MD How do grades affect residency for foreign medical graduates?

[dsw6]

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Hello,

I am a US trained dentist, American by naturalization. My daughter decided to study medicine in Europe and is now in 2nd year out of 6. Always a bright child with good memory is now a miserable kid who is studying non stop and getting louse grades. Lectures and exams are in English. Very few kids get 9's or 10's (exceptional A). She is hobbling along and getting 6's, 7's and some 8's. She says that very few people are getting high marks and about a 6th of the class is repeating first year due to difficulty. She compared US medical schools and what she is doing and she says that her studies are more in depth.

I studied undergrad, DAT tests and dental school in a foreign language (English) and still got high 70's, 80's and low 90's on my boards. Dental school was harder for me than my classmates (Native American speakers) because I didn't speak English as well as I do today.

My kidney specialist is an FMG from Johannesburg and her son finished med school in Tel Aviv and entered internal medicine residency in NYC. I asked how residencies picked applicants and she said grades and USMLE. Now that USMLE is 80% tests score to pass and 4 attempts or bust, I am worried that if my daughter continues with below averages grades her chance of getting picked will be low or none.

Another FMG doctor practicing in the US said that nobody looks at grades and she just has to pass USMLE. That makes no sense as I knew med student match back when I was a dental student, worked off your grades. Dental students had to have near perfect grades if they wanted to get into oral surgery or orthodontic post graduate programs.

Can anyone offer words of advice for this worried mother? Thank you kindly!!

 

[dsw6]

If this needs to be moved somewhere else, could you please let me know where to put it. I saw that it was deleted. Not sure why?

 

[wysdoc]

If this needs to be moved somewhere else, could you please let me know where to put it. I saw that it was deleted. Not sure why?

You posted it twice in the same forum and the duplicate was deleted. Responses will not be instant

 

[dsw6]

Actually I posted it the second time because it was deleted the first time.

 

[MateoGM416]

My kidney specialist is an FMG from Johannesburg and her son finished med school in Tel Aviv and entered internal medicine residency in NYC. I asked how residencies picked applicants and she said grades and USMLE. Now that USMLE is 80% tests score to pass and 4 attempts or bust, I am worried that if my daughter continues with below averages grades her chance of getting picked will be low or none.

Passing on USMLE is anywhere from 60-75% I believe, depending on the form.

Another FMG doctor practicing in the US said that nobody looks at grades and she just has to pass USMLE. That makes no sense as I knew med student match back when I was a dental student, worked off your grades. Dental students had to have near perfect grades if they wanted to get into oral surgery or orthodontic post graduate programs.

Can anyone offer words of advice for this worried mother? Thank you kindly!!

It depends on what specialty she wants. As a foreign medical graduate she is inherently at a disadvantage for competitive specialties and even at less competitive specialties at bigger more renowned academic programs. Though assuming she is a US citizen that helps so she doesn't have to deal with the current visa situation in the US. I think that FMG doctor is correct in that I don't think PD's care about grades from foreign medical schools because they have no frame of reference for how rigorous the coursework is. That is why USMLE Step 2 scores are way more important.

To answer your question, there's a lot of things that go into how competitive FMG's are for different specialties at different programs in different parts of the country. In general, being an FMG makes it harder to match in the US, but that's not a hard rule and plenty of good programs in many specialties match FMG's every year.

 

[dsw6]

What specialties would be less competitive? Yes, she is an American citizen.

Is there a place where I can read how the process goes from application to where to sign up for match? Like a step by step process that explains to US med students what to do and when. Just trying to learn myself and hopefully be useful to her.

Thank you kindly for taking the time!!

 

[MateoGM416]

What specialties would be less competitive? Yes, she is an American citizen.

So surgical specialties are more competitive, as well as those which are considered 'lifestyle' specialties aka 'R.O.A.D.' specialties (radiology, ophthalmology, anesthesiology, dermatology). Primary care specialties such as FM, IM, pediatrics are not competitive to match into.

The only chart I could find to illustrate this is from 2024 match data but the NRMP also publicly released the match data for this most recent match cycle on their website. The general trends stay the same year to year.

Is there a place where I can read how the process goes from application to where to sign up for match? Like a step by step process that explains to US med students what to do and when. Just trying to learn myself and hopefully be useful to her.

Thank you kindly for taking the time!!

I think the most important thing you could do is relax. It's her journey to go through. It sounds like she knows many of these things already. I don't know any good resource that explains the whole process off the top of my head. But I'm guessing her school has counseling or advising for students want to apply for residency in the US as that is obviously not an unpopular thing to do for foreign medical students. In general. She should take USMLE Step 1 before her core clinical rotations start. She should take Step 2 the Spring/Summer before applications open for residency, and she should have her ERAS (the US residency app service) application with letters of recommendation ready by September. Interview season is from October to February. And she should shoot for starting residency as close to graduation as possible.

 

[Goro]

What specialties would be less competitive? Yes, she is an American citizen.

Is there a place where I can read how the process goes from application to where to sign up for match? Like a step by step process that explains to US med students what to do and when. Just trying to learn myself and hopefully be useful to her.

Thank you kindly for taking the time!!

Family Medicine, EM, Peds.

Is it possible she's doing poorly because she's miserable in Europe? That she really doesn't want to be a doctor?

 

[dsw6]

Family Medicine, EM, Peds.

Is it possible she's doing poorly because she's miserable in Europe? That she really doesn't want to be a doctor?

On the contrary. She is near downtown and school with plenty of cafes and shops. She made a lot of friends from all over the world. She loves it there quite a bit because she is bilingual. Plus there are aunts and cousins.

 

[dsw6]

Family Medicine, EM, Peds.

Is it possible she's doing poorly because she's miserable in Europe? That she really doesn't want to be a doctor?

I heard that emergency medicine can be practiced part time. True?

 

[dsw6]

Passing on USMLE is anywhere from 60-75% I believe, depending on the form.



It depends on what specialty she wants. As a foreign medical graduate she is inherently at a disadvantage for competitive specialties and even at less competitive specialties at bigger more renowned academic programs. Though assuming she is a US citizen that helps so she doesn't have to deal with the current visa situation in the US. I think that FMG doctor is correct in that I don't think PD's care about grades from foreign medical schools because they have no frame of reference for how rigorous the coursework is. That is why USMLE Step 2 scores are way more important.

To answer your question, there's a lot of things that go into how competitive FMG's are for different specialties at different programs in different parts of the country. In general, being an FMG makes it harder to match in the US, but that's not a hard rule and plenty of good programs in many specialties match FMG's every year.

As I mentioned earlier my kidney specialist is at the top US hospital and she is from South Africa and a thyroid surgeon from Russia is in a prestigious center.

If she wanted to go to a hospital near our home, would it help if she showed interest and got them to see her, rather than be a name on an application?

 

[NotAProgDirector]

I agree with what has already been said.

Grades are difficult to interpret from international schools. She says that few are getting 9-10's, but how are we to know? Some schools ultimately report class rank/standing -- and that's much easier to interpret. It's always possible that someone on the admissions team will be from that school, and would have more experience, but that's less likely.

The things that will likely matter most:
1. School performance, esp if a class rank/ standing is reported.
2. USMLE scores. A pass the first time on step 1, and a good score on Step 2. If you pass these exams you cannot retake -- so she needs to do as well as possible the first time (and failing is not good).
3. US clinical experience. In her final year, she should come back to the US and do some rotations here. These rotations should be at programs with residencies in the field she is trying to go into, not with just some random doc here in the US.
4. Not needing a visa.

Choice of field is important also. The less competitive fields are IM, FM, ED (competitiveness seems to be in flux from year to year), Peds, Path, Neuro
The mid competitive fields are: Anesthesia, Gen Surgery
The high competitive fields are: Ophthalmology, Dermatology, Radiology, all the surgical subspecialties.

This is a very shortened list -- there are many more options out there, and competitiveness fluctuates over time. Better / more academic hospitals will be more competitive than non -- so although IM is one of the lower competitive fields, IM at a big academic center is mid to high competitive.

 

[NotAProgDirector]

I heard that emergency medicine can be practiced part time. True?

Everything can be practiced part time, theoretically. Some things are easier to do so. Fields that tend to be shift based (i.e. don't require patient continuity) tend to be easier to be PT, but any physician can be.

BUT, when starting out, getting a PT job to start can be more tricky. You learn much about being a physician in your first years of practice. Some places may be less interested in people wanting to start as PT.

As I mentioned earlier my kidney specialist is at the top US hospital and she is from South Africa and a thyroid surgeon from Russia is in a prestigious center.

If she wanted to go to a hospital near our home, would it help if she showed interest and got them to see her, rather than be a name on an application?

Maybe. What hospital are we talking about? If the hospital near your home is "Mass General Hospital in Boston", then no -- although a rotation there with a letter might be very helpful getting a spot elsewhere. If it's Newton Wellesley Hospital (which is outside of Boston and affiliated with MGB), then likely yes. Assuming she does good work while she is there.

 

[dsw6]

US clinical experience. In her final year, she should come back to the US and do some rotations here. These rotations should be at programs with residencies in the field she is trying to go into, not with just some random doc here in the US.

I am copying only this part. What does this actually mean? If she is trying to pass the USMLe part 2 during her last year, and try to match, when would she have time for this before being picked?

 

[dsw6]

Everything can be practiced part time, theoretically. Some things are easier to do so. Fields that tend to be shift based (i.e. don't require patient continuity) tend to be easier to be PT, but any physician can be.

BUT, when starting out, getting a PT job to start can be more tricky. You learn much about being a physician in your first years of practice. Some places may be less interested in people wanting to start as PT.

Maybe. What hospital are we talking about? If the hospital near your home is "Mass General Hospital in Boston", then no -- although a rotation there with a letter might be very helpful getting a spot elsewhere. If it's Newton Wellesley Hospital (which is outside of Boston and affiliated with MGB), then likely yes. Assuming she does good work while she is there.

University of Pennsylvania.

 

[NotAProgDirector]

It is quite possible to do US rotations, take Step 2, and apply for residency all in the same year. STep 2 can be taken at any time, so they could take it the year beforehand if they wish. Many international grads end up taking a gap year -- getting Step 2 and US rotations done in their last year, and then applying the year following for the match, sometimes by also doing an internship in their medical school country. But it's definitely possible to avoid the gap year with planning.

U Penn is a big academic center and is going to be competitive. Looking at their IM residency, they do have a few international grads. So it's possible, but she would need a stellar performance to match there. There are many other programs in the Philadelphia area, many of which are more accepting of international grads. Much will depend upon what field she is interested in.

As others have mentioned, I realize you're trying to help, but this is her problem to deal with. She chose to study medicine in Europe, which will make coming back to the US for residency more complicated. She will need to decide what field she wants to pursue, and ensure that all of the steps are done to get further training in the US if that's what she chooses.

Last, I find the statement that she has compared her education to that in the US and that hers is more "in depth" somewhat comical. She likely has no idea what actually happens in US medical schools. And the fact that many people are repeating might be impacted on whom this school admits, or the quality of their education, rather than comparative rigor.

I do wish her the best of luck. She has chosen a difficult path.

 

[Mr.Smile12]

The current domestic political environment has made it more appealing to study abroad. We have interviewed someone who is doing this in Spain and is helping other Americans get a realistic picture of the challenges to do this. She does not intend to return to the US to practice in the immediate future, but we discuss the challenges of returning (Interview to be posted as Expert Advice Q&A vlog). The article is worth reading because it discusses how students are supported at her school.

Medical School Abroad: My Journey Studying Medicine in Spain | Student Doctor Network | SDN

Abstract: This article presents an American student's firsthand account of pursuing medical school in Spain. The author describes adapting to a post-high

www.studentdoctor.net

I suspect most of her classmates are of a high SES and social standing family, likely with family members in medicine. They are used to the expectations of uni that are not the same as expectations as a US high school student starting out in college.

 

[dsw6]

Just the fact that med school is 6 years vs 4 means that she is definitely studying more. There are no lawsuits unless someone dies, so students are allowed in the OR or clinics to observe and sometimes help.

The deciding factor for her was proximity of family, citizenship, being away from parents 😀 and no 4 years of undergraduate. European high schools are more rigorous and teach more sciences. My high school in Europe each had 14 subjects.

You are right that this is her problem. Being helpful and giving her ideas means I have done what a good parent should do. I won't be able to walk in her shoes, but telling her Keen's are pretty good hiking shoes is how I hope to guide her.

Look at you too here, being very kind and decent! Very much appreciated!!

 

[dsw6]

The current domestic political environment has made it more appealing to study abroad. We have interviewed someone who is doing this in Spain and is helping other Americans get a realistic picture of the challenges to do this. She does not intend to return to the US to practice in the immediate future, but we discuss the challenges of returning (Interview to be posted as Expert Advice Q&A vlog). The article is worth reading because it discusses how students are supported at her school.

Medical School Abroad: My Journey Studying Medicine in Spain | Student Doctor Network | SDN

Abstract: This article presents an American student's firsthand account of pursuing medical school in Spain. The author describes adapting to a post-high

www.studentdoctor.net

I suspect most of her classmates are of a high SES and social standing family, likely with family members in medicine. They are used to the expectations of uni that are not the same as expectations as a US high school student starting out in college.

Very helpful article.

Cost of medical education is outrageous. You are chained to school loans for years.

But dental school is even worse. Friend's daughter graduated Tufts dental school 2 years ago at 400K. Parents paid for it. This is on the top of undergraduate cost and MPH.