Help an AMG understand

[Ice Man]

Hi, I am an US Allopathic MS-II. I know for a fact that those from SGU and Ross (and probably the others) get a great education (I know people from your schools). Then why is there a stigma over getting residency spots? Is it the money thing? ($200,000 per resident US grad vs. $100,000 per resident FMG) Or is that just bunk? What I am asking is why is there a tier level when PD's decide who to select? A PD from Mayo told me that they give US grads (MD/DO) first consideration then FMG. Is it politics?

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[Dr. Nick]

•••quote:•••Originally posted by Ice Man:
•Hi, I am an US Allopathic MS-II. I know for a fact that those from SGU and Ross (and probably the others), get a great education (I know people from your schools). Then why is there a stigma over getting residency spots? Is it the money thing? ($200,000 per resident US grad vs. $100,000 per resident FMG) Or is that just bunk? What I am asking is why is there tier level when PD's decide who to select? A PD from Mayo told me that they give US grads (MD/DO) first consideration then FMG. Is it politics?•••••Money has got to be a big factor.

 

[Stormreaver]

Someone told me that PDs consider the people who go to Caribbean schools as those who were rejected from US med schools; this could be a possible source of bias as well.

 

[ApacheIndian]

Stormreaver pretty much hit the nail on the head... hope you're doing well my friend! Fact is, it's true that most (but not all) of the students at Caribbean schools did get rejected by U.S. schools first. Knowing this, if you were a PD and all other factors were equal, who would you give preference to? Exactly. Me too.

 

[abu barney]

In that case, in PD's eyes, is there a heirarchy among IMGs, or are we just one big lump of assumedly second-class students?

Also, how do USFMGs stand by non-USFMGs, ie, the TRUE IMGs.

 

[bla_3x]

AHH, but what about the FMGs who attain higher board scores than their US counterparts? This SHOULD (or else the PD is a dumbs***) eliminate the idea that a particular FMG is in ANY way less qualified than an US applicant. I mean come on, the boards are the name of the game. With great USMLE scores who gives a care where you went, you are obviously doing quite well

 

[Winged Scapula]

Regardless of what your board scores are, having IMGs as residents sends up a signal to AMGs that your residency program is substandard. And having many non-US citizens or Caribbean grads seems to send a greater stigma than say a resident from Oxford. PDs often believe that US citizens who study abroad, and especially those who do so in the Caribbean or Mexico, have done so because they were rejected from all US schools. Guess what? They're right - few if any US citizens have studied in these countries because they preferred to over a US school.

Fair? Perhaps not. I know many IMGs who have great scores on the USMLEs - then again, many of them have spent MONTHS studying for the exams as opposed to US students who have precious days to a few weeks to do so.

Has it been "proven" that US residency programs get more money for AMGs? I thought this was an "urban legend" and that the Medicare funding was the same. Anyone know for sure?

 

[ApacheIndian]

•••quote:•••Originally posted by abu barney:
•In that case, in PD's eyes, is there a heirarchy among IMGs, or are we just one big lump of assumedly second-class students?

Also, how do USFMGs stand by non-USFMGs, ie, the TRUE IMGs.•••••To your first question: IMO, Step 1 scores are the next criteria that are used to estimate caliber/competence among IMGs. This is probably what they use to screen the hundreds (thousands?) of IMG applications they receive.

Your second question is a very interesting one with no simple answer. On the one hand, US-IMGs have the distinct advantage of mastery of the English language and familiarity with American cultures, social conventions, etc. On the other hand, the US-IMG had the opportunity to study at a U.S. med school, and it is assumed that the reason that he went abroad is b/c he wasn't "good enough" for U.S. schools... i.e. he was rejected (while this may not be the case for all of them, it is for most). The Foreign-IMG has completely understandable and "excusable" reasons for not going to a U.S. school.

 

[ApacheIndian]

•••quote:•••Originally posted by bla_3x:
•AHH, but what about the FMGs who attain higher board scores than their US counterparts? This SHOULD (or else the PD is a dumbs***) eliminate the idea that a particular FMG is in ANY way less qualified than an US applicant. I mean come on, the boards are the name of the game. With great USMLE scores who gives a care where you went, you are obviously doing quite well•••••That's ridiculous. As Kimberly stated above, everyone knows that U.S. students are alotted very little time to study for their boards (a few weeks max), while I've heard of some IMGs taking a whole year of for this! I know a fellow Caribbean student who scored a 220 (mediocre IMO), and he goes around bragging that he beat the U.S. national average and insists that he's just as good as them b/c of this (can anyone say "denial?"). What a loser. Everyone with a brain knows about this study time disparity b/w AMGs and IMGs, and their respective scores should be put in perspective b/c of this very obvious difference.

P.S. If anyone can be objective about this, it's me. I'm also a Caribbean MS-3, and I scored a 244 on Step 1, but I studied 3 MONTHS full time! I'll tip my hat to any AMG that scored over 220 with the limited time they have to prepare... now THAT is a feat.

 

[pimmar]

I don't know necessarily how much time an AMG gets to study for the boards, but I certainly didn't take 3 months nor a year and I did fine. I unlike your FMG, did not apply to US schools. I wasn't satisfied with my MCAT and I didn't want to waste anymore time/money in applying at that time (I had dental school as a backup), and I was fortunate enough to know people who had gone to SGU and had done well. I think what american schools do get is more spoon feeding which we did not get. At least that is what I hear, I can't say for sure. But regarding why certain programs don't consider IMGs even if they score really well, has to do with politics, how strong a program appears to be, that is what percentage of their program is US vs. IMG, they report that, and having a high percentage of IMG makes the program look weaker, but honestly I feel one has to look at the individual person. Also an AMG is under less stress to perform well (unless they plan on going into competitive fields) because they are guaranteed to get a spot somewhere over an IMG simply because they are in a US school. Whereas some programs will throw your file in the garbage and won't even open it if you are an FMG, so as an FMG you need to shine so if and when they open your file you won't look the same as everyone else and you will get the interview. Also many programs require for FMGs to take both steps 1 and 2 before they even consider your application, unlike AMGs who only require step 1. So as an FMG there is a need to prove yourself. Fortunately, after you get a residency slot, it should no longer be an issue, but I guess someone else would have to comment on that.

 

[carddr]

Could be wrong on this but IMO in the US schools there is some teaching-to-the-test, after all it reflects on the school if the AMGs don't do well on the exam. Don't think you will find that in UK, third world, India and so on.

 

[Stormreaver]

While I feel that the time disparity is an issue, the "teaching-to-the-test" is just as important. I had to go through genetics, behav sci, virology and some elements of biochem for the first time while preparing for the boards. Given equivalent time, if I were an AMG I would have probably done better. The second issue is that IMGs are under much greater stress to perform in the Boards-- for the these scores are pretty much it.

The conclusion? I guess I find this position on the fence rather comfortable!

 

[will_lam]

I definitely agree with Kimberli on this topic. It's impossible to reduce the process by which med students (specifically IMG's) obtain residencies down to an exact formula. There are just way too many variables involved to ever think that getting a residency is a matter of following a pre-determined recipe and ending up with the desired results. Factors such as country/place of education, citizenship/visa status, program competitiveness, and obviously USMLE scores all factor in, but each of these things can respectively carry completely different importance with every PD that sets out to evaluate an applicant. For this reason alone there are no steadfast rules for IMG's and residency, only general trends that one should be aware of.

The best description of this came from a post I read on this board whereby an IMG at Stanford apparently spoke to someone involved with the selection of residents and was able to get what I believe to be a fairly accurate view of how PD's approach the issue of IMG's. (I'll try and find the thread and post it's link here later)

I don't make any claims to expertise, but this is what I've come to understand based only upon my own experiences:

1. Some PD's simply will not consider any IMG's.

2. Some PD's are willing to accept IMG's so long as they don't negatively effect the program's reputation in any drastic fashion. Usually this means caribean and grads from India/Pakistan etc. are automatically out of contention while grads from Australia, UK etc. are at least considered. Is this fair? Maybe not, but as the post I referred to above explained, some schools or programs don't want to have University X, Island of Dominica or Medical School of Bangalore listed amongst the other often prestigious medical schools from which their residents have come.

3. USMLE scores are a great comparison tool for use between two or more IMG's, but don't think they are an equalizer between AMG's and IMG's.

As far as the USMLE study time factor goes in relation to IMG's, there is no question that carribean medical students in particular are able to put in ALOT more time than their US counterparts (or even non-US students studying at medical programs within their own country). For example another thread on this board talked about someone from Ross who got an incredibly high score on Step I. When asked how he accomplished this, it was explained that he flew back to the caribean and literally shut himself in a room for three months so that he could study NON-STOP for this entire period. Obviously the hard work paid off and I would congratulate him on the success, but I challenge you to find me a medical student at a medical school outside of the caribean who could have done this.

In short, my advice would be to make yourself aware of what's going on in terms of IMG trends in the US, but don't bother getting caught up in the details of which you have absolutely no control. Work hard and hope for the best....

 

[Winged Scapula]

•••quote:•••Originally posted by will_lam:
• It's impossible to reduce the process by which med students (specifically IMG's) obtain residencies down to an exact formula. There are just way too many variables involved to ever think that getting a residency is a matter of following a pre-determined recipe and ending up with the desired results. Factors such as country/place of education, citizenship/visa status, program competitiveness, and obviously USMLE scores all factor in, but each of these things can respectively carry completely different importance with every PD that sets out to evaluate an applicant. For this reason alone there are no steadfast rules for IMG's and residency, only general trends that one should be aware of. •••••I would love to save this and offer it to the hoardes who either post here or write to me personally asking for my "secret" in obtaining a residency position. I have become some sort of Great White Hope for IMGs seeking a University-based position - even for those in non-surgical fields (which I know NOTHING about). The truth is that selection of residents can be so random and so highly variable between specialties and programs and year of application that it would not be far off to say that there is no secret - you do the best you can with your scores, LORs, US clinical experience and after that, all bets are off.

If you have the relative misfortune to graduate from a school which is less respected you WILL likely have a harder time, especially with competitive residencies. If you have the misfortune to need a Visa, you WILL most likely have a harder time. Bottom line as the above poster states, is that EVEN WITH phenomenal USMLE scores there are no guarantees that you will get any residency, much less a "good" one. You cannot predict biases within programs, and year to year fluctuations in applicant quantitity and quality. You can only do your best, present the best possible application and give it the old college try.

And please don't expect me to know all the answers, especially about fields or programs with which I have no experience. I love to help when I can but find it frustrating to be expected to know everything about all types of residencies. Truth is, there is no one right way to do it (gain a US residency).

 

[abu barney]

My advice to all,

There's only so much you can know about how the system works relative to IMGs, and in the end, there's nothing much you can do about it anway... Except, bust axe in school, and don't let anyone faze you about your goals. Keep your morale up with the IMG "Rudy" stories (not quite a fan of the movie, though

Here's a few of my own...

Just met a grad from Syria. 87 on Step 2, 90 on Step 1. He happened to do a rotation in CT surgery at Mayo clinic, rochester. He matched there this year in prelim surgery. Awesome, the stories only get better...

This other grad from Jordan, my alma mater (to be), has been the talk of the med school. Homeboy got a 99 on Step 1 (don't know the 3 digit) and a 99 on Step 2 (a 280!!!). He did research for a year, then happened to turn down an offer from Duke radiology to go to U of Mich in the same field.

Now get back to the books!

 

[Winged Scapula]

•••quote:•••Originally posted by abu barney:
•My advice to all,

There's only so much you can know about how the system works relative to IMGs, and in the end, there's nothing much you can do about it anway... Except, bust axe in school, and don't let anyone faze you about your goals. Keep your morale up with the IMG "Rudy" stories (not quite a fan of the movie, though

Here's a few of my own...

Just met a grad from Syria. 87 on Step 2, 90 on Step 1. He happened to do a rotation in CT surgery at Mayo clinic, rochester. He matched there this year in prelim surgery. Awesome, the stories only get better...

This other grad from Jordan, my alma mater (to be), has been the talk of the med school. Homeboy got a 99 on Step 1 (don't know the 3 digit) and a 99 on Step 2 (a 280!!!). He did research for a year, then happened to turn down an offer from Duke radiology to go to U of Mich in the same field.

Now get back to the books!•••••Hmmm...I would caution you to be impressed by someone matching into Prelim Surgery at Mayo (or any place for that matter). Not to downplay your acquaintances' accomplishment, but there are literally hundreds of unfilled Prelim Surgery spots. Obtaining a Prelim Surgery spot is not difficult, even at a well-known institution like Mayo, and even for an IMG. The real trick is getting a CATEGORICAL spot - while a Prelim spot *may* translate into a Categorical spot down the line, more often than not it does not and the candidate is left trying to find a spot elsewhere.

However, my best to your friend and I wish him/her luck in the future.

 

[ApacheIndian]

•••quote:•••Originally posted by will_lam:
•3. USMLE scores are a great comparison tool for use between two or more IMG's, but don't think they are an equalizer between AMG's and IMG's.
•••••I'd just like to opine that this is an excellent point (and I want to see if my Avatar is working :wink: )...

 

[ApacheIndian]

EUREKA!!!

 

[Stormreaver]

•••quote:•••Originally posted by Kimberli Cox:
•Hmmm...I would caution you to be impressed by someone matching into Prelim Surgery at Mayo (or any place for that matter). Not to downplay your acquaintances' accomplishment, but there are literally hundreds of unfilled Prelim Surgery spots. Obtaining a Prelim Surgery spot is not difficult, even at a well-known institution like Mayo, and even for an IMG. The real trick is getting a CATEGORICAL spot - while a Prelim spot *may* translate into a Categorical spot down the line, more often than not it does not and the candidate is left trying to find a spot elsewhere.

However, my best to your friend and I wish him/her luck in the future.•••••Ditto-- a lot of ppl I know were offered prelim surg spots at places like Mayo, Yale, U Chicago etc and they turned them down-- for the same reasons that Kimberly described. However, there are truly good stories around. People with solid scores and stellar US letters do tend to Match well. So study hard, and try to get an elective or two in. If you're not in an LCME-recognized school, you might have trouble, but there ARE a few schools which offer electives to foreign non-LCME students.

Keep truckin'!