How Can the NRMP Improve the Match/SOAP Process?

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caliprincess

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The NRMP should allow people to register for SOAP as a separate thing, rather than combining it with the Main Match. It would make it more organized and also, they should simply allow people to apply on the first day to 60 places and see what happens in a week. That would give programs more time to go through the applications and interview more people.

Other than that, I don't think the process can't be changed much. The only way we have less people match is if we create more spots for the numerous amounts of physicians that want to be part the US medical system. Unfortunately people talk about not having enough physicians, maybe they should realize there is a simple solution/investment to that problem.
 
The match should be converted to a "Hunger Games" style event where everybody rushes towards a field full of slips of paper on the ground with specific residencies written on them.
 
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The NRMP should allow people to register for SOAP as a separate thing, rather than combining it with the Main Match...

I think they did it this way because back when it was the Scramble, there were thousands of IMGs that would only participate in the Scramble without even setting up an ERAS or making a rank list. I think ERAS wants people to at least funnel through them before the SOAP so they aren't inundated with applicants who just want to try to SOAP. Plus, it gets them more money too...
 
I don't believe it is true - never heard about it. Why would anyone chose to participate in Scramble only? Just to save $100? Just the exams cost many thousands. IMGs who were not invited for any interviews didn't RANK any programs, but they did registered for the match and applied to 100+ programs.

I think they did it this way because back when it was the Scramble, there were thousands of IMGs that would only participate in the Scramble without even setting up an ERAS or making a rank list. I think ERAS wants people to at least funnel through them before the SOAP so they aren't inundated with applicants who just want to try to SOAP. Plus, it gets them more money too...
 
The NRMP should allow people to register for SOAP as a separate thing, rather than combining it with the Main Match. It would make it more organized and also, they should simply allow people to apply on the first day to 60 places and see what happens in a week. That would give programs more time to go through the applications and interview more people.

Other than that, I don't think the process can't be changed much. The only way we have less people match is if we create more spots for the numerous amounts of physicians that want to be part the US medical system. Unfortunately people talk about not having enough physicians, maybe they should realize there is a simple solution/investment to that problem.

And where does the money for this "simple solution" come from?
 
Based on my experience with SOAP last year, I don't see why the entire process must be compressed into 4-5 days. Why not stretch out the experience to 2-3 weeks? It would give the PDs time to fully review applications and give considered looks at applicants rather than judging them by their raw numbers alone.
 
Based on my experience with SOAP last year, I don't see why the entire process must be compressed into 4-5 days. Why not stretch out the experience to 2-3 weeks? It would give the PDs time to fully review applications and give considered looks at applicants rather than judging them by their raw numbers alone.

That's actually what I was thinking as well...but if I had to wait one more day for the match I would lose my mind.
 
As a Canadian who matched to a residency at home, I've read through the SOAP thread with fascination and more than a bit of horror. It seems fairly awful and more stressful than I can quite imagine. We have our own matching process via CaRMS. The first iteration of the match works essentially the same way as NRMP, but unmatched applicants are directly entered into the second iteration. It works the same way as the first iteration, but only over a few weeks. The "leftovers" vary from year to year, but usually there are many family medicine programs, some IM, and a random assortment of lab specialties and variable other specialties. As before, students apply to whatever programs they want, and programs offer interviews (often phone and/or Skype). Student submit a rank-ordered list as before, programs do the same, and the second "match day" comes in April.

One major difference in Canada is that we have designated IMG spots in the first iteration, such that IMGs are not eligible for the vast majority of spots in the overall match. The second iteration is, however, open to everyone. I support this kind of arrangement, at least insofar as Canadian students - who on average applied more times to get into med school than IMGs! - should have first dibs. At a certain point, it is simply impossible to make any kind of health human resources plans by taking into account the 1500 or more Canadians who choose to study abroad, a sizeable proportion of which never even bothered to apply to Canadian schools.

It is not in any way parochial to argue that US residency positions should be allocated primarily to AMGs, though of course AMGs always have the advantage either way. I don't know how much more the Canadian example has to offer unfortunately - Canadian residency programs are organized at the university level, so all programs are coordinated by the Postgrad Office of each medical school. There are only 17 of them in total, and of those 3 are purely francophone.
 
One major difference in Canada is that we have designated IMG spots in the first iteration, such that IMGs are not eligible for the vast majority of spots in the overall match. The second iteration is, however, open to everyone. I support this kind of arrangement, at least insofar as Canadian students - who on average applied more times to get into med school than IMGs! - should have first dibs. At a certain point, it is simply impossible to make any kind of health human resources plans by taking into account the 1500 or more Canadians who choose to study abroad, a sizeable proportion of which never even bothered to apply to Canadian schools.

It is not in any way parochial to argue that US residency positions should be allocated primarily to AMGs, though of course AMGs always have the advantage either way. I don't know how much more the Canadian example has to offer unfortunately - Canadian residency programs are organized at the university level, so all programs are coordinated by the Postgrad Office of each medical school. There are only 17 of them in total, and of those 3 are purely francophone.

I think an AMG favored first match (even more heavily favored than now) would be ideal. And a second match free-for-all makes sense at that point. Medicare = tax-payers money, and as such we should be taking care of the children of tax-payers and also favoring the schools they go to in U.S.A. because the faculty who are paid with our tuition are also paying taxes. If there are left-over spots afterwards then we can take in IMG's who are probably more than happy to have any shot at a residency in the U.S.
 
The 45 applications should be sent all at once with the rounds system eliminated. I wouldn't be in favor of SOAP lasting more than a week. That would be brutal.
 
I think an AMG favored first match (even more heavily favored than now) would be ideal.

How should this be further accomplished?

95% AMGs match. This figure is apparently wrong (as in, unjust). What is the right/just figure?
 
99% of those who pass all steps, graduate from an American Medical School, and apply broadly enough seems like a reasonable amount. This still leaves plenty of spots available for IMG's, although it is closing with stagnant residency funding. Tell me why a position paid for by the tax-payers should go to a foreign graduate over someone whos family has been paying taxes for what is likely generations?

I don't discount that foreign medical graduates work hard and some are very bright, but this is a matter of protecting the interests of our own citizens who have invested heavily in both taxes and medical training. Thats why I think until we can get past the residency stagnation written into the SGR, we should be using AMG to meet the demands of medical residency positions.
 
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Your protectionism and desire to make your life easier is understandable, but, fortunately, in free economy most employers would always chose employees, at least partially, based on merit. You cannot just block merit-based selection altogether. And currently an IMG has 10x chance to be unmatched as an AMG. Also, the argument of outsourcing jobs does not make sense here as virtually all IMGs, even those who come on visas stay in the US. They also always pay taxes.

Usually, an IMG that matches into a program is WAY, WAY better than an AMG who DID NOT match there. It's not just 40 points higher on average usmle scores, but also significant research record, very high class ranking, clinical experience with outstanding LORs etc. There are too many incentives for a program to select AMGs over IMGs.

Those IMGs who have average application usually match to "IMG mills" to which most AMGs who did not match just didn't apply as they felt it was below them to work in such place. Those mills would be happy to take almost any AMGs as even among IMGs presence of AMGs in the program is considered prestiogious:rolleyes: Mostly, unmatching AMGs are those who did not apply broadly enough for the strength of their application, nothing to do with the competition from IMGs.

I think an AMG favored first match (even more heavily favored than now) would be ideal. And a second match free-for-all makes sense at that point. Medicare = tax-payers money, and as such we should be taking care of the children of tax-payers and also favoring the schools they go to in U.S.A. because the faculty who are paid with our tuition are also paying taxes. If there are left-over spots afterwards then we can take in IMG's who are probably more than happy to have any shot at a residency in the U.S.
 
Its not a free market when there is one payer, the citizens of the U.S., for the majority of residency positions, thus my protectionist stance on the residency market. If hospitals funded their own positions then by all means let it be by a pure meritocracy, but the american tax-payer invests 200k in each students loans and then 150-200k per year for each resident. When push comes to shove with limited residency positions I think matching AMG's preferentially will help keep the brightest students in the States interested in medicine.

Full disclosure - I matched through the main match into a competitive residency position, but I hate watching my classmates, who would be very competent clinicians, struggle through the SOAP.
 
Its not a free market when there is one payer, the citizens of the U.S., for the majority of residency positions, thus my protectionist stance on the residency market. If hospitals funded their own positions then by all means let it be by a pure meritocracy, but the american tax-payer invests 200k in each students loans and then 150-200k per year for each resident. When push comes to shove with limited residency positions I think matching AMG's preferentially will help keep the brightest students in the States interested in medicine.

At the end of the day, it is always in a residency programs best interest to have the best resident they can get, rather than a "name brand" warm body who they will have to wash out. Their rank lists reflect this. Which looks worse, especially at a community program in a geographically undesirable location? Having an all AMG roster with dismissals, or one with a mix that manages to produce stellar residents who get great fellowships?

I think we need more transparency and honesty from programs instead of this voodoo invite process. It would be helpful if programs were required by a certain date, say 1/1 to inform you if they have filled all their interview spots, how many interviews they have conducted, wether you are on a waiting list for interviews, and how far down the list you are. I applied to 65 programs and 20 or so never told me one way or another despite calling and emailing very politely. This will never happen though. PC and PDs are overwhelmed as it is and soft rejections are an easy way to make sure they can always last minute invite you.

Someone also proposed lengthening the soap period from 1 week to 2 or 3; this is a great idea. They should inform those who matched earlier than that monday, let those who didn't have more time to prepare than a couple of hours, and let the PDs have more time to review apps and phone interview.

I don't begrudge you for your opinions; I'm sure if I had gotten in to a US school, I'd probably have a similar attitude. I am a US citizen, who had personally had paid at least 100k in taxes before deciding to go offshore. Add in my family, and the sum easily would pay for my residency position several times over. If I had gone to a middle of the road state school with an easier major and had been from a state other than california, I probably would have had a decent chance at being an AMG. Instead I went to a top 3 engineering school for undergrad with no intention of going into medicine, where the mean GPA is a 2.7. I had a 37 on the MCAT and several years of research at one of the top radiology departments in the country with outstanding letters from clinicians, but nothing can overcome a 2.9.

My full disclosure, I matched rads as a US IMG in the main match, and I worked my ass off for it.
 
Its not a free market when there is one payer, the citizens of the U.S., for the majority of residency positions, thus my protectionist stance on the residency market. If hospitals funded their own positions then by all means let it be by a pure meritocracy, but the american tax-payer invests 200k in each students loans and then 150-200k per year for each resident. When push comes to shove with limited residency positions I think matching AMG's preferentially will help keep the brightest students in the States interested in medicine.

Full disclosure - I matched through the main match into a competitive residency position, but I hate watching my classmates, who would be very competent clinicians, struggle through the SOAP.

As much as my heart goes out to those who did not match, whether they are AMG or IMG I do agree with you.

I think the Canadians have the right system and we should follow it. Our neighbors to the North certainly make no exceptions to wanting Canadian students placed first. Why are we not doing the same?

I also think that while it may be difficult to deal with at first, it would save a great deal of pain and frustration. As Margaret Thatcher would say, Yes the medicine is harsh. (I think she said that?)

Anyways, look at it this way - if you knew as a graduating undergrad that if you went to a Caribbean med school you would only have say a 25% of matching- do you think most people would do it? Probably not. And if people knew that only as an AMG you would get first picks of residency, with say less than 20% of remaining spots to be battled among anyone who is not an AMG in the 2nd round would people still go to med school abroad? Probably not.

The reality is that with the increase in American med schools, Caribbean ones are more and more becoming obsolete, and a money grubbing system that leads nowhere. Sure some people match but many don't and they end up in a huge financial hole.

Just like with everything not everyone can get into certain professions, certain schools, certain specialties. Not just in medicine but every field. Not everyone can get a Harvard MBA and some people may have to settle for a different program for example.

So reading the story of someone like the plastic surgeon from Romania yesterday who says he's depressed because he can't practice plastic surgery in the East Coast and he doesn't want to do FM is not very heart wrenching to me. I've had colleagues who have not matched to plastics who are stellar, and I've had AOA classmates who have gone to FM bc they love it. Why does the Romanian plastic surgeon "deserve" a plastics spot in the US?

The reality is that as a nation, we give everyone handouts and while it would be great to have everyone who wants something get it, the reality is that it won't happen. Given that it makes sense to reserve spots for those who are from here first, and then open up spots to others. We need to take care of ourselves first and the reality of the matter is that Carib med schools should be closed because they bring more pain, frustration, and financial disaster than the few who do make it. That's my take. And progressively, I think threads like this will become more and more prevalent.

If I was graduating undergrad now and I could not make it into an American med school, and my only choice was to go Carib I would probably choose a different career altogether.
 
As much as my heart goes out to those who did not match, whether they are AMG or IMG I do agree with you.

I think the Canadians have the right system and we should follow it. Our neighbors to the North certainly make no exceptions to wanting Canadian students placed first. Why are we not doing the same?

I also think that while it may be difficult to deal with at first, it would save a great deal of pain and frustration. As Margaret Thatcher would say, Yes the medicine is harsh. (I think she said that?)

Anyways, look at it this way - if you knew as a graduating undergrad that if you went to a Caribbean med school you would only have say a 25% of matching- do you think most people would do it? Probably not. And if people knew that only as an AMG you would get first picks of residency, with say less than 20% of remaining spots to be battled among anyone who is not an AMG in the 2nd round would people still go to med school abroad? Probably not.

The reality is that with the increase in American med schools, Caribbean ones are more and more becoming obsolete, and a money grubbing system that leads nowhere. Sure some people match but many don't and they end up in a huge financial hole.

Just like with everything not everyone can get into certain professions, certain schools, certain specialties. Not just in medicine but every field. Not everyone can get a Harvard MBA and some people may have to settle for a different program for example.

So reading the story of someone like the plastic surgeon from Romania yesterday who says he's depressed because he can't practice plastic surgery in the East Coast and he doesn't want to do FM is not very heart wrenching to me. I've had colleagues who have not matched to plastics who are stellar, and I've had AOA classmates who have gone to FM bc they love it. Why does the Romanian plastic surgeon "deserve" a plastics spot in the US?

The reality is that as a nation, we give everyone handouts and while it would be great to have everyone who wants something get it, the reality is that it won't happen. Given that it makes sense to reserve spots for those who are from here first, and then open up spots to others. We need to take care of ourselves first and the reality of the matter is that Carib med schools should be closed because they bring more pain, frustration, and financial disaster than the few who do make it. That's my take. And progressively, I think threads like this will become more and more prevalent.

If I was graduating undergrad now and I could not make it into an American med school, and my only choice was to go Carib I would probably choose a different career altogether.

i do agree that with the opening of more allopathic and osteopathic slots, the caribbean med schools will eventually become obsolete.

however, one must remember that the VAST majority of caribbean students are UNITED STATES CITIZENS. they are "entitled" to tax payer funded residency programs just as much as anyone else.

im a big believer in not creating more bureaucratic rules on who a program director can and cannot take. it is the PD's program, they should take whoever they feel will make the best candidate. if they choose bad candidates, it will reflect poorly on the program and them. its in their own interest to choose wisely. most program directors already give a lot of weight towards AMG's. no need to make it a "requirement."

lastly, what you are proposing is to make people get penalized for messing up in undergrad for things that may (MCAT, GPA) or may not (california resident) be in their control. remember, this is the same undergrad that people 18-22 years old major in some cases completely non-medical related fields.

meanwhile..... you would like there to be NO repercussions to messing up in medical school.....with all the extra benefits of being an AMG, school support, living in the comfort of the states, being older and more mature, studying in the field that is relevant to the career, etc.

kind of a major double standard.... dont you think? personally i think there is much more risk for a program director to take an AMG with red flags versus an IMG with none. i know that is how i feel and how we chose our applicants as well..... although in the end of the day, the majority ended up being AMG's with great applications.

remember....once again.... im talking about IMG's who are born and raised US citizens.
 
I think the Canadians have the right system and we should follow it. Our neighbors to the North certainly make no exceptions to wanting Canadian students placed first. Why are we not doing the same?

Just to be clear, we have a small number of IMG-designated spots as well (often with the requirement for return-of-service). Even with more than enough CMG-designated spots for every graduate, people still go unmatched in the first round (~5% or about the same as the US). So I don't know if you can say that establishing AMG-preference spots will really make that much of a difference. People who take risky match strategies, fail to backup, have "red flags", or otherwise end up unlucky will still be around.

(Note that we don't have either anything like Step scores or even course marks to distinguish amongst applicants. I don't really know how PD's do it.)
 
When exploring the options to fix the scramble, the NRMP considered a two stage match. There was no discussion of limiting applicants in the first stage. The NRMP proposed moving the ROL deadline earlier by about 1-2 weeks, and match day back by 2 weeks. This wasn't widely popular.

If we were to move to a two stage match, and limited applicants to the first stage, the big debate would be AMG's only vs US citizens only. There are reasonable arguments for both.

A two stage match that excludes one class of applicants from the first stage (like either all IMG's, or all non-US citizens) does create a logistical problem. You can keep all of the match results secret until the end of the second stage. In that case, the two stages have to be clse together, as those that match in the first stage aren't going to be willing to wait for results. This would mean that those applicants applying for the second stage would likely have to interview before the first stage (as there simply won't be enough time between the two stages), which means that they could interview at programs that ultimately have no spots in the second stage.

Alternatively, you could run the first stage and release the results immediately. Then those participating in the second stage would do so separately.

Regardless, if applicants who would need visas to start are applying in the second stage, we would need the results early enough to ensure that a visa could be obtained in time. This would likely require moving the match earlier in the year (so that the second stage finishes by the end of March).
 
There was a really good point made that AMG's don't even consider applying to the type of places IMG's match at. If AMG's applied as broadly across tiers of programs as IMG's do there match rate would move even higher in fields outside of the uber competitive ones like Ortho, Urology etc.

How many AMG's who apply to IM apply to smaller, community programs that no one has ever heard of? Places like this would jump at the chance to take an AMG but the AMG's don't apply.
 
There was a really good point made that AMG's don't even consider applying to the type of places IMG's match at. If AMG's applied as broadly across tiers of programs as IMG's do there match rate would move even higher in fields outside of the uber competitive ones like Ortho, Urology etc.

How many AMG's who apply to IM apply to smaller, community programs that no one has ever heard of? Places like this would jump at the chance to take an AMG but the AMG's don't apply.

Part of the issue is geographic mobility. If you are in the US and have put down roots, maybe married someone with their own career or have kids in school, you might be more limited in terms of residency choices than the person who did his med school offshore and his rotations at a half dozen sites across the country. So yeah the offshore guy has fewer roots and can apply to that community hospital in the middle of no where.

But right now the match rate for US seniors is historically around 94%, with another 3-5 or so percent finding things in SOAP/scramble. Im not sure how much more AMG friendly it needs to be. As the number of US seniors continues to increase over time, assuming these percentages hold true, you will see the offshore crowd pushed out of the picture in fairly short order.
 
Part of the issue is geographic mobility. If you are in the US and have put down roots, maybe married someone with their own career or have kids in school, you might be more limited in terms of residency choices than the person who did his med school offshore and his rotations at a half dozen sites across the country. So yeah the offshore guy has fewer roots and can apply to that community hospital in the middle of no where.

But right now the match rate for US seniors is historically around 94%, with another 3-5 or so percent finding things in SOAP/scramble. Im not sure how much more AMG friendly it needs to be. As the number of US seniors continues to increase over time, assuming these percentages hold true, you will see the offshore crowd pushed out of the picture in fairly short order.


Actually person who goes offshore is only out of the US for 2 yrs, so thats not the reason. I believe folks apply because they know they dont have many options, and so pull out all the cards, there's no entitlement.Many would love to go back to their home town, and looking online, I see many do end up doing that, or staying within the region.

I dont even think its an AMG vs offshore thing, because there are more FMGs (non US citizens) than US-IMGs who apply for the match. The reason being that the US is pretty much the only country in the world, that lets non citizens and residents do a medical residency. AMGs who are US citizens cant apply to the Canadian's match for example, but Canadian medical graduates who are Canadian citizens can apply to the US match.
Some progs like seen with Bronx Lebanon have a resident population that is heavily favored towards the Indian circle because many of the top guys running the progs are all Indians, so even if a US-IMG applied there with similar stats with a FMG (who needs a visa), unless their last name is Patel, they may not stand a good chance.
In the UK, there is absolutely no way a non UK citizen would get chosen over a UK citizen regardless of any stats.


I like the 2 step stage, if its US citizen (1st stage) vs non US citizen (2nd stage), regardless AMGs will get chosen 1st over US-IMGs, but at least folks arent being discriminated in one's own country.

I do think that many people outside of medicine, do not even know that tax payer money goes to fund residency, and the amount that is going to non US citizens/residents.
 
As much as my heart goes out to those who did not match, whether they are AMG or IMG I do agree with you.

I think the Canadians have the right system and we should follow it. Our neighbors to the North certainly make no exceptions to wanting Canadian students placed first. Why are we not doing the same?

I also think that while it may be difficult to deal with at first, it would save a great deal of pain and frustration. As Margaret Thatcher would say, Yes the medicine is harsh. (I think she said that?)

Anyways, look at it this way - if you knew as a graduating undergrad that if you went to a Caribbean med school you would only have say a 25% of matching- do you think most people would do it? Probably not. And if people knew that only as an AMG you would get first picks of residency, with say less than 20% of remaining spots to be battled among anyone who is not an AMG in the 2nd round would people still go to med school abroad? Probably not.

The reality is that with the increase in American med schools, Caribbean ones are more and more becoming obsolete, and a money grubbing system that leads nowhere. Sure some people match but many don't and they end up in a huge financial hole.

Just like with everything not everyone can get into certain professions, certain schools, certain specialties. Not just in medicine but every field. Not everyone can get a Harvard MBA and some people may have to settle for a different program for example.

So reading the story of someone like the plastic surgeon from Romania yesterday who says he's depressed because he can't practice plastic surgery in the East Coast and he doesn't want to do FM is not very heart wrenching to me. I've had colleagues who have not matched to plastics who are stellar, and I've had AOA classmates who have gone to FM bc they love it. Why does the Romanian plastic surgeon "deserve" a plastics spot in the US?

The reality is that as a nation, we give everyone handouts and while it would be great to have everyone who wants something get it, the reality is that it won't happen. Given that it makes sense to reserve spots for those who are from here first, and then open up spots to others. We need to take care of ourselves first and the reality of the matter is that Carib med schools should be closed because they bring more pain, frustration, and financial disaster than the few who do make it. That's my take. And progressively, I think threads like this will become more and more prevalent.

If I was graduating undergrad now and I could not make it into an American med school, and my only choice was to go Carib I would probably choose a different career altogether.

This doesnt really solve the problem, again the FMGs (non US citizens, non Carib) are a bigger group. Why close the Carib med schls, and still allow the FMGs from random other non US schools to still be able to apply? Lets look at the bigger picture, and put it all in perspective.
 
This doesnt really solve the problem, again the FMGs (non US citizens, non Carib) are a bigger group. Why close the Carib med schls, and still allow the FMGs from random other non US schools to still be able to apply? Lets look at the bigger picture, and put it all in perspective.

I think the Caribbean schools are more troubling to the AAMC because they aren't set up to train physicians for a local national population, but instead are just backdoor vehicles for people who want to practice in the US. As a result they are essentially US oriented schools not meeting any LCME standards an oversight. There is no US recognized governing body involved, but the whole point of these programs is to send people to the US. So everything these schools do is with an eye toward getting into US residency, doing whatever window dressing appears necessary, but not necessarily educating based on approved standards. This is different than a med school in, say, Germany, where the focus would be to actually to train physicians to take care of the local population, and the school couldn't care less how their application might ultimately be regarded in ERAS. So I think the powers that be would be content driving the offshore schools out of business and gobbling up a chunk of the students that would have gone offshore into LCME governed US programs.
 
Part of the issue is geographic mobility. If you are in the US and have put down roots, maybe married someone with their own career or have kids in school, you might be more limited in terms of residency choices than the person who did his med school offshore and his rotations at a half dozen sites across the country. So yeah the offshore guy has fewer roots and can apply to that community hospital in the middle of no where.

But right now the match rate for US seniors is historically around 94%, with another 3-5 or so percent finding things in SOAP/scramble. Im not sure how much more AMG friendly it needs to be. As the number of US seniors continues to increase over time, assuming these percentages hold true, you will see the offshore crowd pushed out of the picture in fairly short order.

With all due respect the "putting down roots" is a bunch of BS. I know plenty of people in the Caribbean i went to school with who have wives, husbands, families, ties to a certain area who leave just for the opportunity to become a doctor. Then when it comes time to residency apply everywhere regardless of family etc just try to obtain a position.

It comes down AMG do not apply to these non-competitive places. There are a ton of spots in NY, NJ, Chicago etc. at places that are close to 100% IMG because AMG's would never consider applying. I have never seen a AMG on this site applying for IM say they were applying to places like New York Methoidst, Cook County, Bronx Lebanon etc. Either way the AMG match rate is like 95% and im sure another few % gets positions in SOAP so its likely close to 98% of AMG's match.

I 100% agree that AMG's should get preference over USIMG's and IMG's (although i feel USIMG's should be give preference over IMG's as well). As long as they havent failed a board exam, i feel once you fail a board exam the AMG advantage should be gone.

I think i saw that the admittance rate to medical school is like 45% now. We without question need more spots in LCME schools because there are plenty of people with the ability to succeed in medical school forced tot he islands because of lack of spots.
 
I think the Caribbean schools are more troubling to the AAMC because they aren't set up to train physicians for a local national population, but instead are just backdoor vehicles for people who want to practice in the US. As a result they are essentially US oriented schools not meeting any LCME standards an oversight. There is no US recognized governing body involved, but the whole point of these programs is to send people to the US. So everything these schools do is with an eye toward getting into US residency, doing whatever window dressing appears necessary, but not necessarily educating based on approved standards. This is different than a med school in, say, Germany, where the focus would be to actually to train physicians to take care of the local population, and the school couldn't care less how their application might ultimately be regarded in ERAS. So I think the powers that be would be content driving the offshore schools out of business and gobbling up a chunk of the students that would have gone offshore into LCME governed US programs.

ROSS is the largest doctor producing medical school for the united states...... even though it is not in the states. they place more graduates in residencies every year then everyone else, including stateside schools. they tend to have huge class sizes and take an incoming class 3 times a year. they are just pouring docs into the system.
 
Im sure lots of Caribbean students and grads will complain and say that they are US citizens and paid taxes and as such should have the same access as US grads since their taxes pay for Medicare which subsidizes residencies. Problem is, that you didn't go to an accredited US med school and that is on you. Instead of taking the time to improve your CV you copped out and took the easy route to med school admission.

ok, turn it around. why cant AMGs be held accountable for poor choices as well? under-performing in an US med school is all on the AMG. the way the system is set currently, if they lose out a spot in the match to an IMG its either that they had a significantly deficient ERAS CV of they didnt broadly apply with backup programs. having the same CV will always go in favor of the AMG.

what you want is for AMGs to be not held accountable for their performance in med school. that is a recipe for disaster. based upon the way you are wording it by "copping out", you do demonstrate that you really just want to punish IMG's. tell that to an IMG who had a 3.7 GPA with 34 MCAT who was from california. not all IMGs are not qualified.

i dont know how to simplify this more for you.
 
ERAS and NRMP have to coordinate times better. Having an application cycle open up at the same time as offers are being made is ridiculous. You are forced to guess which programs are going to fill, and even if you wait until the end of the offer period, there is only 1 hour for programs to look at your application before the next offer period.

The timeline needs to be better managed.
 
In terms of FMGs vs. IMGs, I tend to favor FMGs since as Law2Doc noted, they went to schools that often had their own national accreditiation rather than the for-profit, doctorate factories of the Caribbean.

show me evidence where IMG's dont turn out to be as qualified of a physician as a AMG or FMG after they completed all their training?

lastly, you should read up on a few topics. i understand this is only your opinion, but you may be able to broaden your knowledge on the topic.

this may give you a start which may help you alter your above comment.

https://www2.ed.gov/about/bdscomm/list/ncfmea.html
 
First, with the increase in med school seats, the number of students with 3.7 GPAs and 34 MCATs not getting into US med schools are going to drop. The difference in accountability is that US grads went the accredited route, something Caribbean grads did not. Just as importantly, there is no reciprocity here. The US took FMGs/IMGs to fill unfilled spots from US grads. If there are enough US grads, then Carib grads are no longer needed. Most other countries do the exact same thing in protecting their own graduates as they went through accredited schools and met the baseline requirements of graduation.

I have no interest in punishing IMGs, I have friends that went to the Caribbean that are thriving in practice now. What I am interested in is making sure that all US grads are taken care of with residency positions since that was the way the system in this country was initially designed and the way other countries run. If a US grad can't get a residency in the US when they are done, there is really nowhere else for them to get PGY training. To me there is essentially a covenant that if you get into and complete US med school, there should be a residency at the end of the rainbow. Since US grads are completing nationally accredited training, it stands to reason that the AAMC should work with the ACGME to make sure that the number of spots available allows for all US grads to have residencies. Two national accreditation organizations working together to match education and work force needs based on graduates from the country. Canada's system is similar and a new US system could account for all US grads and then open the remaining spots to IMGs. Caribbean grads don't have those protections because they don't go to US accredited schools.

fully agree with you on the class sizes. this alone is going to take most of the carib students that are superstars and match all over the states, some even in competitive fields/places that AMG's would want. the AMG that lost it to the carib grad is still going to lose it when that carib grad is an AMG in a few years after the class size increase.

as far as the accreditation.... see my above post.
 
I didn't say that IMGs dont turn out to be qualified physicians. THe problem is there is an upcoming bottleneck and we need to protect US grads just as other nations protect theirs. I am quite aware of the information from the link you noted; that being said, I dont take much solace that St. maarten, Saba, grenada, etc. accrediting these schools because they have no skin in the game. The receive money for having these schools there but arent then obligated to offer post-graduate training so to them its not really an issue.

I'm shocked that a Caribbean grad would promote that the US-IMGs should be lumped in with AMGs.

likewise i am shocked that the AMG doesnt want accountability for AMGs in med school :rolleyes:

isnt it more concerning to you to just promote by default if an AMG is under-performing in med school? this type of thinking is what got our current educational system in this country is such disarray.

why is it hard for you to realize that 99.5% of AMGs would match if they applied broadly to programs like IMGs have to do by default and rank less ideal programs as backups. there.... problem solved.... without needing to change the rules.
 
If you value caribbean accreditation, then you can go to Caribbean residencies. Hmmm, small problem there. Caribbean island accreditation does not equal AAMC accredtiation, the guideline you posted notes "comparable" but this is not an AAMC determination.

unfortunately, you seem very confused on the topic. LCME accredits US allopathic med schools. ACGME accredits residencies. two different entities. once again, i recommend you read up on the topic.

this is a useless conversation. everything is going to change in a few years with the higher class sizes. no point in you getting all worked up over this.
 
Carribs provide worse care than AMGs. Me thinks. Me is probably wrong.
 
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Sorry, meant LCME not AAMC (was using AAMC data on future matriculants to US med schools). My point with ACGME is that the two (LCME, and ACGME) should work together to match US grads and # ofspots. ACGME accredits residencies, creating the number of spots we now have. Matching output from US schools with training numbers makes a lot of sense.

why do they even need to do this. those 5 % that dont match each year either have a major red flag within their application or they made a grave mistake when applying.

an AMG with no major red flags who did not match either was unrealistic with the specialty that they applied, simply did not rank enough programs (for whatever reason), didnt apply to back up programs.

let me ask you a question, if all AMGs with no major red flags (step failures, failed classes, major eval flaws) do the above step....... do you honestly thing that any would be unmatched in something?

if not, then why the need to change everything around for the next 3-4 years that it is even going to matter?
 
Ah..you would like to see evidence. Here it is:

Evaluating The Quality Of Care Provided By Graduates Of International Medical Schools

http://www.ama-assn.org/resources/doc/img/0810-health-affairs-imgs.pdf

I quote:
"We also found that there were fewer in-hospital deaths among the patients of non-U.S.-citizen international graduates than was the case for patients of either U.S.-citizen international graduates or U.S. graduates. The difference between non-U.S.-citizen and U.S.-citizen international graduates was striking. Although this finding may be unique, it is not surprising, given previous research. U.S.-citizen international graduates have lower scores on the cognitive portions of the licensing examination sequence, lower ratings from training program directors, and lower rates of specialty board certification."

A rather damning report, if I may say so. :) In the light of this, may I recommend that we remove Carribs from consideration for the match and restrict it to AMGs and the best of non-US IMGs - exactly what some top residency programs do.

wow..... maybe we should remove AMGs as well :rolleyes:..... because if you would have read your own article closely you would see that when they compared USIMG vs AMG, they did not find a significant change in mortality.

give yourself a pat on the back for that one :rolleyes:
 
I think the transition to the SOAP process has been an improvement. Unlike before where students had to manage multiple phones/fax machines and it often came down to the SCHOOL and it's secretaries now the applicant has much more control. I like the process although fortunately never had to participate.

Survivor DO
 
We need to do this because of a few things:

1) I am in a pretty competitive specialty (rad onc); in the last few years, I have seen some superb students with no red flags who weren't reaching, top of the top, not match because of the competitive nature of rad onc. They were advised not to have a back up besides an internship which is what I was still telling students until the All In policy, since it allows them to get spots that open up during the year. They had to go through SOAP/scramble and it wasn't easy, they got offers and spots but there were often spots that they would have taken in things other than rad onc that were already filled through the match with IMGs/FMGs. This would protect students like them.

2) Even for those students that have had problems/red flags as you note, the reality is they got into a US med school and deserve the same protections as a grads at the top. This is what plenty of other countries do, and for good reason.

I think the idea of the switch makes sense now and in 3-4 years. Better to be pro-active in protecting in US grads. You still haven't answered, why shouldn't the US do what the vast majority of other countries do in protecting their own graduates? Canadian system works well, whats the issue?

1. what you are wanting to do is assure that a huge amount of programs will go unfilled each year. it is a program directors worst nightmare to be stuck having to go through SOAP. then what? for those very few AMGs that this actually affects, you will cause many programs to have to chose IMGs and FMGs without true interviewing because they were barred from the initial match and have to go through soap. from a PD POV, do they really want someone whose heart was set on another specialty?

2. we differ on this. from a PD perspective, why would we want an AMG that has failures on steps, failure in classes, and or poor evaluations vs a solid above average IMG or FMG? PDs have a program to run and they want it to run smoothly without problems. which has more risk for the program and patient care? at this point who cares if one did well in undergrad, lived in the correct state, or knew how to answer questions about english literature or battery configurations on the MCAT when they were 18-22 year old. the program director will want someone who performed well in the field of medicine. what you propose is a good' ole boy club, and once you are in, there is no accountability. this is what happens when an 8th grader is illiterate and we wonder how he got so far in school without being able to read.

the US shouldnt do what the vast majority of countries do because we are the US. we do things differently in almost every field from economics/taxes, freedom of speech, to our healthcare system. we are the land of opportunity. this is why the united states is where a lot of people still want to come and dream of coming.
 
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I think the transition to the SOAP process has been an improvement. Unlike before where students had to manage multiple phones/fax machines and it often came down to the SCHOOL and it's secretaries now the applicant has much more control. I like the process although fortunately never had to participate.

Survivor DO

i agree.
 
likewise i am shocked that the AMG doesnt want accountability for AMGs in med school :rolleyes:

isnt it more concerning to you to just promote by default if an AMG is under-performing in med school? this type of thinking is what got our current educational system in this country is such disarray.

why is it hard for you to realize that 99.5% of AMGs would match if they applied broadly to programs like IMGs have to do by default and rank less ideal programs as backups. there.... problem solved.... without needing to change the rules.

Pardon me, but what the hell are you even talking about? AMGs who fail boards are already doing pretty badly in the match. I know of several who have failed one or more steps of boards; all ended up SOAPing, with a couple still being totally unmatched at this juncture (and these are US MDs). You may not see it this way, but believe me - the system is already pretty punitive towards AMGs who **** up, and some (if not many) PDs probably see a US MD with big red flags as being less desirable than an FMG/IMG/DO.

As far as the original topic - SOAP was a massive improvement over the scramble. I don't think anybody really disagrees with this. Most of the complaints expressed in this thread seem to center around the increasingly competitive nature of the match in the US rather than any particular deficiencies in the SOAP process.
 
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1. There is no guarantee that a huge number of programs will go unfilled. Based on a system similar to Canada's system, a certain number of spots would be open to IMGs/FMGs to fill out the number deficient from US seniors. All other spots would be matched in the primary or scramble/SOAP after the fact.

2. The problem is taht you are neglecting the fact that the reason FMGs/IMGs were included in the national match was because there weren't enough US grads (only about 50% of needed based on NRMP data). Now that we are approaching parity, you seem to be advocating for a system that says since we let the flood gates open when we neeeded to, we shouldn't be able to close them when the need is no longer present. That absolutely goes against how we have practiced busineess and immigration in this country. If we don't have a need for foreign graduates, there is no need to give them residencies.

"PDs have a program to run and they want it to run smoothly without problems. which has more risk for the program and patient care?" Any data to support that an IMG does better than an AMG? There is accountability in the US system in the from of a pass/fail licensing exam (USMLE), tests in M1-4, and once in residency in service exams, licensing exams. This is not a good ole boy's club, but it should be one that protects the interests of the schools it is paying for and that it accreditates.

You can give me that this is the US BS but the reality is in 2013 we live in a globalized society. We face competition daily in every industry from developed and developing nations and as such need to modify things to stay competitive; there is no ability to be mobile for US grads as such we are obligated to protect them and the investment. The same can't be said for US citizens who forgo standardized medical education to go to school outside the country in unaccredited schools. I am the child of an FMG and know that i wouldn't have the life I have today without the opportunity given to my family; that being said, my family came over because of a shortage of residents meaning the residency spot was a benefit to my family and the country. When we start changing that cost/benefit analysis such that it benefits the student but not the country as some of its own are being left out, things need to be re-evaluated.

1. all that would accomplish is filtering more img's to those spots. the fmg who needs a visa is always at inherent disadvantage.

2. AMG's have a huge advantage and you can see it with 95% match rates. once we hit true parity, you can open the flood gates all you want, its GOING to filter out most IMG and FMG's. dont worry, its going to happen sooner or later....and your advice to the prospective rad-onc applicant will change.

"PDs have a program to run and they want it to run smoothly without problems. which has more risk for the program and patient care?" Any data to support that an IMG does better than an AMG? There is accountability in the US system in the from of a pass/fail licensing exam (USMLE), tests in M1-4, and once in residency in service exams, licensing exams. This is not a good ole boy's club, but it should be one that protects the interests of the schools it is paying for and that it accreditates.

pretty much the same tests that an IMG takes as well as NBME shelf exams for every subject and rotation. an AMG with red flags (ie having documented issues with your above listed exams and grades/evaluations) is going to create more risk from a program directors eyes. he doesnt want somebody that may not get along with others, perform horribly, cant take the stress of residency (clearly they couldnt handle med school without issues), flunk the board certification of the specialty when out. all this will make the program and the PD look bad. trust me when i say the PD's want nothing to do with your plan forcing them to take AMG's that demonstrate significant deficiencies.
 
1. How would that filter more IMGs? Say we have 25k spots and 22k US grads; one solution is that in advance of ERAS, 3k spots would be open to IMGs/FMGs and US grads with all other spots limited to US grads only. PDs within the 3k spots could interview IMGs/FMGs and US grads all others US grads only. Once the match is done and SOAP for US grads complete, odds are only a handful of spots would remain.

2, Once we hit true parity, my expectation is that the ACGME and the LCME due to political pressure will close the initial match to non-US grads until all US grads match; cant let students go to US med schools (many of which receive government funding) only to not have training possibilities (which are also governement funded) because foreign grads (IMGs/FMGs) are taking spots. Why bring in foreign grads (IMG or FMG) if you have enough supply in house.

I don't agree with your assessment of medical education for the 1st 2 years; having had friends who went to SGU/Ross, etc. we compared 1st 2 years of classes and they were nowhere near the same. Caribbean students were taught more about what to know for the Step 1 and less about the systems as a whole. When you look at board scores, many of IMG colleagues told me that large numbers of their classmates took 3-6+ months studying compared to AMGs who usually get 3-6 weeks. Third/Fourth year- though both take steps, my understanding is that Carib rotation sites can often be non-university/academic rotations with little impetus for poor grades as the proctors are being paid and can be replaced easily unlike US schools where the school and hospital are affiliated. I am in an academic institution so I am familiar with what PDs face; many PDs will also look ath the fact that Carib students took the easy way out compared with their AMG brethren who may have had to re-apply once or more but did it to go to an accredited school.

You and I will never see eye to eye becuase you favor protecting a class of students who rather than making the sacrifices necessary to pursure accredited edcuation in this country, took the simpler path to an MD and then expect to come back and have access to spots that were only intended for them when there was a surplus. Me, I favor protecting those students who went to accredited schools in this country and for whom the match was created. Protecting US grads is not akin to looking away from the flaws of some US grads- obviously those with red flags will find it difficult to get into competitive specialties. However, since they met the graduate requirements (objective measures for tests/USMLE/etc and subjective measures) they deserve the opportunity to pursue residency in this country (where there education was accredited). If they wanted to pursue education in another country, they would face the same difficulties that IMGs/FMGs face and then some. US-IMGs have a far bigger red flag in my opinon than the ones you mentioned; as such they are welcome to pursue post-graduate training in the countries their schools are accredited in (good luck with that) or try to return. If they return, they should face the same scrutiny that US grads would face trying to go elsewhere.

no point in arguing with you anymore. your facts are flawed based on your logic of finding the exceptions and generalizing them.

according to you IMG's are a far bigger red flag because they didnt do as well in college. but yet somebody who couldnt hack it in med school is not? talk about crazy reasoning.... all to protect the club. quite amazing. tell that to the PD who has that AMG resident who performs just as badly as in med school and is the sole black eye of the program. but by your logic.... its ok.... he was part of the club.

you and I will never see eye to eye becuase you favor protecting a class of students who rather than making the sacrifices necessary to pursure accredited edcuation in this country, took the simpler path to an MD and then expect to come back and have access to spots that were only intended for them when there was a surplus.

excuse me, but most IMG's would take offense to that statement being that their path was definitely not simpler. maybe to get into the med school....... but everything from leaving their country and family behind, to moving around the country, to entering into the match at an inherent disadvantage, to dealing with AMG's with attitudes like yourself.

thankfully, you are in the minority of AMG's. i have a lot of AMG friends who do not have your skewed way of thinking. all the AMG friends on rotations as a med student or my AMG co-residents while in residency dont have your attitude. the medical establishment and program directors dont agree with you either or they would have changed it by now. it seems the only change they did was increase class sizes which will help a lot of people who would have been forced to go to the carib.

agree to disagree and end it there. no point in going on. accept the fact that its not going to change until the class sizes catch up.
 
If the quote below (selection committee member saying that a program loses a lot of money taking FMGs over an American) is even remotely correct, it is a very strong incentive for a PD to select an AMG over an IMG. If s/he still prefers to take an IMG, one has really strong reasons for this decision and no regulator should force him to take someone who he sees significantly inferior.

Besides, how many AMGs do not match at all, even after they reapply next year? It would not be 5%, may be it's 1-2%, not sure. I am sorry for them, but I believe that their existence is a significant motivating factor for the students to work harder in order to not fall among those 1%. When people feel entitled for something, they tend to work less hard to reach it. Calling for the regulators to TOTALLY eliminate the risk of not matching will be detrimental to the quality of US graduates.

There is no real competition between AMGs and IMGs even now - you have a lot of nearly 100% IMG community programs, say in New York or New Jersey, that would be happy to take almost any AMG who applies, but cannot attract them as most AMGs, even in the bottom 5%, feel entitled to prestigious programs in the top 50%...until they find themselves in SOAP.

Even when, eventually, there would be enough US graduates to fill all residency spots and, as result, IMGs would be squeezed out, there, inevitably, still would be some American Graduates, probably the same 1-2%, who will find that no program wants them to be part of it, even at the cost of staying unfilled, and they will have to consider other carrier choices...
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http://forums.studentdoctor.net/showthread.php?p=454700

"As an active member of the residency search committee, I can tell you that DO's are definitely preferred over an FMG. It is possible that your program director has such a skewed view of residency applications that my rule isn't applicable. It is also feasible, at least in one's imagination, that I will be able to fly to work tomorrow.

I take your comments very seriously because people might act on them, having severe deleterious affects on one's career. An osteopathic education is 100% superior to virtually any foreign program, and this is how PD's see it.

There are any number of reasons to admit a DO over a FMG, number one on the list being financial. Admitting an FMG over and osteopath means the program loses several 100k. If your program is admitting FMG's en masse, than I assure you it aint as prestigious as you might think, and it aint getting a lot of applications from DO's. (sorry, I never learned how to spell correctlly.)

Goofy"

1. There is no guarantee that a huge number of programs will go unfilled. Based on a system similar to Canada's system, a certain number of spots would be open to IMGs/FMGs to fill out the number deficient from US seniors. All other spots would be matched in the primary or scramble/SOAP after the fact.

2. The problem is taht you are neglecting the fact that the reason FMGs/IMGs were included in the national match was because there weren't enough US grads (only about 50% of needed based on NRMP data). Now that we are approaching parity, you seem to be advocating for a system that says since we let the flood gates open when we neeeded to, we shouldn't be able to close them when the need is no longer present. That absolutely goes against how we have practiced busineess and immigration in this country. If we don't have a need for foreign graduates, there is no need to give them residencies.

"PDs have a program to run and they want it to run smoothly without problems. which has more risk for the program and patient care?" Any data to support that an IMG does better than an AMG? There is accountability in the US system in the from of a pass/fail licensing exam (USMLE), tests in M1-4, and once in residency in service exams, licensing exams. This is not a good ole boy's club, but it should be one that protects the interests of the schools it is paying for and that it accreditates.

You can give me that this is the US BS but the reality is in 2013 we live in a globalized society. We face competition daily in every industry from developed and developing nations and as such need to modify things to stay competitive; there is no ability to be mobile for US grads as such we are obligated to protect them and the investment. The same can't be said for US citizens who forgo standardized medical education to go to school outside the country in unaccredited schools. I am the child of an FMG and know that i wouldn't have the life I have today without the opportunity given to my family; that being said, my family came over because of a shortage of residents meaning the residency spot was a benefit to my family and the country. When we start changing that cost/benefit analysis such that it benefits the student but not the country as some of its own are being left out, things need to be re-evaluated.
 
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You think PD's dont agree with me; if that was so, why do AMGs with 200s get in over IMGs with 240s. The red flag I raised is not because of their inferior undergrad stats but because they went the path of not going to an LCME accredited schools. That is a big red flag particulary when that accreditation the school does have comes from a Caribbean island compared with accreditation from the UK, etc. Please re-read my sentence, I dont think IMGs have an easy road, particulary for matching. I said they took the easy road to an MD which going to Caribbean is compared with re-dedicating yourself, improving your CV, and taking the chance of failing again in my opinion.

not an easy road to an MD. what you should have said was an easier road to a medical school. their road to becoming eligible for an unrestricted license is definitely not easier including actually getting the MD.

your first sentence is not at all what i meant. of course PD's would rather an AMG.....hense the need for IMGs to have considerably better applications to even get considered before an AMG.

im talking about PD's not wanting the bottom of the barrel AMGs who demonstrated major deficiencies in med school by failing classes/usmle and or bad evaluations. those are the students you want to force PD's to accept before any FMG/IMG's. PD's would disagree with you substantially. they would not want them in their program. even with your dream canada setup..... you are still at the end of the day forcing somebody to take that applicant. PD's want freedom of choice.

in the end, we definitely agree to disagree. what i think we can agree on is that once parity happens, there will be very few IMG's or FMG's getting in. i think i saw that it was 2017 or so. this will give a lot of students that would have been forced to either wait out a few years boosting their CV for a unguaranteed shot at admission to get in as well as those students that really had pretty good stats to begin with that went to the caribbean.

dont get me the wrong way. these conversations can be heated. its sensitive subjects to a lot of people. i know you are just trying to look out for the people close to you as well.

4 years from now will be interesting. for the past 5 years, there has been harping a lot for increased class sizes. this is now happening as well as the expansion of new allopathic schools and DO schools. what happens is suddenly there become more AMGs / DO's than residency slots? now that is a big doomsday scenario. the economy is not recovering and we have a lot of other financial issues that the govt is going to need to tend to. what will happen if there is not money for expansion of residencies?
 
There are any number of reasons to admit a DO over a FMG, number one on the list being financial. Admitting an FMG over and osteopath means the program loses several 100k.

This is not correct, to my understanding. GME reimburements from Medicare are the same for all trainees. FMG's may have a slight extra financial cost due to visas. J Visas are basically free for programs. H Visas cost 4-5K, once. So, slight extra cost to programs if they offer H visas.
 
4 years from now will be interesting. for the past 5 years, there has been harping a lot for increased class sizes. this is now happening as well as the expansion of new allopathic schools and DO schools. what happens is suddenly there become more AMGs / DO's than residency slots?

The interesting question will be what happens when the number of DO students increase to a point that THEY start to affect the AMG match rate?

Gotta feeling that at that time there will be call to limit the spots to just US citizens that are allopathic students...that those DO students should have worked harder to get into an allopathic school and not take the easy way out and choose to go to an osteopathic school...
 
The interesting question will be what happens when the number of DO students increase to a point that THEY start to affect the AMG match rate?

Gotta feeling that at that time there will be call to limit the spots to just US citizens that are allopathic students...that those DO students should have worked harder to get into an allopathic school and not take the easy way out and choose to go to an osteopathic school...

Yep....it will be the same song and dance
 
The interesting question will be what happens when the number of DO students increase to a point that THEY start to affect the AMG match rate?

Gotta feeling that at that time there will be call to limit the spots to just US citizens that are allopathic students...that those DO students should have worked harder to get into an allopathic school and not take the easy way out and choose to go to an osteopathic school...

DO already sees the writing on the wall and that's why if you look at the osteo boards there's already a lot of discussion threads about ongoing AOA-AAMC negotiations/plans (terms of surrender) for osteo merging back into the fold. So I think it's possible DO won't even be around as a separate entity to face this problem.
 
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