curious

[Arctic Char]

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just curious - anyone have an idea as to why EM has such a relatively low representation by IMG's? i.e. relative to ther fields after accounting for competitiveness. rads makes sense, but gen surgery and anesthesiology for example have lots of positions every year and are competitive fields, yet they have significantly higher representation by IMG's than EM . . .

anyone . . . ??

 

[EctopicFetus]

I would think that few other countries see what we see. EM is sorta new so perhaps it is totally different in those other countries. Just my guess though

 

[Dukes]

I would think that few other countries see what we see. EM is sorta new so perhaps it is totally different in those other countries. Just my guess though

I think thats an interesting and probably correct theory there fetus. I think the percentage of IMGs entering EM in recent matches is around 10-20%? Regardless, I would think that the vast majority of those IMGs are american citizens. If this were the case that would certainly support your idea. Any stats out there on the nationalities of the IMGs entering EM?

EM as a specialty is certainly starting to gain popularity overseas mainly in Europe, albeit slowly. As a consequence I think we will see an increasing number of applicants from the region. I spoke to an Icelandic doc applying to my program and his outlook was essentially that he wanted to come learn the specialty the "right way" here in the States and take it back home.

 

[leorl]

1) Not much exposure to it in medical school. The rotations are more observational, so it's hard to get a real feel for it in A&E (ER). You end up feeling like you're just in the way all the time and don't get a whole lot of teaching because everyone's always busy. What I did in my A&E rotation was take some histories (but not with the same weight that your history counts for in the US), take ECGs and bloods. My rotation in the US was a lot more responsibility, which I loved. Anyway, although some people think it's cool, a lot of students don't consider it a first line specialty.

2) which leads me to the second point. There's two sides to A&E - medicine and surgery. You can't enter A&E directly. You either have to apply to either medicine or surgery first. Which means people aren't entering it until they're in an established scheme. In intern year you can apply for it to count as one of your rotations, but that's only like.. 1-3 months of the year. It's also one of the fields where you can't earn overtime as an intern.

 

[Arctic Char]

i see what you are saying. so most of you would presume its more of an issue of less IMG's pursuing EM overall, as opposed to less being accepted (proportionately). interesting. i'll look up some data tomorrow, and i'll post if i find anything interesting or interpretable . . .

 

[trkd]

i see what you are saying. so most of you would presume its more of an issue of less IMG's pursuing EM overall, as opposed to less being accepted (proportionately). interesting. i'll look up some data tomorrow, and i'll post if i find anything interesting or interpretable . . .

I agree with the above. In Aus at least, A&E experiences were a different animal. I don't think there is much of an issue of acceptance though some places don't even consider IMGs regularly (there are many threads on which these places are).

 

[JCserver3]

The lack of proper EMS in other countries leads to EM being practiced differently. My guess is that this is not very appealing to new graduates.

Also, in countries with better access to care, less patients would go to the ED (correct me if I'm wrong).

 

[The White Coat Investor]

Three more thoughts:

1) Maybe emergency docs are more biased against foreign medical grads than other specialists?

2) A lot of emergency medicine is communication, very rapid communication. Language barriers make a huge difference. Think about how much you had to slow down for the last Russian-speaking patient you saw. If you have a really thick accent or poor English skills you might be able to get by in anesthesia, surgery, or medicine because your patient communication time is less or with the case of medicine, you have more time to do it.

3) Perhaps the OP didn't sufficiently account for competitiveness?

 

[EMIMG]

I think that there is still an overall hesitancy for many programs to take IMGs. This can be multi-factorial.

First off, there is always the issue with obtaining a visa for many people. I do not know what it takes for a program to be able to accept/sponsor visas, but I think that many times, if programs can fill without having to go through the visa process, they may be more prone to doing so. Especially in this day and age where there are no guarentees with obtaining a visa, and any delay can hinder the applicant's start date and subsequently cause stressors for everyone else in the program.

There can also be questions about the level of training one receives at a foreign medical school. Until a school has produced many rounds of graduates who are out in the world practicing, I think this is a valid worry. Some schools like those in Europe, Australia, and some of the older Caribbean schools have a track record of putting out highly qualified applicants and programs are therefore more likely to take graduates from those schools rather than a relatively young school.

Next, I think there is a stigma against US citizens that go to foreign medical schools. I think that there are some people out there that are under the opinion that it is a last resort for many students, and the reason they are there is they could not get into a US medical school. And, if they were not good enough back then as a student, there are questions as to their abilities now. I know that when I applied, as a US citizen, I applied to over 40 residency programs, and only had 4 interview offers. On one of these interviews I was talking with a US med school student and I know that they had close to 20 interviews with board scores that were nowhere near mine (I know that board scores are only one part of the equation). But, I also know that from what people told me the rest of my application was strong. There was at least one program that rejected me based only on my application being downloaded (they did not even download my letters of rec or my board scores). So, there is a stigma.

And, of course there are the other issues that have been mentioned previously on this post.

 

[Jeff698]

I think that there are some people out there that are under the opinion that it is a last resort for many students, and the reason they are there is they could not get into a US medical school.

I'm going to have to admit that I think this is a huge part of it. And, while I'm admitting things, I'd have to say I share that opinion.

Of all the US citizens I've known who've gone to foreign medical schools, all tried unsuccessfully to apply to US schools before applying elsewhere.

While I certainly come to this opinion based on a very small sample size, are you saying that this opinion is not correct? Are there really people who choose to go to a foreign medical school instead of in the US? I readily admit my ignorance about this subject and am asking to see if I'm way off base or not.

Take care,
Jeff

 

[Arctic Char]

i understand how you could make this conclusion, but i can speak from experience that it is not correct in every situation. i did two short grad programs in two of the most competitive and prestigious science departments in the world, and left with excellent letters when applying for med school. and i got in to several US schools, even had some near-deals with MD/PhD programs. but in the end, i wanted something more. i needed to branch out, see the world, "expand my horizons" and it has proven to be the best decision i have ever made in my life. i did my research about where i would get a top quality medical education, where i would see diverse cases and learn important skills. and where i would learn new things about the world in a gratuitous fashion alongside medicine. now i've been an alaskan gentile in the Holy Land for a year and a half now and i feel like i want to write a book about my experiences.

at times, when i read about the frustrations of USIMG's securing great residency positions in their fields of choice, i begin to shake my head, because i know some truly remarkable people with unrivaled experience and demonstrated committment and skill who are getting overlooked. but we are a young program, and i sympathize with a PD's inclination of mistrust. yet i know - in fact i see - that the avenues exist for getting where you want to be. we'll just have to work a little harder - but hey, since when did that rule not apply?

anyway, again, many people have connections to other countries. some people can afford tuition in another country a little easier, some have family, ect. some are adventure seekers and want a taste of a new challenge. whatever the reason, I will hope that anyone who paid US taxes all through med school and used stafford loans for tuition would be welcomed home. i'd like to see more regard for some of the more bold and intrepid individuals out there - but of course you can't say that about all USIMG's, naturally.