Foreign competition in residency?

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Is it true that something like 30% of residency spots are filled by foreigners who earned their degrees outside the U.S.? I'm not trying to be xenophobic here, but just wondering where the other 30% of the displaced M.D. graduates from the U.S. would go... And I guess foreign influx would make it even more competetive to obtain a residency position, ugh. Can it get worse than applying to med schools?!?! 😱

 

[docbill]

there are no displaced US graduates.

THere are more residency positions than medical school graduates.

These International Medical Graduates (AKA. IMG) contribute more to the US health care than they take away, since they fill physicians spots (in training and afterwards) that would be left empty and you may have small towns or cities left with a greater shortage of physicians.

 

[silas2642]

Is it true that something like 30% of residency spots are filled by foreigners who earned their degrees outside the U.S.? I'm not trying to be xenophobic here, but just wondering where the other 30% of the displaced M.D. graduates from the U.S. would go... And I guess foreign influx would make it even more competetive to obtain a residency position, ugh. Can it get worse than applying to med schools?!?! 😱

I thought that if all U.S. graduates took all the allopathic residencies in the States that there would still be empty seats. I seriously wouldn't worry about placing; if you've graduated from a US school you're in really good shape.

 

[Law2Doc]

I thought that if all U.S. graduates took all the allopathic residencies in the States that there would still be empty seats. I seriously wouldn't worry about placing; if you've graduated from a US school you're in really good shape.

Sort of, there are more residency seats than allo med students. There are about 16,000 allo grads and 24,000 allo residency positions. There are about 17,000 non-allo grads, which include DOs and foreign docs. Thus there are more hopefulls than spots, but certainly less allo grads than spots. The allo match eats up a big chunk of the spots. In most cases (and there are certainly exceptions) the foreign docs don't displace anyone, and are forced to battle for remaining spots.

 

[p00psicleSTICK]

Law2Doc,

Do foreigners enter residency matchlists together with U.S. allo med students or do hospitals hire foreign MDs to fill up their remaining spots AFTER the match has been complete with just the U.S. allo med students? So basically U.S. allo med students fight for themselves for good residency spots, and the remaining are given up to foreigners?

 

[Law2Doc]

Law2Doc,

Do foreigners enter residency matchlists together with U.S. allo med students or do hospitals hire foreign MDs to fill up their remaining spots AFTER the match has been complete with just the U.S. allo med students? So basically U.S. allo med students fight for themselves for good residency spots, and the remaining are given up to foreigners?

I don't know if foreign students are part of the match process, but you certainly hear about them more in terms of "scrambling" and competing to fill up post-match open spots. Also bear in mind that there are DOs in the mix too -- some that do the allo match, some that scramble and some that pursue their own residencies that are not open to allos. Basically, from what I've heard, the system makes it a very longshot for foreign grads to get competitive residencies, but given the shortage of physicians, residencies in total do outnumber allo med grads, so there are probably some decent spots to be had by some percentage (but not all) of the foreign grads. Anyone who knows more should please correct me -- I'm going from word of mouth knowledge on some of this.

 

[medgirl20]

I don't know if foreign students are part of the match process, but you certainly hear about them more in terms of "scrambling" and competing to fill up post-match open spots. Also bear in mind that there are DOs in the mix too -- some that do the allo match, some that scramble and some that pursue their own residencies that are not open to allos. Basically, from what I've heard, the system makes it a very longshot for foreign grads to get competitive residencies, but given the shortage of physicians, residencies in total do outnumber allo med grads, so there are probably some decent spots to be had by some percentage (but not all) of the foreign grads. Anyone who knows more should please correct me -- I'm going from word of mouth knowledge on some of this.

Foreign graduates apply in the match like everyone else this website was written for IMG's but might help you understand the process.

 

[robotsonic]

Like medgirl said, foreign graduates participate in the same Match that US grads participate in. But this does not mean that they are stealing spots from US grads. IMGs, even when highly qualified, often have difficulty matching in the US, as program directors prefer US grads.
But like others mentioned, the number of graduating physicians in the US is not high enough to fill all of the residency spots, and so there are many spots left over. These are usually positions that American grads don't want - non-competitive specialties in bad locations.

 

[Will Ferrell]

These are usually positions that American grads don't want - non-competitive specialties in bad locations.

Yeah, foreign "competition" is all good (for both America and other doctors).

 

[cfdavid]

there are no displaced US graduates.

THere are more residency positions than medical school graduates.

These International Medical Graduates (AKA. IMG) contribute more to the US health care than they take away, since they fill physicians spots (in training and afterwards) that would be left empty and you may have small towns or cities left with a greater shortage of physicians.

That's true that they fill "unwanted" spots in the current system. But, it's not like we don't have enough qualified pre-meds that would be willing to do family practice in a more rural community or inner city.

The benefit is realized when our country doesn't have to invest in training more doctors (either through more med schools or increased class size). Foreign countries invest in training doctors, and then they come here and work in our society.

My personal opinion is that we should be willing to invest in ourselves and offer those opportunities to Americans. If we are really benefiting from FMG's, then that speaks of a real "shortage" of US trained doctors. Shouldn't we be willing to offer those opportunities to citizens of the US, rather than relying on the brain drain of other countries?

Also, I'd be very interested to learn more about the true cost structure of training a doctor. It seems that residents pay for themselves, working 80 plus hours for 38-45k. But, what about the true cost of training med students?

True, there are infrastructure concerns. Cadavers and standardized patients etc. can't be cheap. But, neither is tuition. Also, to increase class size (versus opening up new schools) doesn't really seem like that much of an increase in overhead. After all, one professor/instructor can teach a course to 200 students just as effectively as he/she can to 100 students.

The only problem could be 3rd and 4th year clinical rotations. Perhaps without a real expansion in clinical instructors (costing money), true exposure would be compromised.

Any thoughts?

 

[cfdavid]

One more thought regarding true costs of even opening up a brand new medical school. Look at all the private schools (MD and DO) that seem to do just fine on their own, with little to no public funding (other than research grants etc. which is fixed from an original budgetary standpoint). They are doing just fine, it seems. Sure, tuition may be more, but students are still willing to invest in themselves such that those schools certainly don't show any lack of interest (just look at the numbers applying). So, why do we still rely on FMG's? Why not increase US medical school class size significantly enough to offset any reliance on FMG's for filling residency positions?

 

[DrBowtie]

That's true that they fill "unwanted" spots in the current system. But, it's not like we don't have enough qualified pre-meds that would be willing to do family practice in a more rural community or inner city.

The benefit is realized when our country doesn't have to invest in training more doctors (either through more med schools or increased class size). Foreign countries invest in training doctors, and then they come here and work in our society.

My personal opinion is that we should be willing to invest in ourselves and offer those opportunities to Americans. If we are really benefiting from FMG's, then that speaks of a real "shortage" of US trained doctors. Shouldn't we be willing to offer those opportunities to citizens of the US, rather than relying on the brain drain of other countries?

Also, I'd be very interested to learn more about the true cost structure of training a doctor. It seems that residents pay for themselves, working 80 plus hours for 38-45k. But, what about the true cost of training med students?

True, there are infrastructure concerns. Cadavers and standardized patients etc. can't be cheap. But, neither is tuition. Also, to increase class size (versus opening up new schools) doesn't really seem like that much of an increase in overhead. After all, one professor/instructor can teach a course to 200 students just as effectively as he/she can to 100 students.

The only problem could be 3rd and 4th year clinical rotations. Perhaps without a real expansion in clinical instructors (costing money), true exposure would be compromised.

Any thoughts?

Most IMG's are Americans going abroad. There are FMGs from their own countries med schools too.

 

[Saluki]

One more thought regarding true costs of even opening up a brand new medical school. Look at all the private schools (MD and DO) that seem to do just fine on their own, with little to no public funding (other than research grants etc. which is fixed from an original budgetary standpoint). They are doing just fine, it seems. Sure, tuition may be more, but students are still willing to invest in themselves such that those schools certainly don't show any lack of interest (just look at the numbers applying). So, why do we still rely on FMG's? Why not increase US medical school class size significantly enough to offset any reliance on FMG's for filling residency positions?

The problem is that if we had more medical school students, we'd have more students competing for the top residency slots, not more choosing family practice. The foreign docs are usually willing to practice in locations that Americans would not... Unless the new school had some kind of service commitment, it would just increase the maldistribution of physicians- an abundance in the suburbs and a shortage in inner city and rural areas...

 

[Law2Doc]

The problem is that if we had more medical school students, we'd have more students competing for the top residency slots, not more choosing family practice. The foreign docs are usually willing to practice in locations that Americans would not... Unless the new school had some kind of service commitment, it would just increase the maldistribution of physicians- an abundance in the suburbs and a shortage in inner city and rural areas...

There are actually currently plans to increase med school enrollment over the next decade, but it will be done slowly. Otherwise, if you suddenly increase the number of med school spots, you would significantly drop the qualifications of those matriculating. Our system is currently very selective in that twice as many folks are applying than there are spots. It is thought that a very gradual increase will let schools increase the number without dipping too deep into the applicant pool, and keep the standards high.

 

[f_w]

Also, I'd be very interested to learn more about the true cost structure of training a doctor. It seems that residents pay for themselves, working 80 plus hours for 38-45k. But, what about the true cost of training med students?

Actually, the federal goverment pays for the training of residents. Hospitals get about 110k per year per resident from medicare. (This is in addition to whatever the hospital bills medicare for services provided to beneficiaries.)

The generous subsidy for residency training doled out by medicare is partially responsible for the relative oversupply of residency positions. In the late 80s hospitals caught on to the fact that the more residents they reported to medicare, the bigger the check was they received. It turned out to be a profitable business for hospitals to train residents and they expanded their programs accordingly. In 1997, congress passed the 'omnibus budget reconciliation act' and froze funding at the 1997 levels. Since then, the number of residency positions has pretty much stebilized.

 

[skypilot]

Is it true that something like 30% of residency spots are filled by foreigners who earned their degrees outside the U.S.? I'm not trying to be xenophobic here, but just wondering where the other 30% of the displaced M.D. graduates from the U.S. would go... And I guess foreign influx would make it even more competetive to obtain a residency position, ugh. Can it get worse than applying to med schools?!?! 😱

I think it is 20% of the PGY1 residency spots are filled by IMGs each year. So it is still a substantial number.

 

[finch]

The problem is that if we had more medical school students, we'd have more students competing for the top residency slots, not more choosing family practice. The foreign docs are usually willing to practice in locations that Americans would not... Unless the new school had some kind of service commitment, it would just increase the maldistribution of physicians- an abundance in the suburbs and a shortage in inner city and rural areas...

If U.S. med school enrollment was increased, more U.S. grads might compete for the competitive spots However, not everyone would get them. The lower tier of U.S. graduates would end up in the less desirable residencies that currently go to IMGs.

 

[chintu]

I agree with what law2doc says. The system is designed such that the american med school admission remains fairly selective in choosing the highly qualified applicants. The dearth of american grads for residency spots is then filled by the highly qualified foreign applicants, the ones who go through many hurdles to then secure a residency spot in a fairly non-competitive field in places where us grads wouldn't want to go. This way we ensure that the us healthcare is filled by the top quality physicians, be it american or foreign. Frankly, I think the system works well. To respond to cfdavid's post, as harsh as it seems that the us med schools reject >50% of premeds each year, i don't think it is done simply to benefit the FMGs; it is more of the us healthcare's own desire to ensure that even the least competitive of residencies are filled by brighter physicians, be that FMGs in this case. If the medschool admissions becomes extremely easy to get into such that anyone who desires it can attain it, then there will be huge burden on the schools to ensure that their students are getting high-quality education such that all grads turn out to be good docs. I don't think anyone desiring to be a doctor is capable enough to be a competent physician; to be a good physician you need to have many qualities, the ones that adcoms look for in their selection. process as of now. I might add, there are plenty of opportunities for premeds who strongly desire to be physician to bolster their record and prove to adcoms that they are capable, such as postbac, masters, more ec's, or if all else fails then either DO or Caribbean stills exists as an option. In my opinion, this is a well designed system.

SLU SOM Class of 2008

 

[Saluki]

If U.S. med school enrollment was increased, more U.S. grads might compete for the competitive spots However, not everyone would get them. The lower tier of U.S. graduates would end up in the less desirable residencies that currently go to IMGs.

I agree. But most of them, even if they ended up in less competitive residencies like family practice would still tend to head toward the same locations. It's generally only the people with visa problems that will head to the less desirable locations b/c those are the only ones available for J-1 visas.

 

[OHMAN0125]

I just wonder is the US taking qualified physicians away from poor countries that really need them more than us?

 

[f_w]

I just wonder is the US taking qualified physicians away from poor countries that really need them more than us?

The US isn't 'taking' anything. They all come by their own volition.

 

[cfdavid]

I agree. But most of them, even if they ended up in less competitive residencies like family practice would still tend to head toward the same locations. It's generally only the people with visa problems that will head to the less desirable locations b/c those are the only ones available for J-1 visas.

All I know is that there are plenty of very hard to understand foreign docs practicing in very desirable areas in my state. So, I'm not sure if they're just waiting it out, and then moving to better locations or what.

 

[cfdavid]

If U.S. med school enrollment was increased, more U.S. grads might compete for the competitive spots However, not everyone would get them. The lower tier of U.S. graduates would end up in the less desirable residencies that currently go to IMGs.

Exactly. But, at least Americans would have those oportunities.

And as far as the desirable vs. less desirable location arguement goes, simple market supply and demand would tend to correct that.

 

[DrBowtie]

Exactly. But, at least Americans would have those oportunities.

And as far as the desirable vs. less desirable location arguement goes, simple market supply and demand would tend to correct that.

They do have them. They go to Ross and SGU.

 

[cfdavid]

They do have them. They go to Ross and SGU.

Perhaps, but from what I see on this forum (and SDN arguably represents a pretty tough/competitive bunch) there are many people with good gpa's and mcat scores that don't get into US MD programs. My arguement is that, if that's the case, we should increase admittance to such schools at a more aggressive rate.

Then, like Finch said, competitive dynamics would take place at the residency level. And the choice locations/programs would go to those most qualfied for that specialty. If FM or IM is deemed less competitive, then those unable to obtain a cardiology fellowship will simply remain an internist (nothing wrong with that).

Also, it may be that FMG's take less competitive specialties and perhaps less sought after residency locations, but the overall arguement that FMG's benefit our society from the standpoint of actually setting up practice in those same areas seems somewhat weak. Just because someone does an FM residency in some rural community doesn't mean they will stay there and practice (which would be the real benefit to the population in that community, provided there's a true shortage).

 

[chintu]

Once again, I think it all goes back to the idea of seeking better brains and skills. True, FMGs leave their own countries and practice only for their purposes; but by doing so, they definitely benefit the american society. Also true that they eventually seek out better places to remain in, but there's always more FMGs taking up those rural areas, etc. and the cycle just continues. Now, while I do not oppose the idea of raising a few spots in us med schools, I don't support it either. True, there are many premeds with good gpa/mcat out there who given a chance might make good physicians; however,in my opinion 50% is still a pretty good acceptance rate compared to some of the other countries. I know this because of my indian heritage where getting into medschool these days is near to impossible (acceptance rate of less than 1% with such a large population competing). Don't get me wrong, I am by no means valuing indian medical education over american as I myself go to a US MD school. I know some FMGs with well established practices in very competitive fields back in their countries who try hard to even compete for fields like FM, IM, peds in places practically unheard of where no US graduate would even consider going. Now why they are willing to do this is beyond this issue, but the point is they do it and definitely benefit the hospital/town they practice in with their bright minds and expertise. Now if we raise a lot of spots in us medschools it will allow any joe blo to be a doctor and I am more than willing to bet that in order for them to graduate medschool we would need to lower the standards of demand, which in effect would produce even more incompetent physicians. I can certainly vouch that in that situation, the ones graduating from the bottom of their class would not compare to those FMGs in their ability to provide good care to the american people. Its easy to think that FMGs take up a lot of US residency spots, just like many immigrants taking up jobs in US; however, the fact of the matter is that without them we wouldn't be one of the best healthcare systems in the world.

Perhaps, but from what I see on this forum (and SDN arguably represents a pretty tough/competitive bunch) there are many people with good gpa's and mcat scores that don't get into US MD programs. My arguement is that, if that's the case, we should increase admittance to such schools at a more aggressive rate.

Then, like Finch said, competitive dynamics would take place at the residency level. And the choice locations/programs would go to those most qualfied for that specialty. If FM or IM is deemed less competitive, then those unable to obtain a cardiology fellowship will simply remain an internist (nothing wrong with that).

Also, it may be that FMG's take less competitive specialties and perhaps less sought after residency locations, but the overall arguement that FMG's benefit our society from the standpoint of actually setting up practice in those same areas seems somewhat weak. Just because someone does an FM residency in some rural community doesn't mean they will stay there and practice (which would be the real benefit to the population in that community, provided there's a true shortage).

 

[DrBowtie]

Perhaps, but from what I see on this forum (and SDN arguably represents a pretty tough/competitive bunch) there are many people with good gpa's and mcat scores that don't get into US MD programs. My arguement is that, if that's the case, we should increase admittance to such schools at a more aggressive rate.

Then, like Finch said, competitive dynamics would take place at the residency level. And the choice locations/programs would go to those most qualfied for that specialty. If FM or IM is deemed less competitive, then those unable to obtain a cardiology fellowship will simply remain an internist (nothing wrong with that).

Also, it may be that FMG's take less competitive specialties and perhaps less sought after residency locations, but the overall arguement that FMG's benefit our society from the standpoint of actually setting up practice in those same areas seems somewhat weak. Just because someone does an FM residency in some rural community doesn't mean they will stay there and practice (which would be the real benefit to the population in that community, provided there's a true shortage).

The competitiveness is already at the residency level. You can get an MD degree no matter your stats if you want one from the Caribbean. You then have to compete for residencies back in the states. If we did open up more spots in the US, I think there is a point where retention starts to become a problem and people will start getting weeded out with large debt.

I don't really see anything wrong with setting the standards high to begin with. It provides job security (and less stress which is already high) to those who are acheivers and the superstars from abroad can come over. I'm not really afraid of the competition but the cost/economics aren't favorable.

As for your arguement that the people who train in these places aren't going to stay there might be true for some, but in general after you have set up shop in a town for 4 years, you are mosre likely to stay there than not. Just look at residency match lists for med schools. You will see a large portion stay at their med schools residencies.

 

[cfdavid]

The competitiveness is already at the residency level. You can get an MD degree no matter your stats if you want one from the Caribbean. You then have to compete for residencies back in the states. If we did open up more spots in the US, I think there is a point where retention starts to become a problem and people will start getting weeded out with large debt.

I don't really see anything wrong with setting the standards high to begin with. It provides job security (and less stress which is already high) to those who are acheivers and the superstars from abroad can come over. I'm not really afraid of the competition but the cost/economics aren't favorable.

As for your arguement that the people who train in these places aren't going to stay there might be true for some, but in general after you have set up shop in a town for 4 years, you are mosre likely to stay there than not. Just look at residency match lists for med schools. You will see a large portion stay at their med schools residencies.

First, I'd never recommend lowering standards in order to increase admissions at US schools. But, it's the qualified applicants that get overlooked (I'm not talking personally, though I'm sure I could have done/be doing better in the current app process) that are the ones I'm arguing for.

Granted, it's not scientific, and I don't know what the actual numbers are, but just from being a member on this forum I read about reapplicants that had what seem to be a very competitive applicantion. These people just didn't get in, for some reason. Sure, one could argue that they look good on paper (md applicants or just what they've said about their app), but can't tie their own shoes, but I'd like to give people more credit than that.

As for the residency situation, I agree that many med students choose to stay close (no numbers, but I'll concede that) for residency training. But, it's quite another to assume that if someone (say a less competitive applicant) is "forced" to go to a less desireable location (based on residency competitiveness), that they would want to stay in that town to set up practice, post residency.

It's hard to argue without some data, but it seems logical that once those people finished up their residency training, they'd move to an area that they found more desirable. (which usually tend to be the more "competitive" locations to begin with) Just ask yourself what you'd do. If the best cardiology fellowship you could find was in some location that you and your wife really found truly unappealing (was far away from your families.. you couldn't imagine raising kids at...etc.), but was all you could get, would you stay after you were done?

 

[DrBowtie]

First, I'd never recommend lowering standards in order to increase admissions at US schools. But, it's the qualified applicants that get overlooked (I'm not talking personally, though I'm sure I could have done/be doing better in the current app process) that are the ones I'm arguing for.

Granted, it's not scientific, and I don't know what the actual numbers are, but just from being a member on this forum I read about reapplicants that had what seem to be a very competitive applicantion. These people just didn't get in, for some reason. Sure, one could argue that they look good on paper (md applicants or just what they've said about their app), but can't tie their own shoes, but I'd like to give people more credit than that.

As for the residency situation, I agree that many med students choose to stay close (no numbers, but I'll concede that) for residency training. But, it's quite another to assume that if someone (say a less competitive applicant) is "forced" to go to a less desireable location (based on residency competitiveness), that they would want to stay in that town to set up practice, post residency.

It's hard to argue without some data, but it seems logical that once those people finished up their residency training, they'd move to an area that they found more desirable. (which usually tend to be the more "competitive" locations to begin with) Just ask yourself what you'd do. If the best cardiology fellowship you could find was in some location that you and your wife really found truly unappealing (was far away from your families.. you couldn't imagine raising kids at...etc.), but was all you could get, would you stay after you were done?

I will also concede that we don't have any hard data so it is hard to make generalizations.

There are some that don't get in the first time with great stats but admissions isn't just based on academic factors (I think it should be heavily numbers slanted). The point is that ANYONE truly can get an MD/DO, it just might not be at the level they want. IMO, I think some US DO schools are starting to come close to the minimum standards becoming only slightly more selective than the Caribbean.

With the whole moving situation, I highly doubt many people just move to an area and then look for a job. If the job market is saturated in the area, especially for someone coming for a foreign school and poor (relative) residency program, they might be forced to stay in the area.

 

[cfdavid]

I will also concede that we don't have any hard data so it is hard to make generalizations.

There are some that don't get in the first time with great stats but admissions isn't just based on academic factors (I think it should be heavily numbers slanted). The point is that ANYONE truly can get an MD/DO, it just might not be at the level they want. IMO, I think some US DO schools are starting to come close to the minimum standards becoming only slightly more selective than the Caribbean.

With the whole moving situation, I highly doubt many people just move to an area and then look for a job. If the job market is saturated in the area, especially for someone coming for a foreign school and poor (relative) residency program, they might be forced to stay in the area.

I'd agree that with the right stuff, Americans really do have a great chance to get into an MD/DO program if they stick to it. Like chintu said, it's a lot better than in other countries (then again, that technically is not part of the discussion, or even that relevant. although, I see his point.)

I also hope that DO schools will strive for improved standards.

 

[cfdavid]

I will also concede that we don't have any hard data so it is hard to make generalizations.

There are some that don't get in the first time with great stats but admissions isn't just based on academic factors (I think it should be heavily numbers slanted). The point is that ANYONE truly can get an MD/DO, it just might not be at the level they want. IMO, I think some US DO schools are starting to come close to the minimum standards becoming only slightly more selective than the Caribbean.

With the whole moving situation, I highly doubt many people just move to an area and then look for a job. If the job market is saturated in the area, especially for someone coming for a foreign school and poor (relative) residency program, they might be forced to stay in the area.

I'd agree that with the right stuff, Americans really do have a great chance to get into an MD/DO program if they stick to it. Like chintu said, it's a lot better than in other countries (then again, that technically is not part of the discussion, or even that relevant. although, I see his point.)

I also hope that DO schools will strive for improved standards. It depends on the school. There may be a couple of "culprits" out there.