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Competitive Specialties for Foreign Medical School Graduates?

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theSupremeHobgoblin

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I cannot find the info I'm interested in in the forums, or here...

(Apparently I cannot post a link, but the document I'm using is:)
NRMP-ECFMG-Charting-Outcomes-in-the-Match-International-Medical-Graduates-2014.pdf
It's at ecfmg

This document has a lot of information on many of the more common specialties. It seems to lack information on orthopedic surgery and neurosurgery, which are what my friend, who is considering foreign medical school, claims to be interested in.

Let's assume my friend is a decent candidate for medical school in the US, but goes abroad for personal reasons not related to academic capacity to go to medical school. According to the document above, for many (most?) specialties listed, his chances of placing into a preferred residency are less, but not actually by that much, if he has the same USMLE scores as domestic MD grads. In fact, in some specialties, it seems (?) to have little impact on residency placement.

1. Can someone explain to me what I'm overlooking here? Example1 (page 19): Anesthesiology match USMLE Step 1 score for domestic graduate: about 238; foreign: 241. Only three points were needed to make the difference. Pathology: 222 vs. 230. The trend is not uncommon. These are real, but they don't seem to be huge differences.

2. My primary question: can/do foreign medical school graduates be competitive candidates for the most highly coveted specialties? Can/do foreign medical school graduates become orthopedic surgeons, neurosurgeons, dermatologists, etc.? How much "better" do their scores have to be? Does going to a foreign school ALONE significantly impact your chance at such specialties? By how much?

Final relevant point - many go to foreign medical schools because they have less aptitude, so it's not surprising they don't get into more competitive specialties. But IF you DO have similar aptitude, and simply choose to go abroad for unrelated reasons, presumably your scores will end up similar on USMLE's regardless of where you go. So do the statistics really provide data that shows it is the SCHOOL, and not the CANDIDATES, that impact placement?

Thank you. If this is elsewhere in the forums I'm all ears...
 

WedgeDawg

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2. My primary question: can/do foreign medical school graduates be competitive candidates for the most highly coveted specialties? Can/do foreign medical school graduates become orthopedic surgeons, neurosurgeons, dermatologists, etc.? How much "better" do their scores have to be? Does going to a foreign school ALONE significantly impact your chance at such specialties? By how much?

Final relevant point - many go to foreign medical schools because they have less aptitude, so it's not surprising they don't get into more competitive specialties. But IF you DO have similar aptitude, and simply choose to go abroad for unrelated reasons, presumably your scores will end up similar on USMLE's regardless of where you go. So do the statistics really provide data that shows it is the SCHOOL, and not the CANDIDATES, that impact placement?

Some programs will not interview non-US medical graduates. There is a box they can click to screen by country of schooling.

There is an inherent bias against non-US medical graduates, particularly in the competitive specialties. And when non-US graduates match into competitive specialties, they are usually coming from reputable schools in countries in Europe/Asia, etc - generally not from the Caribbean. In these specialties, after a certain point, it's not about scores. Research, connections, letters, grades, and where you went to school all make a difference. For neurosurgery for example, there are ~230 spots each year. Most programs take 2 people per year, and they hold onto them for 7 years. There's so much less of a risk taking a US trained doctor than taking one from a Caribbean school with more variable clinical training.

Now, some people do match neurosurgery from the Caribbean every year, but I can count that number on one hand. US vs. not US matters. If you had identical applicants in every way, the US grad wins every time. Oversimplification, but holds true in pretty much every case for what you're asking.
 

WedgeDawg

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for US IMGs
matched (n=3): 26 abstracts/pubs/presentations
unmatched (n=4): 6

also looks like for the people who matched, 2 applied to 2 specialties, one didn't
for those who didn't match, 2 dual applied, 2 didn't

for US MD seniors
matched: 13.4 abstracts/pubs/presentations
unmatched: 8.4
percent graduating from top 40 US schools: 47%

there's your answer
 
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Anti-PD1

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If you want competitive specialties, neurosurgery, ortho, etc, do medical school on American soil. Preferably MD.
 
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A

AnatomyGrey12

Let's assume my friend is a decent candidate for medical school in the US, but goes abroad for personal reasons not related to academic capacity to go to medical school. According to the document above, for many (most?) specialties listed, his chances of placing into a preferred residency are less, but not actually by that much, if he has the same USMLE scores as domestic MD grads. In fact, in some specialties, it seems (?) to have little impact on residency placement.

Because scores aren’t everything. The truth hides in the details.

1. Can someone explain to me what I'm overlooking here? Example1 (page 19): Anesthesiology match USMLE Step 1 score for domestic graduate: about 238; foreign: 241. Only three points were needed to make the difference. Pathology: 222 vs. 230. The trend is not uncommon. These are real, but they don't seem to be huge differences.

You’re missing the fact that most of these FMGs are people who were physicians in their home countries who are trying to get to the US. They also generally have fantastic research.

Can/do foreign medical school graduates become orthopedic surgeons, neurosurgeons, dermatologists, etc.?

Well yeah.

How much "better" do their scores have to be?

It’s not about scores, it’s about everything else. Like WD quoted above. The people who match NS as an FMG has 26 research experiences, and I would bet a lot of money it isn’t just 26 poster. Most likely it numerous publications in very high impact journals, and even then they likely had a very well connected research mentor in the field of NS go to bat for them. Sometimes these people will do research years at residency programs in their field of choice for multiple years and then they get a spot at the program they were doing research at.

Does going to a foreign school ALONE significantly impact your chance at such specialties? By how much?

Yes and by a massive amount. So much so that your chances are essentially 0, even as a decent candidate to that specialty.
 
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gonnif

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I think that instead of asking if an IMG/FMG can get into a competitive residency, you should realize just how tough it is to get into ANY residency for an international graduate

Just some data on SGU, perhaps the "best" of the offshore schools, from 2013 Charting International Outcomes (chart 15, page 22)
upload_2018-1-19_15-1-36-png.228151


This only counts active applicants in residency match and does not count those who initially applied and then either withdrew their application or didnt rank at any residency program. This is was 2% for US MD schools but was 26% for overall US-IMGs in 2013. It also does not count pre-match, which has all but disappeared with the "all in" rule in effect, as well as the SOAP, which only place 2% (74 of 3745) of all US-IMGs in 2013. Overall, US-MD seniors who withdrew, had no rank or didnt match was 7.6% while US-IMGs was a whopping 60%. Additionally about 25% of US senior got post-match placement via SOAP while only 2% of US IMGs did. Attrition at US schools is under 3% while at is unknown at most off-shore schools but is undoubtedly higher. Lastly, about 2012 SGU had a note on their site that 29% of post-graduate placement was non-match placement though I having a hard time reconciling how they can arrive at that figure.
 
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