Are residencies that accept only US MDs better?

[twospadz]

I've heard one gauge of the quality of a MD residency program is the number of US MDs in the program. Is this true?

---

Members don't see this ad.

 

[IlDestriero]

We had a superstar fellow who went to school in Italy of all places who was better than 1/4 the faculty. Things are not black and white. Now we have another one of those damned foreign grads. I hope this one stays on as well.

 

[22031 Alum]

I've heard one gauge of the quality of a MD residency program is the number of US MDs in the program. Is this true?

I think there are too many other factors- both in deciding program "quality" and in determining who ends up where- to make a generalization like that.

 

[Wordead]

I agree that it's generally a poor gauge of program quality. However, if a program is almost all foreign grads (or, sorry, DOs), you have to wonder why american MDs dont want to go there.

 

[bashwell]

Non-US MDs could be at a program for a variety of reasons. Sure, they could be non-US MDs who are at places that are actually quite malignant. Those are more likely the places to avoid. But they could also be superstars at Harvard or similar places (e.g. already attendings in their home nation who came to the US for better or other opportunites, well published including in journals like NEJM or Nature or Science, MD/PhD from top places like Cambridge, Oxford, the Karolinska Institute). They could be at places US MDs find "undesirable" but which are actually perfectly good programs (e.g. due to location). Anyway, point being, it's really hard to generalize and make a blanket statement like that. It really depends on several variables including some possibly intangible variables.

Plus, what's considered "undesirable" in one cycle may change in future cycles. For example, witness how much USC IM has changed over the last decade. If I'm not mistaken, they only have maybe one or two non-US MDs today, whereas it wasn't always like that in the past.

 

[alpinism]

Generally speaking its a red flag if a residency has more than 1 or 2 caribbean grads in their program.

For DOs its a bit more nuanced since some parts of the country (midwest especially) have many DO schools.

 

[Stagg737]

I agree that it's generally a poor gauge of program quality. However, if a program is almost all foreign grads (or, sorry, DOs), you have to wonder why american MDs dont want to go there.

That's hard to gauge since MD applicants could not apply to AOA programs previously. It'll be interesting to see how the demographic of the once-AOA programs will change 5-10 years after the merger happens. I'm assuming you're talking about ACGME programs that have mostly DO/non-U.S. MD grads though. I'm not aware of many programs where this would occur, but I think you'd have to look at where those people are coming from and what they knowledge base (stats I guess...) is to find that out. Plus, if you're saying the quality of program is poor, I don't think it would necessarily be limited to DOs or foreign grads, but rather graduates who were either very weak applicants or just applied so poorly that they were 'stuck' with those programs.

 

[Wordead]

That's hard to gauge since MD applicants could not apply to AOA programs previously. It'll be interesting to see how the demographic of the once-AOA programs will change 5-10 years after the merger happens. I'm assuming you're talking about ACGME programs that have mostly DO/non-U.S. MD grads though. I'm not aware of many programs where this would occur, but I think you'd have to look at where those people are coming from and what they knowledge base (stats I guess...) is to find that out. Plus, if you're saying the quality of program is poor, I don't think it would necessarily be limited to DOs or foreign grads, but rather graduates who were either very weak applicants or just applied so poorly that they were 'stuck' with those programs.

Yeah, was talking about ACGME programs obviously. And sure, weak applicants would make for a weak program but you cant tell that based on school name alone. And you dont have access to their stats.

 

[J ROD]

In general, it is a way to gauge a program's strength. But, ability is not determined by where you went.

 

[TBV]

Yes.

 

[Law2Doc]

Part of the reason programs steer away from foreign grads is less about "quality" and more about US rotation experience and cultural expectations. You can be brilliant and know a ton of medicine, but if you haven't done US rotations and sub-Is, your learning curve will simply be much steeper. Which causes the PD more headaches and puts a heavier burden on your US coresidents. Which by word of mouth translates to less popularity amongst US applicants in future years.

 

[deleted158872]

on a separate topic: how can one tell which residencies are of poor quality or malignant?

 

[Psai]

Word of mouth

US residency programs prefer US MDs. So if the program is not filled by US MDs, either they aren't applying or they are choosing other places over that one for various reasons

 

[Anicetus]

Yes

 

[collegestud2013]

I agree that it's generally a poor gauge of program quality. However, if a program is almost all foreign grads (or, sorry, DOs), you have to wonder why american MDs dont want to go there.

This, but the percentage of FMGs or IMGs probably depends just as much on the specialty as the program. Nearly all American programs will f avor AMGs, which makes sense that someone wanting to practice in the US The least competitive specialties will have a lot of of them (even at a high ranking program within the specialty), while the most competitive ones will have very few IMGs/FMGs (even if it's a mediocre program within the specialty) since they get many more applicants per spot and can afford to be selective. If you look at Charting the Outcomes you'll see the the least competitive specialties (FM, Psych, Pediatrics, IM) will have 30-50% of spots going IMGs/FMGs in a given year, while the most competitive (plastics, ortho, derm, nerusurg, ENT) all have <10%.

 

[Wordead]

This, but the percentage of FMGs or IMGs probably depends just as much on the specialty as the program. Nearly all American programs will f avor AMGs, which makes sense that someone wanting to practice in the US The least competitive specialties will have a lot of of them (even at a high ranking program within the specialty), while the most competitive ones will have very few IMGs/FMGs (even if it's a mediocre program within the specialty) since they get many more applicants per spot and can afford to be selective. If you look at Charting the Outcomes you'll see the the least competitive specialties (FM, Psych, Pediatrics, IM) will have 30-50% of spots going IMGs/FMGs in a given year, while the most competitive (plastics, ortho, derm, nerusurg, ENT) all have <10%.

True, there may be more IMG/FMGs in the less competitive specialties but the top programs in those specialties will still be close to 100% AMG. IM doesnt even belong in that list because the top programs are extremely competitive even for AMGs.

 

[Law2Doc]

Also all foreign grads aren't equal. If a program is filled with people educated in England, Germany, Italy and France that telegraphs something different than Grenada and St. Kitts.

 

[mimelim]

Word of mouth

US residency programs prefer US MDs. So if the program is not filled by US MDs, either they aren't applying or they are choosing other places over that one for various reasons

This is not universally true. We took an FMG over 50 AMG for one of two spots. Sometimes they are just better. We also don't interview DOs or Caribbean graduates. But, top of your class from Western Europe, Qatar, Dow, etc. having already done a pre-lim year in the US, preferably at our hospital (ie we've seen you working on other services and can talk to people about your working in a US hospital)? Why not?

 

[Psai]

Well yeah it's a general rule of thumb, not a holy commandment. I would also take the best the world has to offer

 

[Goro]

One other clue is that if it's a competitive specialty yet they have spots that go unfilled.

on a separate topic: how can one tell which residencies are of poor quality or malignant?

 

[Mad Jack]

I agree that it's generally a poor gauge of program quality. However, if a program is almost all foreign grads (or, sorry, DOs), you have to wonder why american MDs dont want to go there.

Yeah, if it's all IMGs or DOs, you're looking at one of three situations:

1- The program is in an undesirable location, and may or may not provide good training.
2- The program is a sweatshop, and may or may not provide good training.
3- The program has a reputation for poor training, as evidenced by board pass rates and fellowship placement rates.

There's plenty of programs in desirable locales that are known to be malignant but are filled with US MDs anyway, because their location trumps their program quality. Likewise, there are plenty of places where the program isn't particularly malignant, but no US MDs want to go there because they are in BFE.

If you want a good read on program quality, your best bet is to look at the program's first time board pass rates, their fellowship placement rate, and their case volume (as this is often a good index for case variety, which is something you generally want out of training). This is, as always, an oversimplification to a very complex topic- some lower volume places provide better opportunities than higher volume places due to a lack of fellows taking the good stuff, for instance- but it's a good place to start.

If a place has a lot of IMGs and DOs though, you should definitely ask "why?" Because there is probably a good reason in there somewhere, be it location, lack of ancillary services, brutal call schedules, poor training, etc.