How is the average FMG portrayed?

[physiologyman]

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Ok so I wanted to know whether an FMG could be regarded as equal to his US senior counterpart when it comes time for residency matches. I know that the typical reason that FMG’s are looked down upon is because they are thought of as they couldn’t get admission in an American medical university thus they had to go abroad? But let’s just suppose that an FMG went straight from high school into a foreign medical school given the opportunity and due to family reasons but was very intelligent and diligent So he does his medicine and come back home to the US with 250 on the STEPs and around 30 publications and great LOR’s now will he still get second pick from that US senior who graduated from Columbia undergrad and Harvard med school even though the US senior has lower board scores and a lower number of publications and medical related accomplishments just because the us senior was an American graduate.

So What I’m asking is let’s suppose both are trying for MGH neurosurgery will the Harvard kid get it because that’s how it’s always been at MGH in the past. Do residencies choose people based on the competition that year like let’s say if that FMG kid surpasses the US senior in accomplishments he will get the spot or do some residency programs discriminate and say that they will take student s from particular undergrad and med school for the prestige that it is one of their own?

 

[DrFraud]

Both canditates sound very competative. If I didn't have any doubts about either one, and both seemed as strong as you indicate, if I were to choose, I would go with the one that I got along with better.

 

[anon-y-mouse]

Ok so I wanted to know whether an FMG could be regarded as equal to his US senior counterpart when it comes time for residency matches. I know that the typical reason that FMG's are looked down upon is because they are thought of as they couldn't get admission in an American medical university thus they had to go abroad? But let's just suppose that an FMG went straight from high school into a foreign medical school given the opportunity and due to family reasons but was very intelligent and diligent So he does his medicine and come back home to the US with 250 on the STEPs and around 30 publications and great LOR's now will he still get second pick from that US senior who graduated from Columbia undergrad and Harvard med school even though the US senior has lower board scores and a lower number of publications and medical related accomplishments just because the us senior was an American graduate.

So What I'm asking is let's suppose both are trying for MGH neurosurgery will the Harvard kid get it because that's how it's always been at MGH in the past. Do residencies choose people based on the competition that year like let's say if that FMG kid surpasses the US senior in accomplishments he will get the spot or do some residency programs discriminate and say that they will take student s from particular undergrad and med school for the prestige that it is one of their own?

Medicine is still a very conservative field. You would be deluded into thinking that the foreign grad is superior in this case. If you're interested in neurological surgery, you need only look at the current resident list at Johns Hopkins, for example. Do you see a pattern? Interested in another field? Look at the match list for UCSF in Internal Medicine (i.e. SFGH). Like it or not, that American has had access to a strong home program in a particular field, and therefore can participate in research with greater continuity than a Caribbean student, who will find himself moving around quite a bit, for lack of a home teaching hospital. This also affords the chance for the American to obtain the LOR's from the bigshots in the field. Also, 30 publications?! Are you nuts? 30 is on par for an assistant professor in a tenure track. Heck, I don't think my research attending even has 30 publications. Try 1, with maybe a case report or two, for most students who have not taken any time off. Also, MD/PhD/MSTP candidates are much more enticing for some of these positions because of the potential for output, and I'm not sure such a program exists in the sunny Caribbean. Furthermore, for clinical rotations, some schools will take students only from LCME institutions, effectively excluding the Caribbean student from even performing a rotation at said institution. YMMV on this one.

Now to address some specific points in your message. First of all, most programs are aware that getting 99's on the USMLE is relatively easily achieved given a few months of solid, dedicated study, when American students are given on average 4-5 weeks of dedicated study time before rotations. Now as for 'family reasons' and 'very intelligent' or whatever, as much as you would like to think that residency programs will give these candidates a fair shot and put them on a level playing field, it is still very much an uphill battle and the onus is on the candidate to prove himself. There are way too many applicants for each program to delve into the file, sort through 'circumstances', etc. My research mentor, who is also a program director, has told me specifically that he does not interview Caribbean graduates. Two of my immediate family members are PD's and APD's and have similar philosophies (because there are too many good American candidates already), but their interests pique sometimes when they see an egregiously high board score (260+). Now, if the Caribbean candidate did an away rotation at said institution and was a superstar in person, then yes, she would be interviewed and given consideration (of course all away students receive a courtesy interview anyway). Also, AOA is not available in the Caribbean, and is a heavily weighted variable for some residencies/programs (look at match data to figure this out). Say a program can only interview 100 candidates. The program director will set the USMLE filter, perhaps the AOA filter, where a person went to school, then some 'softer' factors like school/LOR/extracurric/publications, and interview accordingly. By and large, there are more well qualified American students than there are Caribbean ones. Also, since American schools have already chosen known "competent" people through the med school admissions process, that doubt is largely eliminated from the situation (which isn't to say the foreign student is incompetent! he's simply more 'unproven'/'unknown' at this stage).

Anyway, all in all, to call it an uphill battle is an understatement. It's more like ascending the Hillary Step on Mount Everest. There are quite a lot of factors which automatically put the foreign student at a disadvantage, regardless of that student's competence. This isn't to say it's not doable! There's always some fabled St George grad who gets a neurosurgery residency somewhere (but, I guarantee you, not at MGH), though I don't think I've ever heard of a Caribbean derm resident for example. You need to be realistic with yourself by looking at NRMP and SF Match data. Also, you need to look at the websites for individual residencies, which will list the residents and their medical schools. This will give you historical data about where they choose their candidates from. Next, look at the match list for somewhere like Penn and compare it with other schools- US, and Caribbean. Also, if you are interested in NS, there are really great spreadsheets listing programs, historical data, where residents have come from, etc. at www.uncleharvey.com

Good luck!

 

[IHeartNerds]

I agree with what's been said so far but remember two things:

1) Not all foreign medical schools are equal. Some are fantastic, especially the ones in Europe. Some are cash-producing mills, like the lesser schools in the Caribbean. I would think that a FMG is not equal to any other FMG ... like in the US, it depends where you went to school, not just step 1 (as much as people would like to ignore this).

2) MGH neurosurgery is overrated, although I assume you just picked the most competitive match location in general and paired it with one of the most competitive specialities. I wouldn't put it in a top 3 training program. Hopkins, Columbia, UCSF, and UVA are all higher quality...

 

[Law2Doc]

will he still get second pick from that US senior who graduated from Columbia undergrad and Harvard med school even though the US senior has lower board scores and a lower number of publications and medical related accomplishments just because the us senior was an American graduate [?}

Well, you have to look at the numbers (from NRMP). In last year's match, 28,737 applicants vied for one of 22,240 first-year residency positions. 94.2% of the 15,242 US allo med students matched, with 84.6% matching into one of their top three choices. Of the remaining 5.8% of US students who didn't match, most scrambled into decent places. FMG's get to fight for the remaining slots. 10,300 FMGs applied to last year's match and only 4,650 matched, or about 45%. So it's fair to say that FMGs do not do well in securing US residencies. Of the 4,650 who do match, it seems primary care is where the bulk end up. Anecdotally, we bring in foreign educated folks (mostly caribbean educated US students) to fill up the excess residency slots not snapped up by the US students; the slots in family medicine, OB, etc in the boonies that the US students snub; the leftovers. So yeah, based purely on the numbers there is a huge bias towards US educated folks. Does that mean an amazingly credentialed, European (or equivalent) educated FMG won't secure a great slot? No. But it does mean he's got to overcome a bias/stigma, and be the exception to the rule.

And I agree that if you just pick a big name place and pair it to a highly competitive specialty and assume it's the pinnacle, you are probably missing the boat. Each specialty has it's own hierarchy of where is best, what programs are good versus malignant. MGH is not the best in every specialty. Access to advisors/mentors in the US as to what programs are the one's to shoot for in a particular specialty is just one example of what you miss out on coming from a foreign locale.

 

[njbmd]

Moved to the Residency Forum which is more appropriate for this thread.

 

[razorback58]

Well, you have to look at the numbers (from NRMP). In last year's match, 28,737 applicants vied for one of 22,240 first-year residency positions. 94.2% of the 15,242 US allo med students matched, with 84.6% matching into one of their top three choices. Of the remaining 5.8% of US students who didn't match, most scrambled into decent places. FMG's get to fight for the remaining slots. 10,300 FMGs applied to last year's match and only 4,650 matched, or about 45%. So it's fair to say that FMGs do not do well in securing US residencies. Of the 4,650 who do match, it seems primary care is where the bulk end up. Anecdotally, we bring in foreign educated folks (mostly caribbean educated US students) to fill up the excess residency slots not snapped up by the US students; the slots in family medicine, OB, etc in the boonies that the US students snub; the leftovers. So yeah, based purely on the numbers there is a huge bias towards US educated folks. Does that mean an amazingly credentialed, European (or equivalent) educated FMG won't secure a great slot? No. But it does mean he's got to overcome a bias/stigma, and be the exception to the rule.

And I agree that if you just pick a big name place and pair it to a highly competitive specialty and assume it's the pinnacle, you are probably missing the boat. Each specialty has it's own hierarchy of where is best, what programs are good versus malignant. MGH is not the best in every specialty. Access to advisors/mentors in the US as to what programs are the one's to shoot for in a particular specialty is just one example of what you miss out on coming from a foreign locale.

Many of the FMG's prematch into a family medicine residency or a few others such as psych, internal or peds. They are not included in the match list stats because they withdrew from the match after signing a prematch offer. As far as I know, nobody has any data on how many prematch. We do have data on those FMG's that went through the match and either matched or did not match.

I am an FMG and my husband and we prematched in 2007. The family program we are in this year prematched everyone. Last year they prematched everyone except 2 people. DO's can also prematch. This year we have one DO and 5 FMG's all accepting prematch offers leaving 6 positions that were not included in the match stats. For all the NRMP knows, the director decided not to fill those positions. You can generally tell if a program prematched by looking at the fill list after match day. It will say how many positions the program offers, how many were filled in the match. When you look at the number of residents they take it might be a different number. Say - 3 positions offered and 2 filled with one open (did not fill in the match) and the website for the program says they take 6. This means they took 3 people outside the match with a prematch offer - matched 2 people and have one spot open for scramble. That is the only way you can figure out who is doing what. Not all programs can offer a prematch offer - it generally is only done in a community base program. Only DO's and FMG's can be given a prematch offer because we are independent agents. The AMG graduate can be given a prematch offer a year after he or she graduates but not during the senior year of the match process.

 

[physiologyman]

what about this person who matched into a Columbia neurosurgery residency how did he do it for an FMG???

http://www.cumc.columbia.edu/dept/nsg/residents/residents/sonabend.html

 

[IHeartNerds]

what about this person who matched into a Columbia neurosurgery residency how did he do it for an FMG???

http://www.cumc.columbia.edu/dept/nsg/residents/residents/sonabend.html

I assume he's a Mexican citizen. There is a huge difference between FMGs who train in their country of origin (Mexico, UK, France, wherever) and Americans going to off-shore medical schools.

 

[Faebinder]

There is a clear bias to the american US seniors.. end of story. AMA pleads against that but they can rot for all the university programs care. The community programs will take the candidate they gotta teach the least.

With regards to USMLE as a comparison between an FMG/IMG and a US senior you need to understand the view on the USMLE. Many old attendings dont even know how different the USMLE now than before, some have taken it 30 years ago back when it was on paper and it was 3 days to finish. Newer attendings realize that if you got 10 years experience under your belt then you are likely ace the USMLE as things are easier for you. Even the USMLE still has a statement that it should not be used for the purpose of grading and rather for checking if the person has the minimum knowledge necessary to be a physician. Universities will look at the USMLE as a guideline but the favor is clear for the US senior. Community programs are all about USMLE cause that means you dont need what they consider "extra teaching".

 

[xaelia]

In my experience in the hospital, the FMG with the greatest chance of being respected is a citizen of another country who trained in their country of citizenship - there is a wide range of inconsistency in their ability and training, but many are brilliant and excellent clinicians.

American citizens who went to caribbean medical schools are looked down upon, even moreso than osteopathic graduates, for graduating from, as perceived, "the bottom of the barrel" medical schools. They may have an advantage in matching, but not in education.

 

[razorback58]

In my experience in the hospital, the FMG with the greatest chance of being respected is a citizen of another country who trained in their country of citizenship - there is a wide range of inconsistency in their ability and training, but many are brilliant and excellent clinicians.

American citizens who went to caribbean medical schools are looked down upon, even moreso than osteopathic graduates, for graduating from, as perceived, "the bottom of the barrel" medical schools. They may have an advantage in matching, but not in education.

Did you score 98% on USMLE Step 1 and 97% on USMLE Step 2? Did you have an advanced degree before starting medical school? The interns that I work with that graduated from other countries don't have the standard of health care we do in the states. EGD's and CABG is something not done in their country and many don't even know the day to day lingo of US medical terms. I am an FMG and just as respected as the DO's and AMG's - it is all about how you conduct yourself, patient care and knowledge - not where you graduated from medical school.

 

[PeepshowJohnny]

Did you score 98% on USMLE Step 1 and 97% on USMLE Step 2? Did you have an advanced degree before starting medical school? The interns that I work with that graduated from other countries don't have the standard of health care we do in the states. EGD's and CABG is something not done in their country and many don't even know the day to day lingo of US medical terms. I am an FMG and just as respected as the DO's and AMG's - it is all about how you conduct yourself, patient care and knowledge - not where you graduated from medical school.

Just FYI, the two digit scores on your steps are not percentiles.

 

[Long Dong]

Did you score 98% on USMLE Step 1 and 97% on USMLE Step 2?

As I remember it xaelia did score 99s/250+ on step 1 and 2.

 

[DrFraud]

There is a clear bias to the american US seniors.. end of story. AMA pleads against that but they can rot for all the university programs care. The community programs will take the candidate they gotta teach the least.

As much as I would prefer otherwise, I have to agree with this, but it becomes much less of a factor when residency begins and even less once board certification is earned. I keep hammering this point but lots of U.S. students seem to ignore the fact that there are a number of foreign trained medical graduates who work at U.S programs and who train U.S. medical students, and so I always find it humorous when I hear about U.S. medical students who are often being trained by FMGs and making comparisons that their training is so much better than the very people who are teaching them.

But as an aside, one constant that I have found at every medical schools I have heard of is that they all seem to manage to grant MDs to both competent and quite incompetant students, and this list includes most U.S. programs and accredited Caribbean programs as well.

 

[Tired]

I keep hammering this point but lots of U.S. students seem to ignore the fact that there are a number of foreign trained medical graduates who work at U.S programs and who train U.S. medical students, and so I always find it humorous when I hear about U.S. medical students who are often being trained by FMGs and making comparisons that their training is so much better than the very people who are teaching them.

Hammer the point all you like, it's still a very obvious selection bias.

The average FMG is weak compared to U.S. seniors, and this is reflected in how they are treated in the match.

 

[DrFraud]

Hammer the point all you like, it's still a very obvious selection bias.

The average FMG is weak compared to U.S. seniors, and this is reflected in how they are treated in the match.

you are joking right......the only thing weak is your argument....

......or can you back up what you are saying: "this is reflected in how they are treated in the match" I don't recall "treatment of fmg..." as being one of the criteria in the match statistics I recently reviewed.

At the end of the day, we'll both be called doctor, and we'll both be treating patients. If the only way you can feel better about yourself is by trying to put your colleagues down, i'm guessing you'll be one unhappy doctor

 

[Tired]

At the end of the day, we'll both be called doctor, and we'll both be treating patients. If the only way you can feel better about yourself is by trying to put your colleagues down, i'm guessing you'll be one unhappy doctor

Whatever gets you out of the bed in the morning.

 

[razorback58]

Just FYI, the two digit scores on your steps are not percentiles.

I know that and never indicated otherwise.

It is so true that many FMG's are not only attendings at MAJOR Medical Universities but there are many Chief residents and other residents that are FMG's that are teaching medicals students and lower level residents each and every day.

You never know who you will be working for or being interviewed by.

 

[DrDre311]

you are joking right......the only thing weak is your argument....

......or can you back up what you are saying: "this is reflected in how they are treated in the match" I don't recall "treatment of fmg..." as being one of the criteria in the match statistics I recently reviewed.

At the end of the day, we'll both be called doctor, and we'll both be treating patients. If the only way you can feel better about yourself is by trying to put your colleagues down, i'm guessing you'll be one unhappy doctor

It is a fact, based on the comprehensive match statistics gathered by the NRMP, that FMG's, IMG's and DO's are less successful as a group in the allopathic match than are U.S. allopathic seniors. This is to say nothing of the medical competence and future success or lack thereof on the part of any one person--just look at the data.

Being an FMG/IMG and, to a lesser extent, a DO, is seen as a weakness in the U.S. allopathic match--warranted or not.

 

[DrFraud]

It is a fact, based on the comprehensive match statistics gathered by the NRMP, that FMG's, IMG's and DO's are less successful as a group in the allopathic match than are U.S. allopathic seniors. This is to say nothing of the medical competence and future success or lack thereof on the part of any one person--just look at the data.

Being an FMG/IMG and, to a lesser extent, a DO, is seen as a weakness in the U.S. allopathic match--warranted or not.

I have looked at the data. If you try and compare two candidates with nearly identical LORs, step scores, and grades, it is NOT clear that the 'average FMG is treated differently', as was the the claim made by Tired.

If you take the graduating class from Ross as an example, a carib. program accredited in all 50 states, and compare students of similar step 1 scores, LORs, and grades with counterparts from say a school like Temple or GW, there is nothing in the statistics, unless I am missing something, that suggests that two candidates of equal caliber, one from Ross, and another from Temple, are treated in a significantly different manner.

Now, would there be a significant difference in perception between a graduate of Temple and Harvard with identical stats....I would suspect yes, but I have not reviewed the data enough to confirm. I would say this if comparing grads from Harvard and Ross as well, but not so much if your comparing grads with equal stats from Ross and Temple.

In the end, as far as perceptions go, you have to look at both the candidate and the med school, but not all carib. programs are alike and neither are all U.S. programs.

 

[Tired]

Being an FMG/IMG and, to a lesser extent, a DO, is seen as a weakness in the U.S. allopathic match--warranted or not.

Don't burst his bubble, he's still caught up in the "all doctors are the same!" line that his interviewers sold him on.

 

[superoxide]

 

[Winged Scapula]

Lemme ask you Dr Freud...

how many of those grads from Ross with identical board scores are getting into Ortho, Derm, Plastics or other competitive specialties? Not nearly as many as a US grad.

As an IMG who interviewed for a competitive specialty and who spent a number of years on interview committees, I feel a bit qualified to tell you that while you may not like the message, IMGs and FMGs are not treated the same in the match as a US MD grad. Even with identical applications, the American MD will almost always be preferred. The IMG/FMG has to be BETTER than the US grad in most cases, not just "identical" (which we know doesn't really exist). There are exceptions I realize, but to paint the picture that foreign grads are not stigmatized in the match is inaccurate.

 

[DrFraud]

Lemme ask you Dr Freud...
how many of those grads from Ross with identical board scores are getting into Ortho, Derm, Plastics or other competitive specialties? Not nearly as many as a US grad.

it's difficult to answer since comparing match results like this requires that you know what specialties a student applyes to.

Look, I'm not trying to say every FMG is identical to every US grad, but neither is every U.S grad identical nor is every FMG.

I've met quite a few grads from my school including someone last year who matched into neurosurgery at Virginia so I am basing what I am saying on more than just stats.

There are so many variables at hand here since some programs won't even consider a FMG but then again some welcome FMGs with open arms. The student who went to Virgina did great and despite all the naysayers who told him what he was trying to do was impossible he somehow managed to convince them that his credentials were worthy of consideration.

 

[Faebinder]

😴

 

[Winged Scapula]

Obviously there are superstars and exceptions to the rule; I mentioned that in my post above.

But again, you cannot make the claim that FMGs are not treated differently based on 1 guy who matched into Neurosurgery at UVA. There will always be exceptions but to assume that you or anyone else will be the exception to the rule is naive. I have a classmate that matched into Derm at a prestigious program; does that mean I would advise people that you can still be a dermatologist if you go abroad for medical school? Not without a LOT of cautionary words.

Finally, perhaps fewer Ross students match into Ortho because fewer apply; but this is a self-selection bias because most of those students aren't naive enough to think that they will be very successful in the match.

 

[DrFraud]

Obviously there are superstars and exceptions to the rule; I mentioned that in my post above.

I think it does depend on where, and what program a student is applying as to the type of bias. This is also a type of self-selection bias that affects where students at my school apply but how this can be measured is difficult to say.

Exceptions and outliners are rarely a good way to establish trends, but your own success is evidence that IMGs/FMGs can and do become established.

You can laugh all you want at me and tell me I'm at a disadvantage come the match but until I get to that point I can't comment on whether or not I have been personally affected by what you are saying. We will have to wait and see what happens

 

[Winged Scapula]

I did not mean for you to interpret my posts above as "laughing at you" because that was not my intent.

And my own success? I'm not doing what I had originally planned (having failed to match into Plastics) but I'm happy. However, the situation for IMGs/FMGs is far more difficult than it was 8 years ago when I went through the match - with more requirements, fewer positions, more competition; I don't know if I'd be successful now. I was in the right place at the right time and made the best of my situation.

That is not meant to discourage you and of course you should try and achieve your goals. But I have enough experience and knowledge of colleagues who outrightly say they do not consider FMGs/IMGs for residency positions, that those applications are ignored when received.

I hope it doesn't affect you and you may never know if it will or not (ie, if you don't apply to programs that are loathe to take FMGs/IMGs or a competitive specialty then you can say you weren't hindered).

Best of luck to you.

 

[DrFraud]

Best of luck to you.

Thank you 👍

 

[exPCM]

I posted this previously --> The AMA now says discrimination against IMGs should be prohibited.
Issue: Some residency programs will not accept graduates of international medical schools.
Proposed action: Ask the Accreditation Council for Graduate Medical Education to make IMG status a prohibited discrimination. [ Adopted ]
See link: http://www.ama-assn.org/amednews/2008/07/07/prsl0707.htm
So in the future I see the day coming when the Ross grad applying to orthopedic surgery with 242 on the USMLE must be ranked over the AMG with 241 on the USMLE or the residency program could face sanctions.

 

[anon-y-mouse]

it's difficult to answer since comparing match results like this requires that you know what specialties a student applyes to.

Look, I'm not trying to say every FMG is identical to every US grad, but neither is every U.S grad identical nor is every FMG.

I've met quite a few grads from my school including someone last year who matched into neurosurgery at Virginia so I am basing what I am saying on more than just stats.

There are so many variables at hand here since some programs won't even consider a FMG but then again some welcome FMGs with open arms. The student who went to Virgina did great and despite all the naysayers who told him what he was trying to do was impossible he somehow managed to convince them that his credentials were worthy of consideration.

Which programs are those?! Open arms? Though superficial, it looks much better on a resident roster to see "Yale x3" rather than "St George, Ross, etc." Like it or not (and whether it's right or not), many people use the resident roster (in addition to other factors) as a prima facie evaluation of the residency program. e.g. "That must be a pretty ****ty program, all their residents are from Grenada". There's an obvious flaw with that reasoning, but a lot of people think that way still to this day.

Anyway though, you've pretty much acknowledged that there are programs out there who won't consider foreign grads, how can you possibly say there is no evidence that FMG's are treated differently in the match? Clearly they will not be ranked at all at a number of institutions. There is your 'data'.

 

[yaah]

Issue: Some residency programs will not accept graduates of international medical schools.
Proposed action: Ask the Accreditation Council for Graduate Medical Education to make IMG status a prohibited discrimination. [ Adopted ]
See link: http://www.ama-assn.org/amednews/200...7/prsl0707.htm
So in the future I see the day coming when the Ross grad applying to orthopedic surgery with 242 on the USMLE must be ranked over the AMG with 241 on the USMLE or the residency program could face sanctions.

Yeah but I doubt that there would ever be an "all things being equal" case like you propose. Applications are always going to be different enough so that PDs are still going to rank who they want. If the AMG in the situation you propose has a "better interview" than the Ross grad then they would still get ranked higher, probably. Legislating against discrimination is not going to eliminate this.

 

[Winged Scapula]

Its awfully hard to prove discrimination. Since, as yaah points out, applications are rarely, if ever, identical and contain some subjective factors (ie, interview), it would be difficult to prove that programs discriminated against the IMG/FMG.

 

[DrDre311]

I have looked at the data. If you try and compare two candidates with nearly identical LORs, step scores, and grades, it is NOT clear that the 'average FMG is treated differently', as was the the claim made by Tired.

If you take the graduating class from Ross as an example, a carib. program accredited in all 50 states, and compare students of similar step 1 scores, LORs, and grades with counterparts from say a school like Temple or GW, there is nothing in the statistics, unless I am missing something, that suggests that two candidates of equal caliber, one from Ross, and another from Temple, are treated in a significantly different manner.

Now, would there be a significant difference in perception between a graduate of Temple and Harvard with identical stats....I would suspect yes, but I have not reviewed the data enough to confirm. I would say this if comparing grads from Harvard and Ross as well, but not so much if your comparing grads with equal stats from Ross and Temple.

In the end, as far as perceptions go, you have to look at both the candidate and the med school, but not all carib. programs are alike and neither are all U.S. programs.

Unless you're looking at stats the rest of us don't have, the NRMP doesn't break it down like that. There's no way, from their numbers, to draw a conclusion about similarity of LOR's/quality pubs/AOA/etc., and even USMLE's are only compared in a broad sense (and for only the past few match cycles, not including this year's).

The numbers don't say what you want them to.

What they do say, in a concrete fashion, is that fewer FMG's/IMG's/DO's/people having done entire residencies in other countries (which are all grouped together as independent applicants--not broken down individually) match, and those that do match have to have better paper applications than their U.S. allopathic counterparts in most cases. This discrepancy is directly correlated with the competitiveness of the specialty.

I've met great FMG's and I've met terrible FMG's (I do have to say that I've only interacted with excellent DO's), and I have no personal bias against FMG's unless they cannot communicate effectively in English and perhaps Spanish, but you're deluding yourself if you think you're on equal footing with any U.S. allopathic grad with similar numbers when it comes to the match. FMG/IMG types have to be stellar/have some connections to get into the tough specialties--fair or not, that's the way it is.

And as WS astutely points out, it'd be awfully tough for any applicant to prove "discrimination" due to FMG status when the match is a bunch of voodoo as it is.

 

[BlondeDocteur]

The bottom line is that no US medical student, ever in the history of mankind, turned down acceptance offers to US medical schools in order to go to the Caribbean. Like it or not, "Caribbean grad" screams "was not competitive enough to get in anywhere 4 years ago." Did well in your clinical rotations? Well, you did well compared to other people who also weren't competitive enough to get in anywhere 4 years ago. The Steps are the only thing that give you any shot at equal footing... but most Carib schools give you months on months to study for them, so those scores are discounted as well.

On the other hand, foreign citizens who went to their national medical schools and excelled are viewed much more kindly. The neurosurg resident at Columbia mentioned above spent two years researching here and won every prize in the book down in Mexico, and happens to speak beautiful fluent English. He is a knock-your-socks-off guy... but he only matched because he had the resources to live in New York for two years.

If physiologyman is a US citizen who went to, say, Pakistan because that's where his family is from and he was able to get a spot at 18 instead of putting himself through the grinder of US med school applications at 22, I'd venture to guess that wouldn't be viewed very favorably, mainly because he never would have established that he was indeed on equal footing with all the American med students.

And lastly, there are some at least understandable reasons why US residencies favor US citizen graduates of US medical schools; after all, residency slots are partially funded by our government and they are intended to train physicians who will take care of American people. So there's a bit of nationalistic self-interest in it all.

I hope no one takes offense at this-- I certainly don't mean to imply that this notion of "competitiveness" necessarily turns on intelligence. The Caribbean is a fantastic proving ground for people who pissed away a few opportunities early in life but just needed a second chance, and many grads make good, dedicated doctors.

 

[DrFraud]

Like it or not, "Caribbean grad" screams "was not competitive enough to get in anywhere 4 years ago."

If the application process for getting into u.s. medical school was more objective (and I am not refering to any considerations about my own background when I write this) I would agree more with you.

Basically, I can tell you from meeting students from most states is that students from some states, like Michigan, which is a great example, has lots of qualified medical students relative to the seats at their state medical schools, and as a result, many of these students who are very qualifed go Caribbean. Florida is another example. With Florida and Michigan opening up new medical schools, students that have credentials like some of my colleagues will become graduates of U.S. programs in the future. Does this mean that the future students similar the folks who screamed 'was not competitive enough to get in anywhere 4 years ago' suddenly grew larger cerebrums.

This is just one example.

I've also met students at U.S. programs who were aided in their admission via a connection of some sort. Did they suddenly become geniuses because they didn't go to a foreign medical school?

Yes, I know these are not representative of all U.S. medical students or Caribbean medical students, but you can not draw the conclusions that you did based soley on the criteria that you indicated.

 

[DrFraud]

The bottom line is that no US medical student, ever in the history of mankind, turned down acceptance offers to US medical schools in order to go to the Caribbean.

Is this a misstatement. I don't know how a U.S medical studentd could turn down an offer in the U.S to go to a non-U.S program. Is this what you were trying to say?

....or were you writing about someone who was accepted to a U.S. program turned it down to go to a Caribbean program. If this is what you mean, then yes, I do know of an example. Its very rare, but in this case there was a good reason for it.

 

[Tired]

If the application process for getting into u.s. medical school was more objective (and I am not refering to any considerations about my own background when I write this) I would agree more with you.

Basically, I can tell you from meeting students from most states is that students from some states, like Michigan, which is a great example, has lots of qualified medical students relative to the seats at their state medical schools, and as a result, many of these students who are very qualifed go Caribbean. Florida is another example. With Florida and Michigan opening up new medical schools, students that have credentials like some of my colleagues will become graduates of U.S. programs in the future. Does this mean that the future students similar the folks who screamed 'was not competitive enough to get in anywhere 4 years ago' suddenly grew larger cerebrums.

This is just one example.

I've also met students at U.S. programs who were aided in their admission via a connection of some sort. Did they suddenly become geniuses because they didn't go to a foreign medical school?

Yes, I know these are not representative of all U.S. medical students or Caribbean medical students, but you can not draw the conclusions that you did based soley on the criteria that you indicated.

Your posts just scream, "I'm trying hard to convince myself that what I'm saying is true!"

 

[DrFraud]

Unless you're looking at stats the rest of us don't have, the NRMP doesn't break it down like that. There's no way, from their numbers, to draw a conclusion about similarity of LOR's/quality pubs/AOA/etc., and even USMLE's are only compared in a broad sense (and for only the past few match cycles, not including this year's).

The numbers don't say what you want them to.

You're missing my point. Another poster suggested that FMGs are at a disadvantage based on data from the NRMP, and since it does not compare students with equal stats, it's impossible to conclude from the data that FMGs are at a disadvantage.

What they do say, in a concrete fashion, is that fewer FMG's/IMG's/DO's/people having done entire residencies in other countries (which are all grouped together as independent applicants--not broken down individually) match, and those that do match have to have better paper applications than their U.S. allopathic counterparts in most cases. This discrepancy is directly correlated with the competitiveness of the specialty.

And I have said this b-4 in another thread, and I will say it again, is that you can not lump all Caribbean grads and U.S grads into separate catagories and draw any conclusions that apply to all programs in both catagories since there are significant differences between programs within the U.S catagory and the Caribbean catagory to warrent further analysis. If you want to be able to say that a grad from SGU is at a disadvantage in comparison to a grad. from Marshall based on the match data, you will need to break the data down further that what is currently done.

I've met great FMG's and I've met terrible FMG's (I do have to say that I've only interacted with excellent DO's), and I have no personal bias against FMG's unless they cannot communicate effectively in English and perhaps Spanish, but you're deluding yourself if you think you're on equal footing with any U.S. allopathic grad with similar numbers when it comes to the match. FMG/IMG types have to be stellar/have some connections to get into the tough specialties--fair or not, that's the way it is.

We can argue all we want about data, but I have no doubts about myself. 🙂 Keep in touch if you wish. I am fairly certain that I will do very well in comparison to most of the students who I have met and worked with who attend U.S. programs. It is you who is delusional if you believe otherwise.

 

[DrFraud]

Your posts just scream, "I'm trying hard to convince myself that what I'm saying is true!"

Or, I'm arguing a point. You seem to like to make a personal attack whenever someone writes anything that you disagree with. Possibly, you scream of 'I can't make a good point so I'll just try and bash the guy I disagree with'

 

[anon-y-mouse]

You're missing my point. Another poster suggested that FMGs are at a disadvantage based on data from the NRMP, and since it does not compare students with equal stats, it's impossible to conclude from the data that FMGs are at a disadvantage.




And I have said this b-4 in another thread, and I will say it again, is that you can not lump all Caribbean grads and U.S grads into separate catagories and draw any conclusions that apply to all programs in both catagories since there are significant differences between programs within the U.S catagory and the Caribbean catagory to warrent further analysis. If you want to be able to say that a grad from SGU is at a disadvantage in comparison to a grad. from Marshall based on the match data, you will need to break the data down further that what is currently done.




We can argue all we want about data, but I have no doubts about myself. 🙂 Keep in touch if you wish. I am fairly certain that I will do very well in comparison to most of the students who I have met and worked with who attend U.S. programs. It is you who is delusional if you believe otherwise.

I think I had to spell 'category' and 'warrant' in a discharge summary today. Anyway, though, a LOT of programs scream, "NO IMG's". What do you say to that? That's clearly a disadvantage.

 

[DrFraud]

I think I had to spell 'category' and 'warrant' in a discharge summary today. Anyway, though, a LOT of programs scream, "NO IMG's". What do you say to that? That's clearly a disadvantage.

I'm not sure how in the world you can argure "A LOT"...is this just more hyperbole, or can you clarify this further. If you visit the Web sites and view the match lists from SGU, SABA, AUC, and ROSS, you will see a wide spectrum of programs that accept IMGs.

Ok, so you have two students, nearly identical in qualifications. One is a fourth year Med student who attends Temple, the other is at SGU, and both want to become EM docs. Both students apply to completely different programs.

The Temple student applyes to 10 programs, does an away rotation at the school ranked third on his original list, and ends up geting the #2 on his list.

The SGU student casts a larger net and applyes to 30 programs, does away rotations at 4 on his rank list including rotaions in EM (#1 on his origianal list), a medicine SubI (#10), trama surgery(#4), and critical care(#5). The program that he does his medicine Sub I also has a classmate from the year b-4. All of the programs he did away rotations at have a reptuation for accepting IMGs. He ends up matching at the #10 program on his list, the same program where he did a Sub I.

Now, did the SGU student do as 'well' as the Temple grad? Both started out as solid candidates with similar qualifications. At the end, both matched into areas they wanted too. Since both students got into EM, how can you say that the IMG was at a significant disadvantage?

 

[Tired]

Or, I'm arguing a point. You seem to like to make a personal attack whenever someone writes anything that you disagree with. Possibly, you scream of 'I can't make a good point so I'll just try and bash the guy I disagree with'

It's not really a "personal attack" when I'm just laughing at your posts.

Like I said, whatever it takes to get you out of bed in the morning.

 

[AlternateSome1]

Now, did the SGU student do as 'well' as the Temple grad? Both started out as solid candidates with similar qualifications. At the end, both matched into areas they wanted too. Since both students got into EM, how can you say that the IMG was at a significant disadvantage?

1) No.

2) The IMG had to do more to match into less. The idea that all EM programs are created equal is just as implausible as the idea that all medical schools are created equal. If your point is that an IMG can work very hard and get what he/she wants, that is true. If your point is that an IMG is at no disadvantage in the match, that is false.

 

[NotAProgDirector]

I posted this previously --> The AMA now says discrimination against IMGs should be prohibited.
Issue: Some residency programs will not accept graduates of international medical schools.
Proposed action: Ask the Accreditation Council for Graduate Medical Education to make IMG status a prohibited discrimination. [ Adopted ]
See link: http://www.ama-assn.org/amednews/2008/07/07/prsl0707.htm
So in the future I see the day coming when the Ross grad applying to orthopedic surgery with 242 on the USMLE must be ranked over the AMG with 241 on the USMLE or the residency program could face sanctions.

This is the craziest thing I have heard in a long time.

As a PD, I am allowed to choose my residents based upon the school to which they went. If I think that School A is better than School B, then I should be allowed to rank someone from school A above School B.

Is one medical school better than another? Well, take this example: School A gives 80% of all students Honors on Medicine, and 20% pass. School B gives 10% of students Honors, and 90% pass. Given two students with Honors, or two students with Pass, School B gets ranked above School A.

If we're going to do this, then we might as well make the name of everyone's medical school anonymous, else people who go to State U will complain that they are being discriminated against compared with those at Ivory Tower Medical School.

Actually, in that case, we might as well rank people solely by their USMLE scores. Everything else in their application could be seen as biased, discriminatory, or unfair.

 

[DrDre311]

You're missing my point. Another poster suggested that FMGs are at a disadvantage based on data from the NRMP, and since it does not compare students with equal stats, it's impossible to conclude from the data that FMGs are at a disadvantage.




And I have said this b-4 in another thread, and I will say it again, is that you can not lump all Caribbean grads and U.S grads into separate catagories and draw any conclusions that apply to all programs in both catagories since there are significant differences between programs within the U.S catagory and the Caribbean catagory to warrent further analysis. If you want to be able to say that a grad from SGU is at a disadvantage in comparison to a grad. from Marshall based on the match data, you will need to break the data down further that what is currently done.




We can argue all we want about data, but I have no doubts about myself. 🙂 Keep in touch if you wish. I am fairly certain that I will do very well in comparison to most of the students who I have met and worked with who attend U.S. programs. It is you who is delusional if you believe otherwise.

The numbers don't have the power to say what you want them to. The only thing that you can objectively conclude, since the NRMP does not and cannot quantify the impact of LOR's, away rotations, and interview quality, is that FMG's/IMG's/DO's, as a group (which is how they are analyzed by the NRMP, as one lumped category despite any mitigating factors) do not succeed as much, as a group, as U.S. allopathic seniors.

You seem to think that the match data compares single-case-success of one grad from one specific U.S. school against one grad from SGU or Ross, and that is a conclusion that the available data does not provide in either direction. The statistical grouping of applicants is too broad to allow such a comparison.

Think you can get into plastics, derm, or neurosurg as a Caribbean grad? Maybe. But the numbers simply say that your chances are not as good as any U.S. grad in the same situation, independent of board scores or any other factor.

It's good that you're confident in yourself, but if I'm delusional, then the bulk of PD's across the U.S. seem to share my delusion. I've been through the most competitive match in medicine and I've seen it from the other side. Go ahead and try to convince yourself that I'm making it up for some reason; in 4 years I will look forward to your posts about whether or not you should take a prelim position.

 

[DrFraud]

1) No.

2) The IMG had to do more to match into less. The idea that all EM programs are created equal is just as implausible as the idea that all medical schools are created equal. If your point is that an IMG can work very hard and get what he/she wants, that is true. If your point is that an IMG is at no disadvantage in the match, that is false.

I agree with you that not all EM programs are the same, but for aguments sake, lets say both students matched at university programs that have a similar ranking.

My general point is that a poster earlier indicated that NRMP match data suggests that all IMGs are at a selective disadvantage against all U.S grads based on the stats., and I am suggesting that the stats do not tell the whole story. Both the program that the U.S grad goes to, as well as the program the IMG goes to matters, as does how well each student approaches the match.

It very much is an uphill stuggle to be an IMG, and I am fairly certain in my case that this has been an extra souce of motivation. I really don't care if I have to work harder. I am more than willing to put forth the effort, partly because I want to make sure I do as well as I can, but mostly, because my future patients will be entrusting me with their health and well-being and I owe it to them to work as hard as I can to prepared to help them.

 

[Tired]

Go ahead and try to convince yourself that I'm making it up for some reason; in 4 years I will look forward to your posts about whether or not you should take a prelim position.

pwnage

I'd say that pretty much wraps up this thread.

 

[DrFraud]

You seem to think that the match data compares single-case-success of one grad from one specific U.S. school against one grad from SGU or Ross, and that is a conclusion that the available data does not provide in either direction. The statistical grouping of applicants is too broad to allow such a comparison..

I do not believe that match data compares individual successes, but some posters are suggesting that automatically, the single cases will reflect the pattern represented by the aggregate data, and I am in disagreement with this.

Think you can get into plastics, derm, or neurosurg as a Caribbean grad? Maybe. But the numbers simply say that your chances are not as good as any U.S. grad in the same situation, independent of board scores or any other factor.

Yes, these would be a long-shot for me, but also for many U.S students too. I am getting my step scores back in a few days, and this will give me a good starting point for gauging my expectations. I honestly have not decided what I would like to specialize in, but most IMGs I met who succedded in the match apply more broadly than equivalent U.S graduates, and this increases their chances. Does it level the playing field....that's hard to say, but it does improve the odds.

It's good that you're confident in yourself, but if I'm delusional, then the bulk of PD's across the U.S. seem to share my delusion. I've been through the most competitive match in medicine and I've seen it from the other side. Go ahead and try to convince yourself that I'm making it up for some reason; in 4 years I will look forward to your posts about whether or not you should take a prelim position.

I'll be finishing up with medical school a bit sooner, hopefully, but we will have to wait and see if I am able to exceed your prediction.