked with on that rotation seemed to think they were putting in incredibly long hours and working hard. They might be putting in 40 hours a week with no weekend call, but to talk to them you'd think they were working 80. Pretty much every US trained resident found themselves rolling their eyes at some of the comments daily. This is why I call these Lite rotations. I'm sure there are some better than others, but the range is part of the problem -- at US programs these are much more standardized, per LCME. And US students don't get to shop for fun cushy rotations the way someone without s single fixed hospital might.

 

[caffeinemia]

Yeah. My institution is huge and thus does have the occasional rotator from the Caribbean. Usually not impressed. Then again, you're generally already pretty annoyed when you consult medicine and a 4th year returns the page...

 

[KnuxNole]

Yeah. My institution is huge and thus does have the occasional rotator from the Caribbean. Usually not impressed. Then again, you're generally already pretty annoyed when you consult medicine and a 4th year returns the page...

True, but then again, that happens at US schools too!

 

[KnuxNole]

Not exaggerated, and we had students from some of these exact offshore schools, doing what they were calling their core rotations. Was a great place to rotate as a resident but as an offshore student you had to be a lot more proactive than 99% of the offshore students I met to get anything out of it. Basically, unlike a US med school rotation, you could do very little and still pass and most people I met opted this route. And they might as well, because most PDs assume this is what the offshore rotations are like. But one word of caution -- even though they all had it pretty cushy, every student I ever worked with on that rotation seemed to think they were putting in incredibly long hours and working hard. They might be putting in 40 hours a week with no weekend call, but to talk to them you'd think they were working 80. Pretty much every US trained resident found themselves rolling their eyes at some of the comments daily. This is why I call these Lite rotations. I'm sure there are some better than others, but the range is part of the problem -- at US programs these are much more standardized, per LCME. And US students don't get to shop for fun cushy rotations the way someone without s single fixed hospital might.

True, but as YOU know, there are plenty of US schools that have core rotations where the student merely shadows as well, but they make it up with lectures or something to show LCME that it's legit or whatever. For US schools, you can pick different hospitals, and some are a lot easier.

And not all Carib students have 40 hour work weeks on core rotations. Although that hospital sounds pathetic for a student, there are several in NYC(which I assume you might be at) that are FAR, FAR from that.

 

[wowsers]

3.03 GPA after 3 years of college?

You are not fit for an academic career like medicine.

 

[Law2Doc]

True, but as YOU know, there are plenty of US schools that have core rotations where the student merely shadows as well, but they make it up with lectures or something to show LCME that it's legit or whatever. For US schools, you can pick different hospitals, and some are a lot easier.

And not all Carib students have 40 hour work weeks on core rotations. Although that hospital sounds pathetic for a student, there are several in NYC(which I assume you might be at) that are FAR, FAR from that.

I actually haven't found this to be the case with US schools in terms of core rotations. But even if there's a range of quality and expectations that will satisfy LCME, it's a very narrow range. Which is sort of my point -- any PD can know that a US grad more or less had real rotations that adequately prepared them for residency. At least a healthy chunk of offshore grads (from what I've seen and heard, actually this is probably more common than not) instead do these lite rotations.

You can say over and over "that hospital sounds pathetic" but frankly my point is this is the education most offshore grads are getting, by virtue of the system they've set up, where the students pick and choose from cash poor community hospitals scattered around the US looking for a few extra bucks, and where the enjoyment/fun of the rotation directly impacts the hospitals cash flow. The offshore grad who reports back to his classmate that a certain rotation was intense and had him doing overnight calls, 5 am pre-rounding and working weekends the whole month isn't going to help that hospital generate as much enrollment for the next session. By contrast the guy who comes back and says they worked 40 hours a week, no overnight call, slept in a lot, ditched rounds a few times without repercussions, and that the place hosted events for the students after work weekly, is going to have a lot of people signing up. That's just the nature of the beast -- you are dealing with human nature and cash flows not educational culture and traditions. Sure in US education people can select different hospital to do rotations, but frequently your choice isn't driven by how cushy it is, but whether you can get a certain rotation under your belt earlier or because different affiliated hospitals are known for different specialties, and some have different residency slots you are trying to audition for. It's often a question of working hard or working really hard, with slightly different surroundings. Those hospitals aren't getting a pile of cash based on how favorably I review them, and that's why I as US med student get worked hard as the low man in the hierarchy wherever I go, while the offshore med student gets treated as a tourist/customer. They are victimized by their consumer clout.

 

[KnuxNole]

Actually, a lot of current med students would kill for a lite surgery rotation, or OB rotation, or wish their rotation can make them hide in the library and work a max of 40 hours...

 

[KnuxNole]

True, which is why I'm sure there are peeps that are jealous of the Carib students. Of course, whether the same jealously would stay during internship training is another story.

Personally, I AM envious of a 40 hour surgery rotations, but whatever. My surgery rotations showed me that I never, ever, ever, ever want to step in the OR. So, it was good for that vs. having an easy rotation and thinking surgery is cool. Then, when hitting residency, knowing that I hate the lifestyle, hours and procedures.

 

[Law2Doc]

True, which is why I'm sure there are peeps that are jealous of the Carib students...

Nobody is jealous of them. That's like being jealous of handicapped people because they can park closer to the supermarket.

 

[KnuxNole]

Nobody is jealous of them. That's like being jealous of handicapped people because they can park closer to the supermarket.

You'd be surprised then. Cause there are peeps who actively **** on their schools, and wish their rotations were 100% easy with little to no effort. They be like "Damn, I WISH I can start at 8, leave at 1, and not do any work! That would be a dream bro!" Some I agree with, some I don't. As you and I both know, not everyone comes into med school wanting to work to their hardest and put in maximum effort. And, as you and I both agree to, there are residents who have the same thinking too, wanting to do as little as possible to start making that bank with no scars.

 

[caffeinemia]

You'd be surprised then. Cause there are peeps who actively **** on their schools, and wish their rotations were 100% easy with little to no effort. They be like "Damn, I WISH I can start at 8, leave at 1, and not do any work! That would be a dream bro!" Some I agree with, some I don't. As you and I both know, not everyone comes into med school wanting to work to their hardest and put in maximum effort. And, as you and I both agree to, there are residents who have the same thinking too, wanting to do as little as possible to start making that bank with no scars.

That's me! Hence, plastic surgery.

Oh wait, you mean we can only start the paraspinous flap closure after ortho does the 8 hr, 10 level fusion? Dang, guess no dinner plans anymore. Rinse and repeat everyday for 6 years ughhhhh

 

[caffeinemia]

Bilateral DIEPs...

Nah. At my institution, those take about 6 hours. Not so bad. Done by 2pm.

 

[fancymylotus]

That's me! Hence, plastic surgery.

Oh wait, you mean we can only start the paraspinous flap closure after ortho does the 8 hr, 10 level fusion? Dang, guess no dinner plans anymore. Rinse and repeat everyday for 6 years ughhhhh

Not jealous

 

[fancymylotus]

They were just starting to do them when I was on my plastics rotation. And the chief expected the intern to stay and do PM rounds after the case.

Wtf?! What the ****. I cant even. So youre supposed to wake up at 4am(ungodly hour) and be actively doing stuff till like 6 or 7pm? six or seven days a week?

 

[caffeinemia]

Wtf?! What the ****. I cant even. So youre supposed to wake up at 4am(ungodly hour) and be actively doing stuff till like 6 or 7pm? six or seven days a week?

Yeah, pretty much. We still do evening rounds when there's a new free flap on the service, which is like every day.

Strangely, DIEPs are really only available to about 20% of the patients in this country... so most people aren't very good at them. Our program probably does at least a couple hundred a year, so it's bread and butter for us. Of course, the downside is.. face transplant? What? Huh?

 

[fancymylotus]

Yeah, pretty much. We still do evening rounds when there's a new free flap on the service, which is like every day.

Strangely, DIEPs are really only available to about 20% of the patients in this country... so most people aren't very good at them. Our program probably does at least a couple hundred a year, so it's bread and butter for us. Of course, the downside is.. face transplant? What? Huh?

Meanie.

Its funny, the more I see Kaus' schedule and the more I read posts on the non-lounge parts of SDN, the more I realize that I would have been totally miserable as a physician. I guess its a good thing I had some semblance of self-awareness at age 21 and didnt go the MD route to appease my parents, bc otherwise I would be one depressed mopey horrid 29 y/o right now.

 

[Mr Doc Turr]

I looked up the 2014 match statistics and found that only 78 percent of graduates of osteopathic medical schools matched into residency (PGY1).

US allopathic seniors had a 94 percent match.

We also saw that 67 percent of SGU residents matched (I understand this number is inflated due to attrition and preliminary spots)

Is this something to worry about, for the DO schools?

 

[cidem2065]

No. Those are ACGME residencies and do not include AOA residency figures.

 

[DoctorSynthesis]

I looked up the 2014 match statistics and found that only 78 percent of graduates of osteopathic medical schools matched into residency (PGY1).

US allopathic seniors had a 94 percent match.

We also saw that 67 percent of SGU residents matched (I understand this number is inflated due to attrition and preliminary spots)

Is this something to worry about, for the DO schools?

As @cidem2065 pointed out those numbers are off. You must include figures from AOA and ACGME match. When you do that DOs and US MDs match pretty much everyone. While carribean has extreme difficulties and if you do match its most like a dead end prelim spot and/or a specialty you are uninterested in.

NSU com as an example only had 6 unmatched
http://medicine.nova.edu/aboutus/residency-match-data-comlex-board-scores.html

And all osteopathic schools match their students at a similar rate. Certain schools do slightly better but they all do well.

 

[Stagg737]

But your list would never look like that.

Actually, my current (extremely early) list looks something like that, though I'm 99.99% sure I won't stand a chance in my desired field going ACGME as a DO.

While I think there will be a upsurge in MDs "taking" DO spots, I think it has to be taken in mind that up until now DOs have had the option of trying to match into MD spots. So while there may be the appearance of a sudden grabbing up of spots favoring MDs, I think it will be more akin to finally equlibriating things that have been kept uneven to date. Further, I think it likely that traditionally DO programs will still keep some level of favoritism to DO applicants in the same way that there is till a tinge of favoritism against DOs applying into MD programs. Over time this may gradually wash away as the new process takes hold, but I would predict in 30 years that hospitals affiliated with DO schools will still be taking mostly DO grads, and hospitals with MD affilliations will be still taking mostly MD grads. Tribalism.

Right, but keep in mind that many of the ACGME spots taken by DOs are in the less competitive specialties. You don't see many DOs going into non-AOA derm or ortho programs, but if MDs can match into AOA that's where they'll end up. There's no reason for an MD to go into an AOA peds or psych program when they could just match into an ACGME one. I really hope the italicized line remains true, as my possibly slim chances of matching into ortho will dwindle to zero if that's not the case

I looked up the 2014 match statistics and found that only 78 percent of graduates of osteopathic medical schools matched into residency (PGY1).

US allopathic seniors had a 94 percent match.

We also saw that 67 percent of SGU residents matched (I understand this number is inflated due to attrition and preliminary spots)

Is this something to worry about, for the DO schools?

Keep in mind that the DO number is severely under-inflated. DOs can currently apply AOA and ACGME and if you get an AOA spot you are automatically pulled out of the ACGME match. I believe the NRMP reports DO students who enter the NRMP but end up at AOA programs as 'unmatched' because they didn't match in the ACGME, so a very large percentage of the unmatched DO students actually did match (just not to allopathic programs). Some of the more experienced individuals here like @gyngyn , @Goro , or @Law2Doc can correct me if I'm wrong. I know the school I attend (DO) had a 100% match rate last year and only 2 pre-lim surgery spots out of ~265 people, so realistically a 99.2% match rate.

TL;DR: If you're a competent student matching somewhere is not an issue for U.S. MDs or DOs.

 

[hushcom]

Keep in mind that the DO number is severely under-inflated. DOs can currently apply AOA and ACGME and if you get an AOA spot you are automatically pulled out of the ACGME match. I believe the NRMP reports DO students who enter the NRMP but end up at AOA programs as 'unmatched' because they didn't match in the ACGME,

I am not a pro at match issues, but after perusing the 2014 NRMP report I believe this is incorrect. The NRMP categorizes applicants as active, withdrawn, and no rank list. Active applicants are defined as having submitted a certified rank order list. The outcome for active applicants is either matched or unmatched.

Since it would make no sense to run the NRMP match algorithm for applicants who were removed from the process by matching AOA, I think those persons would be classified as withdrawn. There is also plenty of time between the matches to match AOA and never bother to submit a rank list to the NRMP, thus ending up in the no rank list category.

 

[Law2Doc]

I am not a pro at match issues, but after perusing the 2014 NRMP report I believe this is incorrect. The NRMP categorizes applicants as active, withdrawn, and no rank list. Active applicants are defined as having submitted a certified rank order list. The outcome for active applicants is either matched or unmatched.

Since it would make no sense to run the NRMP match algorithm for applicants who were removed from the process by matching AOA, I think those persons would be classified as withdrawn. There is also plenty of time between the matches to match AOA and never bother to submit a rank list to the NRMP, thus ending up in the no rank list category.

I think the point though is that 78% of those still left in the allo match after the Osteo match is a lot different than 78% of the total. So you basically need to be adding that 78% to another X% to get total percent matched. By contrast, offshore grads are a much lower percentage even after massive attrition so you basically ought to be dividing their percentages in half to get a sense of the real number of those who matriculate and ultimately match -ie 67% of the 50% matriculated who get to the match is really 34%.

 

[caffeinemia]

I think the point though is that 78% of those still left in the allo match after the Osteo match is a lot different than 78% of the total. So you basically need to be adding that 78% to another X% to get total percent matched. By contrast, offshore grads are a much lower percentage even after massive attrition so you basically ought to be dividing their percentages in half to get a sense of the real number of those who matriculate and ultimately match -ie 67% of the 50% matriculated who get to the match is really 34%.

Lawyers and math are a dangerous combination.

 

[KnuxNole]

What helps ImGs is matching into places that solely take foreign med students or the places where US grads would rather soap than going to, especially in Fm/Im/peds, this is a good chunk. Remember, the difference is a Carib grad wants to match anywhere regardless of location and training, while a US grad wants to match where location and best training is.

 

[Goro]

This is another element to which we have been trying to educate the pro-Carib diploma mill camp.

Yes, one may land a residency, but they're likely to be in piss-poor residency sites.

So lets review the pathologies one more time:

High attrition rate for matriculants
EDIT: Greater likelihood that it will take you longer than 4 years to graduate.
Poor odds of ever matching
IF matches occur, will not be in your first or even second choice of specialty.
IF matches occur, will not be in your first or even second choice of residency site.

Is this too difficult a concept to understand?

What helps ImGs is matching into places that solely take foreign med students or the places where US grads would rather soap than going to, especially in Fm/Im/peds, this is a good chunk. Remember, the difference is a Carib grad wants to match anywhere regardless of location and training, while a US grad wants to match where location and best training is.

 

[caffeinemia]

This is another element to which we have been trying to educate the peo-Carbi diploma camp.

Yes, one may land a residency, but they're likely to be in piss-poor residency sites.

So lets review the pathologies one more time:

High attrition rate for matriculants
Poor odds of ever matching
IF matches occur, will not be in your first or even second choice of specialty.
IF matches occur, will not be in your first or even second choice of residency site.

Is this too difficult a concept to understand?

WALL WALL WALL WALL.

Although if you want some interesting reading, you should read Abraham Verghese' Cutting for Stone. It's a lot of historical fiction, but has some interesting and bittersweet discourse on the nature IMG taking poor US residency spots.

 

[hushcom]

I think the point though is that 78% of those still left in the allo match after the Osteo match is a lot different than 78% of the total.

That may be a larger point within this discussion, but I was specifically addressing the notion that the remaining 22% includes people who matched AOA. Just a small, tangential spur, really.

 

[Law2Doc]

What helps ImGs is matching into places that solely take foreign med students or the places where US grads would rather soap than going to, especially in Fm/Im/peds, this is a good chunk. Remember, the difference is a Carib grad wants to match anywhere regardless of location and training, while a US grad wants to match where location and best training is.

This is a rapidly disappearing type of residency. In the day of prematches there used to be a lot of these "undesirable" residencies, grabbing up IMGs because they thought that's who they could get. Then the "all in" rule pushed most of these into the match and suddenly they were getting apps from US grads-- the people they had assumed they weren't attractive to.

So it's kind of like they were the self conscious guy/gal who always thought s/he was a loser, always dating others similarly attainable, but transfers to a new city and suddenly the beautiful people are throwing themselves at him/her -- how long do the IMGs keep this bastion?

And as US enrollment continues to rise there's a push down effect and these residencies are seeing better and better applications each year. So the "solely takes foreign grads" is becoming a so last year-- something people won't see much of going forward.

 

[DoctorSynthesis]

This is another element to which we have been trying to educate the pro-Carib diploma mill camp.

Yes, one may land a residency, but they're likely to be in piss-poor residency sites.

So lets review the pathologies one more time:

High attrition rate for matriculants
Poor odds of ever matching
IF matches occur, will not be in your first or even second choice of specialty.
IF matches occur, will not be in your first or even second choice of residency site.

Is this too difficult a concept to understand?

And very likely to be in a dead end prelim spot.

 

[caffeinemia]

This is a rapidly disappearing type of residency. In the day of prematches there used to be a lot of these "undesirable" residencies, grabbing up IMGs because they thought that's who they could get. Then the "all in" rule pushed most of these into the match and suddenly they were getting apps from US grads-- the people they had assumed they weren't attractive to.

So it's kind of like they were the self conscious guy/gal who always thought s/he was a loser, always dating others similarly attainable, but transfers to a new city and suddenly the beautiful people are throwing themselves at him/her -- how long do the IMGs keep this bastion?

And as US enrollment continues to rise there's a push down effect and these residencies are seeing better and better applications each year. So the "solely takes foreign grads" is becoming a so last year-- something people won't see much of going forward.

Are you single? Your use of bastion titillates me.

 

[KnuxNole]

This is a rapidly disappearing type of residency. In the day of prematches there used to be a lot of these "undesirable" residencies, grabbing up IMGs because they thought that's who they could get. Then the "all in" rule pushed most of these into the match and suddenly they were getting apps from US grads-- the people they had assumed they weren't attractive to.

So it's kind of like they were the self conscious guy/gal who always thought s/he was a loser, always dating others similarly attainable, but transfers to a new city and suddenly the beautiful people are throwing themselves at him/her -- how long do the IMGs keep this bastion?

And as US enrollment continues to rise there's a push down effect and these residencies are seeing better and better applications each year. So the "solely takes foreign grads" is becoming a so last year-- something people won't see much of going forward.

True, and those residencies are gonna have to step it up, since they won't be used to having more than 1-2 US grad residents in their programs, which hopefully they won't scoff at their seniors, who will all be foreign grads. As of right now, those are the places that some people interview at and go "Is this...a real residency?"

 

[DetectiveAlonzo]

And very likely to be in a dead end prelim spot.

What do you mean by "dead-end"? Like after that 1-year in that specific program, they have to apply for the match again? or are just kicked out and left with no job/residency?

 

[Law2Doc]

What do you mean by "dead-end"? Like after that 1-year in that specific program, they have to apply for the match again? or are just kicked out and left with no job/residency?

Yes and yes.

 

[DetectiveAlonzo]

Ahhh.. ok I see...

Is there anything an IMG applicant can do in that one-year to "strengthen" their application or situation if they do have to apply the following year again? Or are they pretty much poop out of luck? That's scary.

 

[gyngyn]

Ahhh.. ok I see...

Is there anything an IMG applicant can do in that one-year to "strengthen" their application or situation if they do have to apply the following year again? Or are they pretty much poop out of luck? That's scary.

Each year from graduation makes a less appealing application.
They can keep aiming lower and broader, though.

 

[Mr Doc Turr]

No. Those are ACGME residencies and do not include AOA residency figures.

So this means that 78 percent of DOs matched into M.D residencies? And the rest matched into DO residencies?

 

[WedgeDawg]

So this means that 78 percent of DOs matched into M.D residencies? And the rest matched into DO residencies?

This means that 78% of DOs who applied to MD residencies marched into MD residencies.

 

[Mr Doc Turr]

Yes and yes.

When I first asked this question last week, I was iffy about SGU and Ross.

Now after reading all these posts, I would say that there's no chance of me going there.

Not sure where to begin next time I see my uncle lol....

 

[Mr Doc Turr]

This means that 78% of DOs who applied to MD residencies marched into MD residencies.

In the same table, what does it mean by 22 percent (611 total) unmatched PGY1 and 24 percent (892) withdrew?

 

[DoctorSynthesis]

Ahhh.. ok I see...

Is there anything an IMG applicant can do in that one-year to "strengthen" their application or situation if they do have to apply the following year again? Or are they pretty much poop out of luck? That's scary.

Go to an american school... Hmm its to late now. Oh well.

In the same table, what does it mean by 22 percent (611 total) unmatched PGY1 and 24 percent (892) withdrew?

24 percent withdrew and 22 percent that did MD only might not have matched. However when you factor in this as only a sub population applying acgme only you realize that this isnt the full picture. The actual amount of unmatched is very low. NSU com had 6 no placement and some of those might just be doing research (I asked). Most other schools are similar. It doesn't natter what your uncle thinks. You have to live with your decisions. Not your uncle.

 

[Mr Doc Turr]

Go to an american school... Hmm its to late now. Oh well.


24 percent withdrew and 22 percent that did MD only might not have matched. However when you factor in this as only a sub population applying acgme only you realize that this isnt the full picture. The actual amount of unmatched is very low. NSU com had 6 no placement and some of those might just be doing research (I asked). Most other schools are similar. It doesn't natter what your uncle thinks. You have to live with your decisions. Not your uncle.

Ok thanks... Does anyone know how many DOs matched into AOA residencies? (I'm assuming its close to 100)

And are their chances of getting into an MD residency lower than it is for AOA? If so, by how much?

Thanks

 

[wowsers]

Ok thanks... Does anyone know how many DOs matched into AOA residencies? (I'm assuming its close to 100)

And are their chances of getting into an MD residency lower than it is for AOA? If so, by how much?

Thanks

The second question has been answered by previous posts here

 

[DoctorSynthesis]

Ok thanks... Does anyone know how many DOs matched into AOA residencies? (I'm assuming its close to 100)

And are their chances of getting into an MD residency lower than it is for AOA? If so, by how much?

Thanks

There are way more then a 100 AOA resendencies. As a DO you are at a small disadvantage at acgme resendencies but have a whole other group of resendencies to enter. With carribean you only have acgme and are at a huge disadvantage.

 

[hushcom]

Ok thanks... Does anyone know how many DOs matched into AOA residencies? (I'm assuming its close to 100)

The AOA match rate this year was 75% (2,179 of 2,907 applicants). This may reflect some of the gamesmanship that SoutherSurgeon mentioned above.

http://thedo.osteopathic.org/2015/02/aoa-match-pairs-medical-students-up-with-residency-programs/

https://www.natmatch.com/aoairp/ and click on "match statistics."

 

[IslandStyle808]

What do you mean by "dead-end"? Like after that 1-year in that specific program, they have to apply for the match again? or are just kicked out and left with no job/residency?

The only middle ground to not having a residency is to apply to another transitional internship, which IMGs also do. Once they have enough years (usually 2-3), they can be employed by a hospital in certain states as a general practitioner (your licensed but not board certified, thus cannot set up shop by yourself). However, you can't count on this either because hospitals are wanting more and more doctors that are board certified (completing the residency and speciality boards as well). This pathway of practicing, without a residency, may also be closed in the near future.