Am I missing something here?

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Uncle Albert

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This is N=1 but I've noticed so many IMGs who do IM residency at no name community programs who end up with cardiology, GI, and heme onc fellowship placements at university programs. Given that the match rate for US residents into cards (66%), GI (75%) and onc (80%) are not that optimal, how are university programs choosing IMGs over US grads? I was told by many attendings that the top 4 factors (only factors) for fellowship placement are (in order): 1. Whether or not you are US citizen 2. Prestige of your IM residency program 3. Prestige of your medical school 4. Research.

Am I missing something here? IMGs usually only have research on their side but how are they still landing competitive fellowship spots over US grads?


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Network, perhaps? It's not 100% meritocracy.

edit (not sure if i'm oversharing): fwiw, since the USA is considered a world leader in terms of both healthcare and medical education, there are certain agreements between academic institutions wherein there are slots in reserve for IMG/FMG with the agreement that these individuals will go back to their countries and improve the healthcare and medical education situation there. Keep in mind that I'm currently still a medstudent and this information isn't based on firsthand experience/knowledge so take it how you will :)
 
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There's also board scores, awards, advanced degrees, connections, etc.
 
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This is N=1 but I've noticed so many IMGs who do IM residency at no name community programs who end up with cardiology, GI, and heme onc fellowship placements at university programs. Given that the match rate for US residents into cards (66%), GI (75%) and onc (80%) are not that optimal, how are university programs choosing IMGs over US grads? I was told by many attendings that the top 4 factors (only factors) for fellowship placement are (in order): 1. Whether or not you are US citizen 2. Prestige of your IM residency program 3. Prestige of your medical school 4. Research.

Am I missing something here? IMGs usually only have research on their side but how are they still landing competitive fellowship spots over US grads?


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Residency is the biggest bottle neck for FMGs as they haven't "proven" themselves in the US healthcare system yet. You will find that the ones that match so well have likely phenomenal board scores, huge amounts of research in the subspecialty they apply for, and may even have connections at these places due to previous research.

So, yes, you are missing something. They matched poorly in IM given the innate bias against them at the level of residency, but once they are through residency, this bias is mostly gone and they match appropriately.
 
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I was told by many attendings that the top 4 factors (only factors) for fellowship placement are (in order): 1. Whether or not you are US citizen 2. Prestige of your IM residency program 3. Prestige of your medical school 4. Research.

Am I missing something here?


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your attendings are wrong....

getting a fellowship isn't always about what you know, but who you know...and who you impress...
 
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your attendings are wrong....

getting a fellowship isn't always about what you know, but who you know...and who you impress...

Although networking is part of the process, it is nowhere as important as your your residency, medical school, research, and step scores. Potentially if you were a borderline applicant for a program, a call may help.
 
I was told by many attendings that the top 4 factors (only factors) for fellowship placement are (in order): 1. Whether or not you are US citizen 2. Prestige of your IM residency program 3. Prestige of your medical school 4. Research.

Sorry... but those "many attendings" don't know jack s*** how fellowship placement works.
 
Although networking is part of the process, it is nowhere as important as your your residency, medical school, research, and step scores. Potentially if you were a borderline applicant for a program, a call may help.
that may be true for residency but fellowship is a different ball of wax...step scores play a very small role, if any...med school, too will play a small role...that is old news compared to how you did in residency and what research (if its a subspecialty that cares about research) you have done that has resulted in publication or presentation (ideally at a national meeting), but do not underestimate the power of a great LoR (or well placed call) from a known leader in the field...it can open many a doors.
 
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that may be true for residency but fellowship is a different ball of wax...step scores play a very small role, if any...med school, too will play a small role...that is old news compared to how you did in residency and what research (if its a subspecialty that cares about research) you have done that has resulted in publication or presentation (ideally at a national meeting), but do not underestimate the power of a great LoR (or well placed call) from a known leader in the field...it can open many a doors.
I actually did not mean to displace the importance of LoR. I completely agree, the LoR are extremely important as well. Through my personal experience and knowing the cardiology PD at my residency institution; the most important factors were: 1. residency program 2. research 3. med school 4. LoR 5. Step scores.
 
My $0.02 based on my personal experience:

Many IMG residents were already physicians in their home country, or else were able to get into a US program in the first place by virtue of their superiority to many of their home country peers; Aga Khan University for instance has >2000 medical undergraduates, so the bar is already high just to get to the US programs. If you factor in the more rigorous clinical training received by medical undergraduates in most other countries as compared to US schools where medical students are protected and given very little real responsibility or rigorous training in clinical skills, the end result is that the clinical acumen of many IMGs is superior to their AMG colleagues, at least early in residency. So as interns they're doing things that they've already been comfortable doing as medical students or as physicians prior to even starting residency. As a result many IMGs have much more mental bandwidth available to pursue research projects and be more productive earlier in residency while their AMG colleagues are still trying to figure out how to replace phosphate deficits on the floor.

Fellowship program directors can look at this and see that those IMGs will be better research worker bees in fellowship as well. If you're a NIH-funded faculty researcher you need warm bodies to do your grunt work, so IMGs who've done well in medical school at home, then performed well and been productive in research in their residency program in the US are prime candidates.
 
Things are still pretty good for the AMG as a whole, see the NRMP fellowship match data from 2017

Gi -US grads matched 319/377
Cards US grads matched 482/577
Pulm/CC- US grads matched 289/323

http://www.nrmp.org/wp-content/uploads/2017/02/Results-and-Data-SMS-2017.pdf

Now we don't have all the data on what kind of people were matching or where they matched. But its unlikely the majority of those who are going unmatched are average or above average USMD applicants. Be your best self and I imagine things work out for most people.
 
Things are still pretty good for the AMG as a whole, see the NRMP fellowship match data from 2017

Gi -US grads matched 319/377
Cards US grads matched 482/577
Pulm/CC- US grads matched 289/323

http://www.nrmp.org/wp-content/uploads/2017/02/Results-and-Data-SMS-2017.pdf

Now we don't have all the data on what kind of people were matching or where they matched. But its unlikely the majority of those who are going unmatched are average or above average USMD applicants. Be your best self and I imagine things work out for most people.

oh absolutely....i don't think anyone was saying that a solid AMG isn't going to match into fellowship , but the OPs question was why do you see so many FMG (and mind you these are , as Drfunk pointed out, FMGs from domiciled schools in their own country) match into coveted fellowship spots and unlike residency, where the comparison to an AMG is not as easy to do, residency has a way of evening the playing field to some extent.
 
This is N=1 but I've noticed so many IMGs who do IM residency at no name community programs who end up with cardiology, GI, and heme onc fellowship placements at university programs. Given that the match rate for US residents into cards (66%), GI (75%) and onc (80%) are not that optimal, how are university programs choosing IMGs over US grads? I was told by many attendings that the top 4 factors (only factors) for fellowship placement are (in order): 1. Whether or not you are US citizen 2. Prestige of your IM residency program 3. Prestige of your medical school 4. Research.

Am I missing something here? IMGs usually only have research on their side but how are they still landing competitive fellowship spots over US grads?


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#'Merica!

I guess you're one of those people who thought "we need to build a wall" last November.
 
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#'Merica!

I guess you're one of those people who thought "we need to build a wall" last November.

No I'm not.

My question was basically if AMGs are held in such a higher regard than IMGs when it comes to getting into an IM residency, why doesn't this hold true for fellowship?

I understand that connections and letters of rec play a big role but I have been told by a plethora of attendings that the 4 factors I listed are the most important in that order. Obviously, if you are on a first-name basis with the PD of a program, then you are set regardless of whether you are AMG/IMG or other stuff. But for the vast majority of us, including me, who will probably not have relatives/close friends as program directors or high-ups in the medical food-chain, doesn't it hold true that AMG status, respectable academic IM program, graduate of US allopathic school, and research matter the most in that order?
 
My $0.02 based on my personal experience:

Many IMG residents were already physicians in their home country, or else were able to get into a US program in the first place by virtue of their superiority to many of their home country peers; Aga Khan University for instance has >2000 medical undergraduates, so the bar is already high just to get to the US programs. If you factor in the more rigorous clinical training received by medical undergraduates in most other countries as compared to US schools where medical students are protected and given very little real responsibility or rigorous training in clinical skills, the end result is that the clinical acumen of many IMGs is superior to their AMG colleagues, at least early in residency. So as interns they're doing things that they've already been comfortable doing as medical students or as physicians prior to even starting residency. As a result many IMGs have much more mental bandwidth available to pursue research projects and be more productive earlier in residency while their AMG colleagues are still trying to figure out how to replace phosphate deficits on the floor.

Fellowship program directors can look at this and see that those IMGs will be better research worker bees in fellowship as well. If you're a NIH-funded faculty researcher you need warm bodies to do your grunt work, so IMGs who've done well in medical school at home, then performed well and been productive in research in their residency program in the US are prime candidates.

To be honest, having worked with IMG and AMG hospitalists and knowing people who went to residency programs with IMGs, I do not agree with your impression at all. However, I also believe that it is impossible to compare IMGs as a whole, there is dramatic differences between IMGs depending on where they come from and obtained their education. One thing I have observed for sure though is that IMG are typically older than AMG; and many have spent some significant time doing research prior to research which can definitely help their application.
 
No I'm not.

My question was basically if AMGs are held in such a higher regard than IMGs when it comes to getting into an IM residency, why doesn't this hold true for fellowship?

I understand that connections and letters of rec play a big role but I have been told by a plethora of attendings that the 4 factors I listed are the most important in that order. Obviously, if you are on a first-name basis with the PD of a program, then you are set regardless of whether you are AMG/IMG or other stuff. But for the vast majority of us, including me, who will probably not have relatives/close friends as program directors or high-ups in the medical food-chain, doesn't it hold true that AMG status, respectable academic IM program, graduate of US allopathic school, and research matter the most in that order?

Take a look at the link someone posted with NRMP. You do realize that
"Gi -US grads matched 319/377
Cards US grads matched 482/577
Pulm/CC- US grads matched 289/323"

So US grads have significantly higher chance of matching still compared to IMGs. For GI, 34% of IMG matched compared to 85% of AMG. For Cards, 64% IMG matched compared to 84% of AMG. Its interesting that it is actually easier for IMGs to match into cards, possibly due to the significant more number of spots and less AMG applying in cards.
 
Take a look at the link someone posted with NRMP. You do realize that
"Gi -US grads matched 319/377
Cards US grads matched 482/577
Pulm/CC- US grads matched 289/323"

So US grads have significantly higher chance of matching still compared to IMGs. For GI, 34% of IMG matched compared to 85% of AMG. For Cards, 64% IMG matched compared to 84% of AMG. Its interesting that it is actually easier for IMGs to match into cards, possibly due to the significant more number of spots and less AMG applying in cards.

The competitiveness for any internal medicine fellowship (and medical specialty in general) correlates directly with how favorable their presumed "$ to amount worked" ratio is. This isn't looking so favorable for cardiology recently thus less competitive than before.

I have noticed that IMGs, especially those from Asia, have this unusual glorified view of cards, maybe for cultural reasons.
 
To be honest, having worked with IMG and AMG hospitalists and knowing people who went to residency programs with IMGs, I do not agree with your impression at all. However, I also believe that it is impossible to compare IMGs as a whole, there is dramatic differences between IMGs depending on where they come from and obtained their education. One thing I have observed for sure though is that IMG are typically older than AMG; and many have spent some significant time doing research prior to research which can definitely help their application.

I'm sure it varies by program. As I said, this is just based on my experience. I suppose I should say that it was at an upper tier academic internal medicine program that (at the time anyway) had a much higher proportion of IMGs than other similar programs, so there is some selection bias in terms of the IMGs I trained around. Also as you note, many IMGs have had to spend a year or more in various research assistant positions in the US (essentially working as cheap lab labor for researchers) while they study for and complete their step exams, so that also may offer a leg up in terms of research experience before residency.
 
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Exa
No I'm not.

My question was basically if AMGs are held in such a higher regard than IMGs when it comes to getting into an IM residency, why doesn't this hold true for fellowship?

I understand that connections and letters of rec play a big role but I have been told by a plethora of attendings that the 4 factors I listed are the most important in that order. Obviously, if you are on a first-name basis with the PD of a program, then you are set regardless of whether you are AMG/IMG or other stuff. But for the vast majority of us, including me, who will probably not have relatives/close friends as program directors or high-ups in the medical food-chain, doesn't it hold true that AMG status, respectable academic IM program, graduate of US allopathic school, and research matter the most in that order?
exactly what part of "no" did you not understand?
 
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