How competitive was Path this year?

[gbwillner]

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According to the NRMP,

There were 326 US applicants this year, and of those 298 matched. I guess that means that 28 people did not match. Overall, there were 793 applicants, 467 being IMGs. 169 of them did not match. There were also a total of 4,024 ranked positions this year.

I wonder if this is any more/less competitive than previous years. Also, I must add that I doubt these numbers include post-scramble fillings/applications since that would be incredibly efficient of NRMP to post very nice figures like these on their web site a day after the match.

 

[pathstudent]

Not sure but I think that is a bit of a dip relative to the last few years. Also of note is that ~35-40% of all new path residents are FMGs. Not sure what this means but this in stark contrast to ENT, Urology, Orthopedics, Categorical Surgery where the fill near 100% with AMGs. I don't know why FMGs aren't interested in those fields.

No offense to international medical grads as I know they are among the best and brightest in academic pathology and have made an enormous contribution to American academic medicine, but one way to decrease the number of pathology trainees a year would be to do away with FMGs entirely. I believe the FMG thing started in the 60/70s when the federal govt was predicting a massive shortage of doctors in the US.

I just checked that in 2004 61.2% of all new pathology residents were AMGs, in 2000 it was only 30% so it looks like path had a big increase in popularity and is sort of leveling off.

 

[Rosenthal]

According to the NRMP,

There were 326 US applicants this year, and of those 298 matched. I guess that means that 28 people did not match. Overall, there were 793 applicants, 467 being IMGs. 169 of them did not match. There were also a total of 4,024 ranked positions this year.

I wonder if this is any more/less competitive than previous years. Also, I must add that I doubt these numbers include post-scramble fillings/applications since that would be incredibly efficient of NRMP to post very nice figures like these on their web site a day after the match.

It's probably not that different from last year. NRMP data show that 307 US applicants applied pathology in 2007, 18 did not match. There were 260 independent applicants, 129 did not match. A total of 3989 positions ranked, 2345 of those were from US applicants. It seems that more IMGs applied this year, but this could be a result of different calculation method. For example, 479 independent applicants actually ranked pathology last year, 260 of them ranked ONLY pathology, 87 ranked pathology first, and 132 ranked pathology somewhere else. 324 US applicants ranked pathology, 307 of them ranked ONLY pathology.

Not realy sure what persentage of total positions were filled by premathes. NRMP doesn't show these data.

 

[Rosenthal]

Not sure but I think that is a bit of a dip relative to the last few years. Also of note is that ~35-40% of all new path residents are FMGs. Not sure what this means but this in stark contrast to ENT, Urology, Orthopedics, Categorical Surgery where the fill near 100% with AMGs. I don't know why FMGs aren't interested in those fields.

No offense to international medical grads as I know they are among the best and brightest in academic pathology and have made an enormous contribution to American academic medicine, but one way to decrease the number of pathology trainees a year would be to do away with FMGs entirely. I believe the FMG thing started in the 60/70s when the federal govt was predicting a massive shortage of doctors in the US.

No offense taken. I think the reason they take this many FMGs in pathology is because there are not enough AMG applicants to fill all the positions. They took in all the AMGs they can find, and the rest will go to IMGs. For plastic surgery and Dermatology, roughly there are 180 AMGs for every 100 spots, thus you see very few IMGs, most of them very bright, or having strong connections.

To change the situation, you either need to cut down the number of training spots, or entice more AMGs to apply.

 

[gbwillner]

Not sure but I think that is a bit of a dip relative to the last few years. Also of note is that ~35-40% of all new path residents are FMGs. Not sure what this means but this in stark contrast to ENT, Urology, Orthopedics, Categorical Surgery where the fill near 100% with AMGs. I don't know why FMGs aren't interested in those fields.

No offense to international medical grads as I know they are among the best and brightest in academic pathology and have made an enormous contribution to American academic medicine, but one way to decrease the number of pathology trainees a year would be to do away with FMGs entirely. I believe the FMG thing started in the 60/70s when the federal govt was predicting a massive shortage of doctors in the US.

I just checked that in 2004 61.2% of all new pathology residents were AMGs, in 2000 it was only 30% so it looks like path had a big increase in popularity and is sort of leveling off.

I don't think it's a dip in competitiveness- 91% of US applicants matched this year versus 94% last year, and there were 5 fewer slots, and 15 fewer than in 2005. There are more FMGs in path than the surgical specialties, but not more than in FM, IM, Neurology, psych, or PMNR. IM has the highest percentage of IMGs, and is only 54% AMG.

 

[gbwillner]

They took in all the AMGs they can find, and the rest will go to IMGs. For plastic surgery and Dermatology, roughly there are 180 AMGs for every 100 spots, thus you see very few IMGs, most of them very bright, or having strong connections.

To change the situation, you either need to cut down the number of training spots, or entice more AMGs to apply.

I doubt that. Even the most competitive programs have many IMGs. I think part of the reason there are so many IMGs is because there is a misperception in the international community that it's easy to match into the US in path but impossible in other fields, so they are enticed to try. Many of them are already trained pathologists elsewhere and just want to move to the US to make money. They look great to PDs- they get already-trained pathologists for free.

I wonder how many surgeons would go through residency again just to move to the US?

 

[pathstudent]

I doubt that. Even the most competitive programs have many IMGs. I think part of the reason there are so many IMGs is because there is a misperception in the international community that it's easy to match into the US in path but impossible in other fields, so they are enticed to try. Many of them are already trained pathologists elsewhere and just want to move to the US to make money. They look great to PDs- they get already-trained pathologists for free.

I wonder how many surgeons would go through residency again just to move to the US?

You're logic is seriously askew. >90% of all ent, urology and ortho residents were AMGs in 2007. I just checked the NRMPs official data.

In other words american medical grads can basically fill those residency positions entirely. This is obviously not the case in pathology where over the last ten years only 30-60% of the spots fill with AMGs.

If only 60% of the ortho spots filled with AMGs, then FMGs would be going for ortho.

 

[Rosenthal]

I doubt that. Even the most competitive programs have many IMGs. I think part of the reason there are so many IMGs is because there is a misperception in the international community that it's easy to match into the US in path but impossible in other fields, so they are enticed to try. Many of them are already trained pathologists elsewhere and just want to move to the US to make money. They look great to PDs- they get already-trained pathologists for free.

I wonder how many surgeons would go through residency again just to move to the US?

I was speaking in a general sense, not of individual programs. What I meant was, of the five hundred something spots, the number of IMGs roughly equall to the total available postions minus number of AMG applicants. This is also true for IM and FM.

Individually speaking, competitive IMGs can still get into great programs. Other than some top Pathology and IM programs, I also know a few IMGs who got into Radiology and Ophthalmology this year.

 

[106174]

Taking the data from the post that started this thread, imagine what it would be like if there were only 300 spots offered in Pathology every year --- Pathology will become as competitive as Dermatology (Dermatology offers 290 spots and about 900 people apply), the caliber of the candidates will get even better, the match rate will be 100% instead of 92% (one of the lowest in the match), and the job market will finally become EXCELLENT (instead of being mediocre and what people describe as "not so bad"). Dermatology has a winning strategy --- make the club highly exclusive and it effortlessly becomes what everybody wants. And the irony of Pathology's current status is that it has all the makings of a highly competitive specialty, ie very controllable lifestyle, high income potential, and intellectually challenging and stimulating. Pathology is much like Dermatology sans the nuances of patient care, and Radiology sans the overnight and weekend calls and the lack of color. So why then are we not way up there in the competitive ladder? Because we have way too many residency slots!

 

[Arctic Char]

According to the NRMP,

There were 326 US applicants this year, and of those 298 matched. I guess that means that 28 people did not match. Overall, there were 793 applicants, 467 being IMGs. 169 of them did not match. There were also a total of 4,024 ranked positions this year.

I wonder if this is any more/less competitive than previous years. Also, I must add that I doubt these numbers include post-scramble fillings/applications since that would be incredibly efficient of NRMP to post very nice figures like these on their web site a day after the match.

those numbers can't be right. 298 AMG's, and 467-169 = 298 IMG's. to make it exactly 298 AMG's + exactly 298 IMG's =596 total matched. ?? sounds fishy to me . . .

 

[b&ierstiefel]

those numbers can't be right. 298 AMG's, and 467-169 = 298 IMG's. to make it exactly 298 AMG's + exactly 298 IMG's =596 total matched. ?? sounds fishy to me . . .

I know a few people who submitted pathology + another specialties on their rank list and matched into that other specialty. Perhaps this cohort contributes to the number not making much sense. If this was a predominant source of the discrepancy in numbers, it's not surprising that a significant # of path applicants matched into other specialties.

 

[Matte Kudesai]

No offense taken. I think the reason they take this many FMGs in pathology is because there are not enough AMG applicants to fill all the positions. They took in all the AMGs they can find, and the rest will go to IMGs. For plastic surgery and Dermatology, roughly there are 180 AMGs for every 100 spots, thus you see very few IMGs, most of them very bright, or having strong connections.

To change the situation, you either need to cut down the number of training spots, or entice more AMGs to apply.

Another reason IMG's are hired is the presumed need for major medical centers to acquire trainees with a research background. There are many IMG's that apply with PhD's. Medical centers want research oriented individuals to promulgate an inherent paradigm...

Departments within medical centers are increasingly needing to demonstrate generation of grant funding as a hallmark of success. This is analogous to a corporate CEO's desire to show quarterly gains in share values. Many medical centers are fighting for the same pool of grant funding which is abysmally low.

Securing grant funding is linked to recruiting candidates that offer potential. Many IMG's that prematch or successfully match into pathology have graduate degrees and/or established research backgrounds.

 

[rirriri]

i am a USIMG (born here, raised here, went to med school in Europe), however I AM as well a bit disturbed by the high FMG (foreign born IMG) concentration in pathology.

What bothers me the MOST is how FMGs often come to this country as ALREADY TRAINED Pathologists. They are completely trained, and 90% competent in the scientific aspect of Pathology. They are not great communicators, they are not well rounded candidates, and they have their fare share of problems; HOWEVER they serve as pseudo-attendings almost in many cases....many have PhDs, and many have very broad academic research backgrounds.

While i respect these FMGs for that academic achievements, intelligence, and dedication to the science and this field; I feel that TOO MANY path residents are still FMGs.

That being said, you guys are not accurately looking at the TREND of FMG/IMG/AMG ratio rather than the absolute numbers. In the 80s, the FMG concentration in Pathology was much higher.....since then the AMG ratio has definitely gone up, and probably will continue to go up in the future.

Having said that, i still know of a couple programs here where nearly ALL the residents are foreign born, foreign trained, Pathology residents; which i feel is quite depressing. the ASCP/CAP/etc. needs to crack down on this search for pre-trained scut labour.

 

[yaah]

One question which I don't know if anybody knows: What % of FMG path residents end up staying in the US after residency? I was under the impression that many came here to train but yet then went back and don't enter the job market here (because they couldn't get the right permit, maybe?). I really don't know how the system works - can you come here, do a residency, and then be kicked back out? Or do you get permission to stay after being here a few years?

I only ask because I know of a few FMGs who did residency in the US, then couldn't stay for whatever reason and went back home (or maybe to Canada). Do they then keep trying to come back for years afterwards? Or is every graduate of a US residency program a potential candidate for a job in the US if they can get one? I am ignorant on these issues.

It also seems as though other countries are far more stringent on allowing foreigners in to work in medicine than the US is. I doubt that is going to ever change so long as America continues to need more primary care docs. But it's hard to establish rules where you allow in people going into primary care but not allow specialists.

 

[Matte Kudesai]

One question which I don't know if anybody knows: What % of FMG path residents end up staying in the US after residency? I was under the impression that many came here to train but yet then went back and don't enter the job market here (because they couldn't get the right permit, maybe?). I really don't know how the system works - can you come here, do a residency, and then be kicked back out? Or do you get permission to stay after being here a few years?

I only ask because I know of a few FMGs who did residency in the US, then couldn't stay for whatever reason and went back home (or maybe to Canada). Do they then keep trying to come back for years afterwards? Or is every graduate of a US residency program a potential candidate for a job in the US if they can get one? I am ignorant on these issues.

It also seems as though other countries are far more stringent on allowing foreigners in to work in medicine than the US is. I doubt that is going to ever change so long as America continues to need more primary care docs. But it's hard to establish rules where you allow in people going into primary care but not allow specialists.

Generally they go back for two years (as required by immigration) then return to academic jobs. If they are successful in gaining a green card they may transition to private practice. I believe most educational visas are for 7 years. So after 7 years you have to go back home for at least two before being granted a return working visa. It seems that the majority of US grads will take private practice after training rather than remaining in academics. As we have seen there is a need for academic pathologists and many centers will grant the visa status necessary for returning IMG's to get a license and sign out. Some IMG/FMG's with connections can circumvent having to leave by getting waiver type visas... not sure how that works. The US medical grad interest in pathology will likely continue to increase.

 

[106174]

One question which I don't know if anybody knows: What % of FMG path residents end up staying in the US after residency?

It depends on their visa status. Those with a J1 visa are mandated by law to go back to their home country for 2 years before they can come back to the US. After fulfilling this 2-year requirement, they typically apply to jobs here in the US and if they are successful, they then get what is called an H1 (working) visa, which is a pathway to getting a green card.

This 2-year requirement can be waived, so you will hear FMGs with J1 visas talk about applying for a "waiver" job. This J1 Waiver Program was formulated by the federal government to provide doctors to underserved/rural areas. FMGs who avail of this waiver program are required to practice in that underserved area (the government has a list of these cities and they determine which areas qualify as underserved) for 3 years. After 3 years, they are free to move anywhere they want to because at that time, they will have obtained an H1 visa and will have been on their way to getting a green card.

Getting a waiver job is quite easy for the primary care specialists, as you might imagine. In Path, because there are way more applicants to choose from than there are jobs available, and because there are enough AMGs available, employers shy away from FMGs with visas. Hence, waiver jobs are EXTREMELY difficult to come by in Path, forcing FMGs to go back to their home countries to fulfill the 2-year requirement discussed above.

 

[Matte Kudesai]

It depends on their visa status. Those with a J1 visa are mandated by law to go back to their home country for 2 years before they can come back to the US. After fulfilling this 2-year requirement, they typically apply to jobs here in the US and if they are successful, they then get what is called an H1 (working) visa, which is a pathway to getting a green card.

This 2-year requirement can be waived, so you will hear FMGs with J1 visas talk about applying for a "waiver" job. This J1 Waiver Program was formulated by the federal government to provide doctors to underserved/rural areas. FMGs who avail of this waiver program are required to practice in that underserved area (the government has a list of these cities and they determine which areas qualify as underserved) for 3 years. After 3 years, they are free to move anywhere they want to because at that time, they will have obtained an H1 visa and will have been on their way to getting a green card.

Getting a waiver job is quite easy for the primary care specialists, as you might imagine. In Path, because there are way more applicants to choose from than there are jobs available, and because there are enough AMGs available, employers shy away from FMGs with visas. Hence, waiver jobs are EXTREMELY difficult to come by in Path, forcing FMGs to go back to their home countries to fulfill the 2-year requirement discussed above.

They initially get to stay for seven years right? Also when they come back for the H1 do they mostly get academic jobs?

 

[EtOHWithdrawal]

Generally they go back for two years (as required by immigration) then return to academic jobs. If they are successful in gaining a green card they will transition to private practice. I believe most educational visas are for 7 years. So after 7 years you have to go back home for at least two before being granted a return working visa. It seems that the majority of US grads will take private practice after training rather than remaining in academics. As we have seen there is a need for academic pathologists and many centers will grant the visa status necessary for returning IMG's to get a license and sign out. Some IMG/FMG's with connections can circumvent having to leave by getting waiver type visas... not sure how that works. The US medical grad interest in pathology will likely continue to increase.

They only have to return to their country of origin for two years if they came on a J-1 visa (started by the Kennedy administration to encourage people to return fully trained to where they are needed most), but not on an H1b visa. Not all programs will sponsor an H1b visa. Those who are only able to get a J1 can still stay by getting a waiver, which usually entails working in an area of need for a period of time.

It is really funny to me how the hint of paranoia starts to creep up around the issue of FMG's.

The talk of the job market being poor...the "too many foreigners" argument...Next you will hear the "They took our jobs!" (see South Park).

In fact you do hear this argument on these forums, usually disguised as "less than stellar applicants" taking jobs no one from a "good program" would consider, creating pressure for "good candidates" to take crappy jobs in pod labs or for managed care firms or whatever by forcing down pay...

Compare and contrast to the arguments surrounding immigrants from Mexico working in construction or agriculture, forcing down wages for American citizens who want to be framers or farmers... See the "why would they hire us for $10 an hour when they can pay a mexican guy $5 an hour to do the same work" argument.

Truth is, you aren't gonna "do away with FMG's" any more than they will fix the border in Arizona. Get used to it.

 

[exPCM]

One question which I don't know if anybody knows: What % of FMG path residents end up staying in the US after residency? I was under the impression that many came here to train but yet then went back and don't enter the job market here (because they couldn't get the right permit, maybe?). I really don't know how the system works - can you come here, do a residency, and then be kicked back out? Or do you get permission to stay after being here a few years?

I only ask because I know of a few FMGs who did residency in the US, then couldn't stay for whatever reason and went back home (or maybe to Canada). Do they then keep trying to come back for years afterwards? Or is every graduate of a US residency program a potential candidate for a job in the US if they can get one? I am ignorant on these issues.

It also seems as though other countries are far more stringent on allowing foreigners in to work in medicine than the US is. I doubt that is going to ever change so long as America continues to need more primary care docs. But it's hard to establish rules where you allow in people going into primary care but not allow specialists.

I can tell you that about three years ago I saw data which indicated that for many years the percentage of doctors who come here for training on J-1 visas and then remain in the U.S. afterward has been ~85 percent (they are allowed to stay through various J-1 visa waiver programs, they are able to get a green card, etc.). The other 15 percent have been leaving the U.S. and typically returning to their home countries. So as a rule of thumb you can figure that 85 percent of FMG pathology residents will end up competing with the AMGs for jobs in our dismal pathology job market. The non-Carribean FMGs typically have little or no educational debt. The average AMG has ~140K in educational debt. So the FMGs can work cheaper than the AMGs and still take home more money when you factor in the student loan payments. This phenomenon tends to contribute to depressing the salaries in pathology.

 

[exPCM]

Taking the data from the post that started this thread, imagine what it would be like if there were only 300 spots offered in Pathology every year --- Pathology will become as competitive as Dermatology (Dermatology offers 290 spots and about 900 people apply), the caliber of the candidates will get even better, the match rate will be 100% instead of 92% (one of the lowest in the match), and the job market will finally become EXCELLENT (instead of being mediocre and what people describe as "not so bad"). Dermatology has a winning strategy --- make the club highly exclusive and it effortlessly becomes what everybody wants. And the irony of Pathology's current status is that it has all the makings of a highly competitive specialty, ie very controllable lifestyle, high income potential, and intellectually challenging and stimulating. Pathology is much like Dermatology sans the nuances of patient care, and Radiology sans the overnight and weekend calls and the lack of color. So why then are we not way up there in the competitive ladder? Because we have way too many residency slots!

This is an excellent post. I completely agree.

 

[yaah]

It is really funny to me how the hint of paranoia starts to creep up around the issue of FMG's.

The talk of the job market being poor...the "too many foreigners" argument...Next you will hear the "They took our jobs!" (see South Park).

I would be careful about attributing too much to paranoia. The fact remains that as americans we invest a lot in society at training our own citizens for medical careers. It's not really as simple as "they took errr jobs!" When you invest 8 years + in education at great expense and then find weaknesses in the field that ignore these sacrifices, it's a bit off putting. It basically amounts to a tax (that foreign grads do not often have to pay, although no doubt many have similar expenses) on your earnings and potential. Personally, it doesn't effect me that much, I went to a cheap state school and have no loans. It did bother me in medical school to do some rotations with residents who were already fully trained (in another country) and just doing a residency in this country to fulfill criteria, many did not have any interest in all in teaching or even doing their work, because they already had all the experience they needed. Conversely though, there were some american grads who were even worse and didn't want to teach, didn't want to do anything except boss around med students. There are also many american grads who develop a sense of superiority and paranoia over foreign graduates, as if somehow that alone entitles them to more respect or first choice of opportunities. But if a foreign graduate is willing to work as hard and demonstrates the same or better talent how can you argue?

And the other factor, of course, is that apparently american med schools do not produce sufficient physicians to meet the needed supply. Perhaps it does in pathology and some other fields, but not overall. So the fact remains that the american medical system as it stands now requires infusion of labor from foreign locales. Eliminating foreign grads from pathology residency would likely be an unqualified disaster, given how many great people in pathology have come from and continue to come from other countries.

Of course, as anyone with any experience in medicine will tell you, excellent performance does not depend on national origin or status. And, conversely, neither does poor performance! I have met many excellent FMG physicians and many poor FMG physicians. Same with american grads. The list of FMGs who are leaders in pathology is extensive. The thing is, everybody can come up with a case study to fit whatever stereotype they want to promulgate.

Thanks for the responses on visas, etc. I had no idea it was as high as 85%.

 

[Rosenthal]

Having said that, i still know of a couple programs here where nearly ALL the residents are foreign born, foreign trained, Pathology residents; which i feel is quite depressing. the ASCP/CAP/etc. needs to crack down on this search for pre-trained scut labour.

I highly doubt those programs took that many FMGs by choice. Some community hospitals do prefer experienced FMGs for IM and FM specialties, but this is not the case for pathology. Scut labor kind of work does not really require a trained pathologist to do. I am also not sure how useful it is for a resident to know how to diagnose; the attendings will still have to make their own decision anyway. When programs have to choose FMGs, they will be able to pick trained instead of those with no experiences, as supply of FMGs is still much larger than demand.

I don't think it's a secret that programs in general prefer AMGs. Most AMGs will not rank some less desirable programs. Those are usually the FMG-heavy ones. Other programs will take a small percentage of FMGs and then try very hard to fill the rest with AMGs. Some very good programs (especially the southern ones) rarely grant interviews to FMGs. Then others do give interviews to FMGs but are proud if they can fill all the spots by AMGs. Interestingly, some very competitive programs will take FMGs, with no need to worry that this will tarnish their 'good program' image. These programs usually are still dominated by AMGs, and they tend to prefer FMGs with good research background. From my own standpoint, I certainly give kudos to these programs for being able to look pass the IMG label.

Years ago when only around 140 AMGs entered pathology annually, pathology was also a less competitive specialty for FMGs. Those who lack communication skills and couldn't get into IM would apply pathology and still got in. This is not the case anymore. Pathology is now as least as competitive, if not more, than IM and programs nowadays put a heavy emphasis on communication skills when recruiting FMGs.

 

[mlw03]

emphasizing communication skills, for IMGs and AMGs alike, is crucial. the more time i spend in the medical field, including various areas within pathology, the more i learn that strong communication is vital to doing a good job. for all the effort that goes into language certification i still see residents with poor english skills (in various areas, including path). any decent residency program can teach you the facts needed to enter a pathology career, but in my opinion, it is almost impossible to teach good communication skills. by the time we're this age, we either know how to communicate or we don't. trying to determine whether someone can or cannot communicate well during a brief interview day is a daunting task, and this is one aspect that really could be well addressed by the letter of recomendation.

all this said, it still seems like most of the posters here on SDN, AMGs and IMGs, got one of their top 3 choices this year, and 41 spots didn't even fill via the match. so while i don't think it was a super easy year for pathology, i don't think it was a super hard year either.

 

[HRantz]

trying to determine whether someone can or cannot communicate well during a brief interview day is a daunting task, and this is one aspect that really could be well addressed by the letter of recomendation.

It's especially difficult to determine their communication skills in English when you, as the interviewer, conduct the interview in the interviewee's foreign language. This really happens. Then later the attending is surprised that the now-resident doesn't speak English well. 😕

 

[mlw03]

It's especially difficult to determine their communication skills in English when you, as the interviewer, conduct the interview in the interviewee's foreign language. This really happens. Then later the attending is surprised that the now-resident doesn't speak English well. 😕

😱 i'd say "you've gotta be kidding" but i actually don't have that hard a time believing this happens.

 

[Matte Kudesai]

Frankly the majority of FMG/IMG's that I have worked with have been excellent communicators and exceedingly competent and hard working.

They tend to thrive here. I am also amazed at the amount of grant funding some have secured during these barren times.

 

[gbwillner]

Frankly the majority of FMG/IMG's that I have worked with have been excellent communicators and exceedingly competent and hard working.

They tend to thrive here. I am also amazed at the amount of grant funding some have secured during these barren times.

no more zappa?

 

[paleman]

i am a USIMG (born here, raised here, went to med school in Europe), however I AM as well a bit disturbed by the high FMG (foreign born IMG) concentration in pathology.

What bothers me the MOST is how FMGs often come to this country as ALREADY TRAINED Pathologists. They are completely trained, and 90% competent in the scientific aspect of Pathology. They are not great communicators, they are not well rounded candidates, and they have their fare share of problems; HOWEVER they serve as pseudo-attendings almost in many cases....many have PhDs, and many have very broad academic research backgrounds.

While i respect these FMGs for that academic achievements, intelligence, and dedication to the science and this field; I feel that TOO MANY path residents are still FMGs.

That being said, you guys are not accurately looking at the TREND of FMG/IMG/AMG ratio rather than the absolute numbers. In the 80s, the FMG concentration in Pathology was much higher.....since then the AMG ratio has definitely gone up, and probably will continue to go up in the future.

Having said that, i still know of a couple programs here where nearly ALL the residents are foreign born, foreign trained, Pathology residents; which i feel is quite depressing. the ASCP/CAP/etc. needs to crack down on this search for pre-trained scut labour.

dude, IMHO, you are a hypocrite. YOU are a FMG!

 

[pathfreak]

i am a USIMG (born here, raised here, went to med school in Europe), however I AM as well a bit disturbed by the high FMG (foreign born IMG) concentration in pathology.

What bothers me the MOST is how FMGs often come to this country as ALREADY TRAINED Pathologists. They are completely trained, and 90% competent in the scientific aspect of Pathology. They are not great communicators, they are not well rounded candidates, and they have their fare share of problems; HOWEVER they serve as pseudo-attendings almost in many cases....many have PhDs, and many have very broad academic research backgrounds.

While i respect these FMGs for that academic achievements, intelligence, and dedication to the science and this field; I feel that TOO MANY path residents are still FMGs.

That being said, you guys are not accurately looking at the TREND of FMG/IMG/AMG ratio rather than the absolute numbers. In the 80s, the FMG concentration in Pathology was much higher.....since then the AMG ratio has definitely gone up, and probably will continue to go up in the future.

Having said that, i still know of a couple programs here where nearly ALL the residents are foreign born, foreign trained, Pathology residents; which i feel is quite depressing. the ASCP/CAP/etc. needs to crack down on this search for pre-trained scut labour.

My personal experience is that most of the programs (top, mid and lower tier) try their best to woo US students into their residency program, especially in pathology , when there are lot of IMGs , many of which are as qualified as their US contemporaries. Many top tier(Yale, UVa ),not all ,do give pre-match positions to these IMGs every year,which the PDs dont want to lose in the match, as they are the one with good amount of research experience & PDs dont want , may be they cannot, rank an IMG on the top of an AMG for match. The mid and the lower tier programs have to settle with FMGs;many of these programs are where the US MS dont even apply. These are the places which have FMGs and only FMGs.

I dont think the presence of IMGs compromises the match results of any single US MS , atleast in pathology. The unlucky 28 unmatched US MS probably represent a cohort which didnot want to go to mid tier or lower program, but couldnot make into top tier program. However there could be other resons for not matching. I definitely feel sad for them. I hope they must have gottn a scramble position.

I think, decreasing the number of seats offered for pathology will only increase the unmatched IMG as well as US MS, though the number of IMGs unmatched will definitely be more. This will absolutely decrease the number of pathologists produced every year. This may also lower the enthusiasm of the US MS to get into pathology as their chances of matching will also be affected.

Moral of the story 😛athology in US cannot totally neglect the IMGs as they have been a part of it since decades🙂 .

 

[Matte Kudesai]

i am a USIMG (born here, raised here, went to med school in Europe), however I AM as well a bit disturbed by the high FMG (foreign born IMG) concentration in pathology.

What bothers me the MOST is how FMGs often come to this country as ALREADY TRAINED Pathologists. They are completely trained, and 90% competent in the scientific aspect of Pathology. They are not great communicators, they are not well rounded candidates, and they have their fare share of problems; HOWEVER they serve as pseudo-attendings almost in many cases....many have PhDs, and many have very broad academic research backgrounds.

While i respect these FMGs for that academic achievements, intelligence, and dedication to the science and this field; I feel that TOO MANY path residents are still FMGs.

That being said, you guys are not accurately looking at the TREND of FMG/IMG/AMG ratio rather than the absolute numbers. In the 80s, the FMG concentration in Pathology was much higher.....since then the AMG ratio has definitely gone up, and probably will continue to go up in the future.

Having said that, i still know of a couple programs here where nearly ALL the residents are foreign born, foreign trained, Pathology residents; which i feel is quite depressing. the ASCP/CAP/etc. needs to crack down on this search for pre-trained scut labour.

You seem to emphasize foreign born.... Lots of foreign born FMG's pass the CSA without any problems or even step 2/3....Many USIMG's fail both(regardless of whether trained in Poland, Ireland or the Caribbean)... This is puzzling because USIMG's have the benefit of supposedly speaking English as their native language.


Pathology training should create competent confident physicians that can stand up to pushy surgeons and clinicians that expect a magic show. You know ... surgeons who attempt to force a diagnosis on some cauterized piece of crap. Also please train pathologists that can make a meaningful, accurate, and strong diagnosis. This wishy washy noncommitted crap is a waste of time and money.

 

[mcfaddens]

You seem to emphasize foreign born.... Lots of foreign born FMG's pass the CSA without any problems or even step 2/3....Many USIMG's fail both(regardless of whether trained in Poland, Ireland or the Caribbean)... This is puzzling because USIMG's have the benefit of supposedly speaking English as their native language.


Pathology training should create competent confident physicians that can stand up to pushy surgeons and clinicians that expect a magic show. You know ... surgeons who attempt to force a diagnosis on some cauterized piece of crap. Also please train pathologists that can make a meaningful, accurate, and strong diagnosis. This wishy washy noncommitted crap is a waste of time and money.

Dosent matter who you are or where you come from, you cant fix stupid

 

[rirriri]

You seem to emphasize foreign born.... Lots of foreign born FMG's pass the CSA without any problems or even step 2/3....Many USIMG's fail both(regardless of whether trained in Poland, Ireland or the Caribbean)... This is puzzling because USIMG's have the benefit of supposedly speaking English as their native language.


Pathology training should create competent confident physicians that can stand up to pushy surgeons and clinicians that expect a magic show. You know ... surgeons who attempt to force a diagnosis on some cauterized piece of crap. Also please train pathologists that can make a meaningful, accurate, and strong diagnosis. This wishy washy noncommitted crap is a waste of time and money.

oh i agree with you completely. don't get me wrong, i'm not saying that just because someone is born in this country; they are automatically of a higher caliber of communication, information relay, power, etc....however I don't feel it is fair to compare an already trained physician to someone who has just finished medical school. These pre-trained physicians have experience, which cannot be learned with anything aside from TIME.

As for the USMLE exams....i don't think those really mean squat to be honest. FMGs study 1 year for each step sometimes, and take multiple courses in order to pass them quite often....whereas USIMGs are often on a tighter schedule while trying to cope with clinical rotations just as US grads are doing...

i, personally, have interactions with several AMGs who are terrible at communications and their work as well in residency....so as the poster above me alluded to; i don't think it matters where people come from, they can always be stupid.

 

[Arctic Char]

i don't think it matters where people come from, they can always be stupid.

indeed. and for the record, the only thing more annoying than a stupid person is a stupid doctor . . .

 

[Matte Kudesai]

FMGs study 1 year for each step sometimes, and take multiple courses in order to pass them quite often....whereas USIMGs are often on a tighter schedule while trying to cope with clinical rotations just as US grads are doing...

I would concede that this may be true.... The steps are designed for at the most 6 weeks of study. That is what a normal US medical school schedule would allow. There must be an advantage to having unlimited time and resources.

Then maybe they should change the rules on who can take the USMLE's. Because once you get through these steps you can drop your application in the pool. Can't you take these exams in other countries now? Make them only available in the US, prohibitively expensive for non US citizens and permanent residents, and include a component that tests communication skills at the end of each part. This will never happen because I guarantee the board makes a poop load of money from foreigners who take the steps.

 

[106174]

I think, decreasing the number of seats offered for pathology will only increase the unmatched IMG as well as US MS, though the number of IMGs unmatched will definitely be more. This will absolutely decrease the number of pathologists produced every year. This may also lower the enthusiasm of the US MS to get into pathology as their chances of matching will also be affected.

I disagree. It is human nature to want something that is difficult to acquire. If successful, it makes victory sweeter.

 

[106174]

As for the USMLE exams....i don't think those really mean squat to be honest. FMGs study 1 year for each step sometimes, and take multiple courses in order to pass them quite often....whereas USIMGs are often on a tighter schedule while trying to cope with clinical rotations just as US grads are doing...

This is why I think that programs that put too much premium on USMLE scores without taking the entire application into consideration, are making a big mistake. Being an FMG or an AMG is irrelevant as long as the applicant exhibits a CONSISTENT, EXCELLENT track record. An applicant who scores a 260 on both steps after a mediocre performance in medical school will raise a red flag in my head --- I will think that he or she might just be a good test taker or must be extremely lucky. By contrast, an applicant who finished at the top of his medical school class and despite scoring only a 230 on both steps (which is still high) will look golden to me and thus will be ranked higher than the other applicant.

The amount of time used to study for the USMLEs might play a role in determining one's success in these tests but I believe it is minor at best. I do not mean to sound arrogant but, IN GENERAL (there are exceptions, of course), a middle-of-the-road student, no matter how hard or long he/she studies for a test, will almost always get just average scores. On the other hand, a bright topnotch student, as long as he/she studies adequately for a test, will consistently perform very well.

Having said all that, I do think that the resources available to students right now are extremely helpful in them scoring very well in the USMLEs. The number of people I know who have scored >250 on both steps is unbelievable. The USMLE World practice tests, they told me, helped them a lot. A few years back, all we had was First Aid.

 

[gbwillner]

This is why I think that programs that put too much premium on USMLE scores without taking the entire application into consideration, are making a big mistake. Being an FMG or an AMG is irrelevant as long as the applicant exhibits a CONSISTENT, EXCELLENT track record. An applicant who scores a 260 on both steps after a mediocre performance in medical school will raise a red flag in my head --- I will think that he or she might just be a good test taker or must be extremely lucky. By contrast, an applicant who finished at the top of his medical school class and despite scoring only a 230 on both steps (which is still high) will look golden to me and thus will be ranked higher than the other applicant.

Meh. If you score a 260 on both steps then de facto you are a good test taker, and 99% chance you are at the top of your class since most programs use the shelf boards (which are essentially the same as the steps in style and content) to determine your grade. You can actually be a crappy clinician with horrible interpersonal skills and still do very well.

There are many "middle of the road" med students who are awesome clinicians but just don't test well. There is more to diagnosis that a one-line sentence with a "buzz word" that must be read and processed in 1 minute and 2 seconds.

 

[Matte Kudesai]

Meh. If you score a 260 on both steps then de facto you are a good test taker, and 99% chance you are at the top of your class since most programs use the shelf boards (which are essentially the same as the steps in style and content) to determine your grade. You can actually be a crappy clinician with horrible interpersonal skills and still do very well.

There are many "middle of the road" med students who are awesome clinicians but just don't test well. There is more to diagnosis that a one-line sentence with a "buzz word" that must be read and processed in 1 minute and 2 seconds.

There is a tendency to make the most of our own personal strengths. Great test takers will generally highlight and emphasize scores...
Poor test takers feel that test scores are not as important as other qualities...
Researchers laud publications and grants...
Teachers... teaching awards..
Others .... cases signed out and how much money that generates.
Who knows in the real world what trumps what..... It is in the eye of the beholder.

 

[Jesmine]

As for the USMLE exams....i don't think those really mean squat to be honest. FMGs study 1 year for each step sometimes, and take multiple courses in order to pass them quite often....whereas USIMGs are often on a tighter schedule while trying to cope with clinical rotations just as US grads are doing...

I'm an IMG. I think the topic here is about training spots and job market, which is perfectly reasonable. It is about the system, not how good IMGs are.

About USMLE exams, I think they are more difficult for IMGs because they are not in our native language and most of us are several years out of med school. The preparation time is limited as well because we usually are doing research at the same time, which means reading literature and doing experiments most of the time. Most people do not take classes.

Anyhow, I do not think USMLE scores mean the same for IMGs as for AMGs. It tells PDs that he/she has no problem understanding English and still remember what he/she learned in med school. It helps with getting invs, but not much afterwards. Those IMGs who do get into path programs are usually hardworking pathologists and very good scientists.

 

[HCE]

According to the NRMP,

There were 326 US applicants this year, and of those 298 matched. I guess that means that 28 people did not match. Overall, there were 793 applicants, 467 being IMGs. 169 of them did not match. There were also a total of 4,024 ranked positions this year.

I wonder if this is any more/less competitive than previous years. Also, I must add that I doubt these numbers include post-scramble fillings/applications since that would be incredibly efficient of NRMP to post very nice figures like these on their web site a day after the match.

In the NRMP's stats, are D.O.'s considered AMGs, or are they lumped together with IMGs as "Independent Applicants?" Just wondering if there was an increase this year in D.O. applicants to the specialty...perhaps this could explain at least part of the "increase" in non-"US" applicants.

 

[Rosenthal]

In the NRMP's stats, are D.O.'s considered AMGs, or are they lumped together with IMGs as "Independent Applicants?" Just wondering if there was an increase this year in D.O. applicants to the specialty...perhaps this could explain at least part of the "increase" in non-"US" applicants.

D.O.s are considered independent applicants. I only see data from 2007😛athology total positions 513, filled 466, US senior 296, US grads 43, 5th pathway 1, US IMG 22, Osteo 29, canadian 0, IMG 75.

Not sure how many D.O.s applied this year, but because their number is so small, this may not affect the total independent application pool much. What I heard is due to a policy change in UK, many IMGs who are partly trained in UK are heading to US. Also some who planed to go to UK are heading to US. That may be a major reason for the increase.

 

[Arctic Char]

D.O.s are considered independent applicants. I only see data from 2007😛athology total positions 513, filled 466, US senior 296, US grads 43, 5th pathway 1, US IMG 22, Osteo 29, canadian 0, IMG 75.

Not sure how many D.O.s applied this year, but because their number is so small, this may not affect the total independent application pool much. What I heard is due to a policy change in UK, many IMGs who are partly trained in UK are heading to US. Also some who planed to go to UK are heading to US. That may be a major reason for the increase.

where did you get that data? everything i've ever seen lumped all "independent applicants" together without breaking down their details . . . ?

 

[Rosenthal]

where did you get that data? everything i've ever seen lumped all "independent applicants" together without breaking down their details . . . ?

It's a daunting task to relocate them again, seems even harder than finding them the first time. 😳 Finally got it after a word search of 'osteo' in a mega NRMP data file:
http://www.nrmp.org/data/resultsanddata2007.pdf
page 32/92, table 15.

If I didn't match, I would try to find a job at NRMP handling research and data request: "The charge for research and data request is $100 for processing and $75 per hour for research staff time."😛