How much of an advantage do US graduates have over IMGs when it comes to match

[Reborn07]

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I ask this because many IMGs have already worked in their field and it doesn't seem fair to compare against someone just graduated from medical school.

 

[Gfunk6]

It depends on too many different factors including the exact residency one is applying for, the type of hospital, the residency program's prediliction for taking IMGs in past matches, etc.

For instance I would imagine that in a competitve field like Derm or Plastics there will be very few if any IMGs in NE or West coast residency programs.

However for community-based FM/IM programs there may well be a majority of IMGs.

 

[exPCM]

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[colbgw02]

I ask this because many IMGs have already worked in their field and it doesn't seem fair to compare against someone just graduated from medical school.

Actually, it's very fair. Considering that GME slots are almost exclusively paid for with federal Medicare dollars, it makes perfect sense to fill those slots with applicants who 1) have an education whose quality is a known quantity and 2) are more likely to serve in an area that will benefit the taxpayers that helped to provide that education. It's a higher likelihood of return on investment.

 

[yaah]

I ask this because many IMGs have already worked in their field and it doesn't seem fair to compare against someone just graduated from medical school.

Why is it not fair though? Medical schools in this country work to provide doctors for this country, and affiliated residency programs obviously have a vested interest in hiring american graduates. I think you're going to have a hard time if you are trying to argue that people who go to med school here (and pay all that money) would be at a disadvantage in getting a US residency. One of the main purposes of residency is to train physicians, after all. It is also often easier to evaluate the credentials of an american graduate, because the medical school process is more standardized and familiar, so you know what you are getting, obviously. The known commodity is often more important.

In general though, candidates are evaluated individually when it comes to residency, because the pools are smaller and program directors can afford to do this. IMGs with good credentials will often do very well.

 

[TheWowEffect]

US graduates have huge advantage over IMGs, no matter what!!! This is a well established fact. End of discussion. Someone please close this thread.

 

[deleted109597]

US graduates have huge advantage over IMGs, no matter what!!! This is a well established fact. End of discussion. Someone please close this thread.

While true, every year US grads fail to match while IMGs do match in places that US grads could have gone to. Usually this is because IMGs apply much more broadly because they a) have the time to do so, b) have the money to do so, and c) have much higher board scores because of time and money issues discussed in a and b.

 

[Bring It On]

As stated, if your scores are extremely high and you have outstanding LORs, you will match over any US student....it is a known fact! Go back to the threads on "who didn't match"....a lot of US students....just the facts🙂

 

[sirus_virus]

I ask this because many IMGs have already worked in their field and it doesn't seem fair to compare against someone just graduated from medical school.

What. Name me one country on planet mother f$cking Earth that gives advantages to foreigners over their own citizens when it comes to employment. Forget about the amount of money US students are paying for medschool, or the fact that programs are more familiar with American credentials. Just tell me why a qualified American should stand in line behind foreigners for an American job. More importantly, tell me which other country does that kind of crap.

 

[jennyboo]

I ask this because many IMGs have already worked in their field and it doesn't seem fair to compare against someone just graduated from medical school.

I am a US grad. From what I have seen, the US grad has a fairly significant advantage in the applications process.

Many residency programs do not interview IMGs, because they get enough US grad applications that they don't need to include IMGs in their interviewing process. Some specialties are very difficult for an IMG to enter. Some specialties are not difficult for IMGs to enter, but it is rare to find an IMG in the more competitive residency programs within even less competitive specialties.

Many people have heated opinions about whether this is fair or not. I personally would not worry about whether it's "fair" -- it is the reality. As an IMG, this means it is especially important to DO WELL ON THE USMLE EXAMS and to APPLY BROADLY. It is also important to be willing to enter a back-up specialty if your original specialty is extremely competitive in the US and accepts few foreign grads.

 

[dutchman]

I ask this because many IMGs have already worked in their field and it doesn't seem fair to compare against someone just graduated from medical school.

If you are talking about foreign doctors(FMGs), then I don't think this is unique to the United States. I at least know my home country (Netherlands) giveS zero priority to foreign doctors when it comes to competitive specialties. In New Zealand, they will not even let you in at all, unless you want to serve in some underserved area, usually somewhere in the mountains with natives. Canada, and recently the UK are not that far off either. I think FMGs have a sweet gig in the US, and it will be foolish for them to try to complain, less Americans remember they don't owe them anything.

 

[razorback58]

We can sign a pre-match. This happens all the time in psych, FP and IM. US grads cannot do this.

 

[DOCTORSAIB]

We can sign a pre-match. This happens all the time in psych, FP and IM. US grads cannot do this.

That is not entirely true. DO's can sign pre-match offers in the MD match as well but it is much more the exception than the rule.

Besides, why are you bragging about this to begin with? It's annoying for multiple reasons: 1) The fields you've mentioned generally do not attract the cream of the crop; save maybe top programs (esp. IM). So it's almost a moot point in this discussion. 2) Pre-match offers are a loop-hole that most US MD's are not too happy with.

Moral of story: Congrats on your match (or pre-match). Now stop being annoying please...🙂

 

[SLUser11]

These arguments suck because there is way too much emotion and bias involved.

If you want to waste your time debating the fairness, or even the reality of the fact that FMGs are always going to be at a disadvantage, go to the Caribbean forums and look at pretty much every thread.

Besides the extremely uncommon and yet extremely well-advertised cinderella stories, most FMGs will have to make compromises regarding both what they do and where they do it in order to practice medicine in the US.

Personally, I think it's fair. But I don't want to bring my own emotion or bias into the argument, so I'll leave it at that.

 

[SLUser11]

While true, every year US grads fail to match while IMGs do match in places that US grads could have gone to. Usually this is because IMGs apply much more broadly because they a) have the time to do so, b) have the money to do so, and c) have much higher board scores because of time and money issues discussed in a and b.

US allopathic med students universally have the time and money to apply broadly. That's what the loans are for. Without significantly stretching the pocketbook, a motivated US senior could apply to 80 places and interview at 15.

As a matter of fact, according the the NRMPs match outcomes from a couple years ago, For Emergency Medicine, US seniors ranking 6-7 places had a 90%+ chance of matching, 8-9 95-99%, and 10-15+ rankings basically a 100% chance.

The real secret to matching is getting the interviews, which relies on your board scores as mentioned. But then again, for Emergency medicine that year, 85% of US seniors with a 190-200 on step 1 matched, and 91% of those with a 200-210.

Basically what I'm saying is that if you crunch the numbers, your aforementioned factors don't really affect a US senior's ability to match, as long as they can pass step 1 and get 6 interviews.

(Don't blame the FMGs.....they didn't steal your job)

 

[mgdsh]

That is not entirely true. DO's can sign pre-match offers in the MD match as well but it is much more the exception than the rule.

Besides, why are you bragging about this to begin with? It's annoying for multiple reasons: 1) The fields you've mentioned generally do not attract the cream of the crop; save maybe top programs (esp. IM). So it's almost a moot point in this discussion. 2) Pre-match offers are a loop-hole that most US MD's are not too happy with.

Moral of story: Congrats on your match (or pre-match). Now stop being annoying please...🙂

HA! You're annoyed because of the ONE advantage we have over US grads? Get over it. And don't assume that we only pre-match in IM, FP and Psych. I know of FMGs who have pre-matched fields like rads.

Honestly at the end of the day it doesn't even matter where you went to med school. Most people don't ask and don't care. The thing that matters more often is the personality which you carry yourselves with, how you treat your patients, and where you did your residency. It's amazing how many US grads forget about that.

Also don't forget there's plenty of students who were born and raised in the US that don't get into US Allopathic schools. They either go to the DO schools, Carib, Europe, or even other countries. Either we screwed around in undergrad, wanted to save some time, or didn't decide on going into medicine until it was late.

Being from a US MD school you have a huge advantage. Isn't that enough for most of you? Somehow I feel like a lot of you have a complex at state. Going through a path that isn't as traditional or mainstream as the ones you go through, we have considerably more challenges and aren't spoon fed.

I could literally go on, but if you're going to get the point, you will.

 

[colbgw02]

Going through a path that isn't as traditional or mainstream as the ones you go through, we have considerably more challenges and aren't spoon fed.

I love the implication that traditional students are somehow spoon fed. I'm not trying to invalidate your other points, because I don't really care if an IMG or FMG finds a loophole. Good for them.

Sure, there are a few folks who were helped out by Daddy or had their name on one of the buildings, but even they have to work very hard. Besides, for the vast majority of us, getting into a U.S. allopathic medical school and then into competitive residency programs means that we were handed precisely squadoosh.

 

[MacGyver]

Of course AMGs have an advantage of IMGs but its not as big as you think. There are a fair number of PDs who are sympathetic towards them and treat them just like US grads and offer them slots accordingly.

20% of categorical general surgery slots went to IMGs last year, so you guys dont have as much of an advantage over them as you think.

 

[Faebinder]

I agree that the advantage is shrinking. Namely because of:

1) Ease of issuing visas (J1 are like Kit-Kat bars and most don't go to their home country after they are done with residency and if you are lucky you can get the H1 which is the cheesecake of deserts). This also makes the FMGs less able to complain so ACGME wont hear bad things about the programs (I know one story of a close friend where ECFMG called and threatened to remove the J1 visa of this person. In April, she had signed a contract for cat surgery starting july which was independant of the fact that she was in a pediatric residency and so she wanted to just stop finishing that year but ECFMG threatened to pull her J1 and not give her a new visa for the surgery residency if she left early. My understanding is that the peds program didnt like having an open spot for a couple of months and complained to ECFMG which took action.)

2) Programs want to do less teaching and more treating patients (many non academic programs see applicants from overseas with higher board scores + 5 or so years experience as an asset. They dont have to teach them as much and they dont have to worry about them possibly failing the specialty boards as much). Why risk taking a 75 scoring AMG when there is that 95 scoring FMG who wont make the program look bad when he takes the board exams? Looking good is more important to the program, after all, it wants to survive ACGME's scrutinizing glare which checks on the number of residents that pass the specialty boards of their residency. Programs that want to teach less and less and yet worry about the boards simply take high scorers regardless of origin.

Someone can correct me if any of my statements are wrong. I highly doubt I misrepresented anything and I am certainly not implying that all programs are malignant, but the advantage is definitely not that big when it comes to upper board scores. At lower board scores the advantage is very evident.

 

[Apollyon]

My take:

Several people have brushed up against it above, re: low-caliber American grads. Those are the people that complain about the FMGs getting spots, and this is predicated on the, ipso facto, "I'm an American grad, so I deserve a spot ahead of anyone else" mentality. The American grads that used the same effort that it took to get into medical school to get through medical school have the boards, grades, recs, and personality to get the spots they want. Some few years ago, when Brad Deal was AMSA President, he said, regarding IMGs and residency placement, "If someone has better board scores, better grades, better recommendation letters, and interviews better, don't you think they deserve a spot?" (paraphrased) And that is where it's at. If the only reason someone is an FMG is because they are from New York or California (as was ~1/2 my class in med school at St. George's, me included), and the state schools are woefully applied to more vs spots available, and all the above is true, I have little sympathy and less respect for anyone who would cry discrimination or the equivalent because someone with more substance displaces them.

Getting into MD school in the US may be the gold standard, but that doesn't mean that it guarantees anything - from simply graduating to getting the residency spot of your choice. I mean, it's like the FMG "can I get a derm position" question. Most American grads don't get it. That means that, if you have to ask, YOU ain't gettin' it.

 

[deleted109597]

My take:

Several people have brushed up against it above, re: low-caliber American grads. Those are the people that complain about the FMGs getting spots, and this is predicated on the, ipso facto, "I'm an American grad, so I deserve a spot ahead of anyone else" mentality. The American grads that used the same effort that it took to get into medical school to get through medical school have the boards, grades, recs, and personality to get the spots they want. Some few years ago, when Brad Deal was AMSA President, he said, regarding IMGs and residency placement, "If someone has better board scores, better grades, better recommendation letters, and interviews better, don't you think they deserve a spot?" (paraphrased) And that is where it's at. If the only reason someone is an FMG is because they are from New York or California (as was ~1/2 my class in med school at St. George's, me included), and the state schools are woefully applied to more vs spots available, and all the above is true, I have little sympathy and less respect for anyone who would cry discrimination or the equivalent because someone with more substance displaces them.

Getting into MD school in the US may be the gold standard, but that doesn't mean that it guarantees anything - from simply graduating to getting the residency spot of your choice. I mean, it's like the FMG "can I get a derm position" question. Most American grads don't get it. That means that, if you have to ask, YOU ain't gettin' it.

Yeah, it is a tough way to say that there are differences without offending anyone. Say that the DOs shouldn't be able to do both matchs if MDs can't, and you're opening a can of worms. Same with saying anything about FMGs. I work with plenty of FMGs, and have in the past. I have nothing against them, and one of my mentors in undergrad made a statement that the Carib students are usually better doctors because they have had to try harder to get through everything, and there may be some basis to that (however, each person makes whatever they want out of their schooling usually). The problem is that there aren't as many MD slots in the US as there are people applying, and that is why the number of DO spots is skyrocketing, as well as why people go to the Caribbean. So then you get into the difference between FMG and IMG, at least from the standpoint of US born vs foreign born. Many people feel that US tax money shouldn't pay to train people who aren't US citizens. On the flip side, there are more residency spots than there are US grads every year, so they have to be filled by someone.
All I was trying to say that there is no cut and dry answer to this. Lots of places will hire FMGs simply because they are afraid they wouldn't fill, and can pre-match them into primary care roles. I just leads me to believe that this is simply another reason this madness needs to change.

 

[deleted109597]

US allopathic med students universally have the time and money to apply broadly. That's what the loans are for. Without significantly stretching the pocketbook, a motivated US senior could apply to 80 places and interview at 15.

I didn't fly, interviewed at 11, and was stretching my loan dollars to the limit. I had to get a private loan on top of them to foot the bill.

As a matter of fact, according the the NRMPs match outcomes from a couple years ago, For Emergency Medicine, US seniors ranking 6-7 places had a 90%+ chance of matching, 8-9 95-99%, and 10-15+ rankings basically a 100% chance.

From a couple of years ago, OB was easy to get into as well. There were 2 prelim spots after the match this year. You can't base it on old data, and lots more people interviewed at 10+ programs this year.

The real secret to matching is getting the interviews, which relies on your board scores as mentioned. But then again, for Emergency medicine that year, 85% of US seniors with a 190-200 on step 1 matched, and 91% of those with a 200-210.

I got 14 interviews, could only go on 11, and had board scores higher than those. Significantly higher, as a matter of fact. When I asked after the match, a lot came down to the couple's match and geography (IE, they thought I wouldn't want to live there but couldn't ask me during the interview apparently, and me talking about housing wasn't sufficient).

Basically what I'm saying is that if you crunch the numbers, your aforementioned factors don't really affect a US senior's ability to match, as long as they can pass step 1 and get 6 interviews.

Hardly. Wait until this year's numbers come out.

(Don't blame the FMGs.....they didn't steal your job)

Did I? I just said they had jobs because they applied more broadly, interviewed more broadly, and had higher scores. I have heard of some applying to every program. I don't know many US MD kids who did that. I also know quite a few that have double 99s. Once again, not many US kids have that. However, do I think that if I could have applied to those programs, I might have had a better shot at the job than an FMG? That's tricky, as not many FMGs get into EM to begin with (less than 10% typically). Who knows. I certainly don't.

I still think that this year came down to numbers, because I know lots of people who decided at the last minute to do EM, had no research, no experience, but had better numbers, and they got spots. Because I was so middle of the road with Step 1 and GPA, and PDs don't care about Step 2 (unless you do worse than Step 1, whereas I did much better), I didn't stand out. Couple's match didn't help either.

 

[chumbojumbo]

Just to chime in and add on what McNinja said...IM an IMG applied to EM this past year...below average step 1, above average step 2, applied to over 100 programs, got a whopping 4 interviews, and not suprisingly, did NOT match...do I think its unfair, NO, am I pissed, you bet your ass I am...but i will be applying again this year baby.

CJ

 

[Tired]

Some few years ago, when Brad Deal was AMSA President, he said, regarding IMGs and residency placement, "If someone has better board scores, better grades, better recommendation letters, and interviews better, don't you think they deserve a spot?" (paraphrased) And that is where it's at.

Overly simplistic statement.

Are academic credentials really the only criteria for admission to residency programs? Obviously not, since residencies are funded with public money. There are interests in this system that are seperate from pure academic prowess. The U.S. has an interest in producing doctors who represent the communities they serve, and will work in areas and fields that they are needed in. This is why medical schools ask if you are from "medically underserved areas", why race and gender are increasingly accounted for in the admissions process, and why so many schools have begun pushing for more students to enter primary care professions.

You don't have to like it (and I know a lot of SDN doesn't), but medical school and residency admissions serve a larger public good, which is why we fund it with our tax dollars. While society is served well by taking the best and the brightest, they also have the expectation that the doctors they train will work for patients in this country, and be able to culturally relate to their population base.

Anyone who has seen a brilliant but English-deficient resident stumble through an awkward patient history ought to recognize immediately why FMGs are viewed much more skeptically than your average American grad.

 

[Faebinder]

Overly simplistic statement.

Are academic credentials really the only criteria for admission to residency programs? Obviously not, since residencies are funded with public money.
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*snip*
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Anyone who has seen a brilliant but English-deficient resident stumble through an awkward patient history ought to recognize immediately why FMGs are viewed much more skeptically than your average American grad.

And yet simple board scores are used as screeners and are probably the biggest factor that impact ranking despite the fact that there are minor difference between the ranges of the board scores. Residencies just want residents to come do the work and cause the least bit of havoc (preferably with the least bit of training effort). Now if a community PAID for the residency position (directly, not through medicare), interest sparkles in whether or not the resident will stick around after residency. This is true in some cases of rural family medicine program.

 

[dkpwalker]

Just to chime in and add on what McNinja said...IM an IMG applied to EM this past year...below average step 1, above average step 2, applied to over 100 programs, got a whopping 4 interviews, and not suprisingly, did NOT match...do I think its unfair, NO, am I pissed, you bet your ass I am...but i will be applying again this year baby.

CJ

That's the spirit, i am an IMG too looking to apply to EM with below average step 1 scores and above average step 2 scores, now i hope i will match come next year so i won't have to do this all over again and like chumbojumbo, i will not be giving up. As for what is fair or not, i am just happy to be able to get a chance to train in the US. As long as the doctor speaks good english and doesn't compromise patient care then that's all that should matter isn't it?...and for the record, not all AMERICANS speak good english.

 

[mgdsh]

Overly simplistic statement.

Are academic credentials really the only criteria for admission to residency programs? Obviously not, since residencies are funded with public money. There are interests in this system that are seperate from pure academic prowess.

That's true and I agree with you to some extent.

The U.S. has an interest in producing doctors who represent the communities they serve, and will work in areas and fields that they are needed in. This is why medical schools ask if you are from "medically underserved areas", why race and gender are increasingly accounted for in the admissions process, and why so many schools have begun pushing for more students to enter primary care professions.

At the end of the day most US grads specialize more often than IMGs/FMGs and a good portion (even if they won't admit it) look down on primary care physicians.

Also I hate to say it, but people who come from under-served areas usually work hard and usually are motivated so they get out of those under-served/low-income areas.

You don't have to like it (and I know a lot of SDN doesn't), but medical school and residency admissions serve a larger public good, which is why we fund it with our tax dollars. While society is served well by taking the best and the brightest, they also have the expectation that the doctors they train will work for patients in this country, and be able to culturally relate to their population base.

That's not entirely true either. Usually the most competitive and the more qualified students/applicants end up going into specialized areas of medicine. They would serve a greater good by going into more primary care specialties.

 

[Apollyon]

Overly simplistic statement.

How do you figure? What else IS there? Have you done any residency interviews (seriously)? Grades, board scores, recommendations, and how you do on the interview is what gets you a spot. And, even in the face of THAT, there are still PDs that will take a "lesser qualified" AMG (or FMG from Sackler - won't tell you what program or where), so as to not be "stigmatized" by taking an FMG.

For one, it is a straightforward statement - if you think it is "overly simplistic", that is your interpretation. Secondly, as a new military doctor, if you think that that is "overly simplistic", you are going to be asking yourself if they think you're special ed with some (most) of the stuff you will be told or read from your superiors.

 

[colbgw02]

At the end of the day most US grads specialize more often than IMGs/FMGs and a good portion (even if they won't admit it) look down on primary care physicians.

Let's be clear here - almost everyone specializes. GPs are few and far between. US grads may be more likely to specialize in non-primary care fields. Frankly, I don't know; I haven't seen the numbers.

Also I hate to say it, but people who come from under-served areas usually work hard and usually are motivated so they get out of those under-served/low-income areas.

Perhaps, but a major reason for admitting URMs into medical school with comparatively lower academic credentials is that the studies have shown that they're more likely to practice in underserved areas.

That's not entirely true either. Usually the most competitive and the more qualified students/applicants end up going into specialized areas of medicine. They would serve a greater good by going into more primary care specialties.

In our construct, location trumps specialty with regards to importance. An orthopaedist working in Hometown, USA, is much more valuable than a family practicioner who returns to his/her native country.

 

[colbgw02]

Secondly, as a new military doctor, if you think that that is "overly simplistic", you are going to be asking yourself if they think you're special ed with some (most) of the stuff you will be told or read from your superiors.

That's random....and irrelevant.

 

[Apollyon]

That's random....and irrelevant.

Not actually - if that's his viewpoint, it is directly applicable to his life in the military. Therefore, neither random nor irrelevant. Not especially relevant, but certainly not irrelevant. And absolutely not random.

 

[Apollyon]

Perhaps, but a major reason for admitting URMs into medical school with comparatively lower academic credentials is that the studies have shown that they're more likely to practice in underserved areas.

Not to be argumentative - show me these studies.

 

[McGillGrad]

As far as I am concerned, the only advantage that an AMG has over me is landing an interview.

There are programs that will outright deny IMGs interviews, and that is fine. There are also programs that will deny non-Ivey grads interviews. That's life.

There is no AMG out there that can offer anything that I cannot if we have similar scores and LORs. If I am the right fit for the program, then I will get it.

IMGs who are flexible with location and who tackle the match strategically will have little problem matching in an acceptable place.

Other issues mentioned are mainly personal insecurities injecting themselves into people's thinking. IMGs only represent themselves so trying to defend some of the idiots in the Caribbean is not my purpose. There are many Carib students that I would not allow to serve me coffee, let alone treat me at a hospital.

The IMG stereotype didn't create itself. Then again, I am sure EVERY single AMG has people in their class that they would not trust to hold a colostomy bag.

 

[mgdsh]

Let's be clear here - almost everyone specializes. GPs are few and far between. US grads may be more likely to specialize in non-primary care fields. Frankly, I don't know; I haven't seen the numbers.

Uh, most of those residents who match into family practice are considered primary care physicians and have few options in which to 'specialize.' I'd say less than 50% of internal medicine residents specialize as well.

Perhaps, but a major reason for admitting URMs into medical school with comparatively lower academic credentials is that the studies have shown that they're more likely to practice in underserved areas.

They might be more likely to, but what % is that? What % of them return to underserved areas? Do you have actual #s?

Also tell me why they bother to do this in undergrad and other types of graduate schools. *HINT:* This country is about providing opportunities to people who work hard and show that no matter where they come from (foreign country, or underserved area), that intelligence + hard work pays off.

In our construct, location trumps specialty with regards to importance. An orthopaedist working in Hometown, USA, is much more valuable than a family practicioner who returns to his/her native country.

Ha! Most of those FMGs that were foreign born and come here to complete a residency stay here. Why would they work their tails off, complete another series of exams, and work to getting a license in a country just to return back to where they are from, when they could have done a residency program in their home country with about 1/10th of the headache?

 

[colbgw02]

Not to be argumentative - show me these studies.

They might be more likely to, but what % is that? What % of them return to underserved areas? Do you have actual #s?

I'm not going to do the research, because, frankly, I don't care enough. However, at least 3-4 times a year there is a very heated debate in the pre-allopathic forum of SDN regarding URM admission to medical school. Invariably, there are multiple studies that are referenced on those threads that demonstrate the point I am making. So the numbers are out there if you care to do a search. Sorry I can't/won't quote the exact studies for you, but like I said, this topic isn't exactly near-and-dear to me.

Not actually - if that's his viewpoint, it is directly applicable to his life in the military. Therefore, neither random nor irrelevant. Not especially relevant, but certainly not irrelevant. And absolutely not random.

Well, I still think it's random and irrelevant. What exactly does the fact that Tired is a military physician have to do with thinking your statement was overly simplistic? Are you meaning to say that military physicians can't think anything is overly simplistic because they necessarily have to deal with simpleton superiors who will order them to do inane tasks and are somehow not qualified to judge overly simplistic? Sorry, I'm not following. Having to fall in line at work when your boss wants X and disagreeing with a statemnt about an esoteric topic on an internet message board don't appear to have a lot in common to me.

 

[Lion-O]

While true, every year US grads fail to match while IMGs do match in places that US grads could have gone to. Usually this is because IMGs apply much more broadly because they a) have the time to do so, b) have the money to do so, and c) have much higher board scores because of time and money issues discussed in a and b.

Though appealing as a rationalization, this statement is completely false as shown in the NRMP Outcomes document released last year:

IMGs do not have higher board scores, nor do they apply more broadly.

 

[deleted109597]

1. Nothing you showed says anything about how broadly they applied, and it has been shown that IMGs often get fewer interviews than comparable US grads.
2. The scores data disproves one statement I made (possibly), but apparently proves that they have an advantage somehow if they rank fewer places and have lower scores but still get jobs in those positions.
So how does one rationalize this information?

 

[Haley]

Actually contrary to what most may think, img's seem to have the advantage over us grads because they can pre-match. Also, the ones from Irish schools are hailed for their superior clinical skills. They seem to know things that US grads never heard of. How pretentious are we to think the only place in the world to produce a good doctor is in the US. I think we've all been brainwashed.

 

[Faebinder]

Actually contrary to what most may think, img's seem to have the advantage over us grads because they can pre-match. Also, the ones from Irish schools are hailed for their superior clinical skills. They seem to know things that US grads never heard of. How pretentious are we to think the only place in the world to produce a good doctor is in the US. I think we've all been brainwashed.

And yet, we get an enormous number of irish docs applying to US residencies but little number of US graduates applying to irish residencies.... hmm.. I know what you will say... It's money. You are right, we all know the match is not about how knowledgable you are. When you got 4000 applicants begging for a position, you get arrogant. It's expected. Don't pass your judgement by labeling all the US as "brainwashed". There is a difference between brainwashed and arrogant.

Many applicants, means PDs get to choose. They want to look good and guess whom do they choose? Those who look good on paper. (Having a non US graduate with high scores looks much better for a program than a low scoring US graduate... sometimes that's not true and the program director doesn't see it that way but that's getting less common as we get more and more applicants. Luckily for US graduates, they are still the higher scorers on the steps... for now. Until the steps start expecting things that no new unexperienced graduate can sanely be expected to know in their 4 years of med school vs the people with 10 years of practice experience.)

 

[Tired]

How do you figure? What else IS there? Have you done any residency interviews (seriously)? Grades, board scores, recommendations, and how you do on the interview is what gets you a spot. And, even in the face of THAT, there are still PDs that will take a "lesser qualified" AMG (or FMG from Sackler - won't tell you what program or where), so as to not be "stigmatized" by taking an FMG.

But that's exactly my point! For all the comments about how academics either do govern, or should govern, the admissions process has strong skepticism towards FMGs, and I would argue rightly so. Honestly, it sounds like we agree.

For one, it is a straightforward statement - if you think it is "overly simplistic", that is your interpretation. Secondly, as a new military doctor, if you think that that is "overly simplistic", you are going to be asking yourself if they think you're special ed with some (most) of the stuff you will be told or read from your superiors.

I do think it's overly simplistic, and yes, much of what is presented to me is also overly simplistic in the military environment (took me less than a week to learn that). Such is life, I don't complain.

 

[SLUser11]

I got 14 interviews, could only go on 11, and had board scores higher than those. Significantly higher, as a matter of fact. When I asked after the match, a lot came down to the couple's match and geography (IE, they thought I wouldn't want to live there but couldn't ask me during the interview apparently, and me talking about housing wasn't sufficient).

I think that in a lot of regards, your story is the exception to the rule, which is good because it makes it very likely that you'll match next year. Still, I think the NRMP data is still pretty accurate and the most recent data readily available.

You pointed out that 1. You were couples matching, and 2. Geography was a priority. These factors drastically affect your ability to match. If you had cast a larger net with interviews, and were more willing to train in unfavorable situations, you'd probably be in the ER right now. The only true advantage the IMGs have over you is their willingness to train anywhere they can get in.

As far as I am concerned, the only advantage that an AMG has over me is landing an interview.

There is no AMG out there that can offer anything that I cannot if we have similar scores and LORs. If I am the right fit for the program, then I will get it.

IMGs who are flexible with location and who tackle the match strategically will have little problem matching in an acceptable place.

While I've never observed you clinically so I can't comment on that, you will likely find that even after you land the interview, and you're surrounded by US allopathic students with the exact same caliber of scores and LORs, you'll be at a huge disadvantage.

Of course, it does depend on what specialty you're shooting for, but don't fooled into thinking it's an even playing field once your foot is in the door. Your perceived inadequacies will follow you longer than you think. Just poking around SDN for 3 years, I've read multiple stories of overconfident DOs and IMGs that are shocked in March when they don't match.

I put "perceived" in bold because you might be an excellent physician. I just want you to take some of your own advice and "tackle the match strategically."

The IMG stereotype didn't create itself.

I haven't worked with many Caribbean students. Unfortunately, the ones I did work with (on an away rotation) seemed a little weak. That was an n=4 experience, so I by no means adopt this as the standard.

Then again, I am sure EVERY single AMG has people in their class that they would not trust to hold a colostomy bag.

Absolutely. A hierarchy exists in medical school the same as in high school, etc, where some people are considered really smart, and others kind of dumb. Still, there were a couple classmates that made me exceptionally nervous.....of course, most of them went into their appropriate specialties......

Actually contrary to what most may think, img's seem to have the advantage over us grads because they can pre-match. Also, the ones from Irish schools are hailed for their superior clinical skills. They seem to know things that US grads never heard of. How pretentious are we to think the only place in the world to produce a good doctor is in the US. I think we've all been brainwashed.

No. That is completely wrong. Sorry.

 

[Tired]

That's not entirely true either. Usually the most competitive and the more qualified students/applicants end up going into specialized areas of medicine. They would serve a greater good by going into more primary care specialties.

I see you've been brainwashed like so many before us.

Let me tell you about my day: I'm on Neurosurgery, we did two VP shunt placements and two cranioplasties. All four guys were Iraq vets with battle injuries. The VP shunts will prevent hydrocephalus recurrence and hopefully get them to wake up. The other two will let the guys walk around without a helmet, and hopefully reverse some of their neuro deficits. That's one day's worth of work.

Tell me what the GP saw in clinic today that made that kind of impact on someone's life?

 

[yaah]

Tell me what the GP saw in clinic today that made that kind of impact on someone's life?

That kind of elitism isn't going to get you very far.

Do you honestly believe what you said? Every field of medicine is important, but for different reasons. Just because something is tangible and sounds more exciting and is over quicker doesn't mean it is better or more important or requires more intellectual acumen. As you advance in your studies, you will realize that generalizations are wildly inaccurate. Just as there are smart and dedicated neurosurgeons there are those who are the opposite. And some of the smartest, most dedicated, and knowledgable physicians you will meet will be generalists.

If you really need more of an essay, realize that for the patients you described, the general practitioners will bear far more of the burden and make far more of a difference (as you are dealing with someone with chronic disabilities and related issues) than someone who does a 1-2 hour procedure and has a follow up clinic visit to check the wound two weeks later. For other situations, it's different. That's why you can't generalize so much. Of course many graduates who end up in primary care have aspirations for something else, but that doesn't even come close to meaning that the majority do.

 

[mlw03]

I see you've been brainwashed like so many before us.

Let me tell you about my day: I'm on Neurosurgery, we did two VP shunt placements and two cranioplasties. All four guys were Iraq vets with battle injuries. The VP shunts will prevent hydrocephalus recurrence and hopefully get them to wake up. The other two will let the guys walk around without a helmet, and hopefully reverse some of their neuro deficits. That's one day's worth of work.

Tell me what the GP saw in clinic today that made that kind of impact on someone's life?

please come down off that surgeon's high horse. surgeons can make an immediate difference, primary care docs make a difference in the long run that's just as important. WE'RE ALL important. the pediatrician who gave 25 kids vaccinations today made a difference. the FP who managed 25 cases of diabetes made a difference. the psychiatrist who helps the bipolar patient function in society made a difference. do i need to go on? what you wrote contributes to why there seems to be so much anger between medicine and surgery, and for what purpose? i know you were just responding to someone else's post (which i happen to disagree with - people should go into what they enjoy most, period. the idea that top students should do a primary care is just as silly as they should do ortho just because they can).

and this is all written by someone who's going into pathology... and i think we're important too, damnit.

 

[Faebinder]

I see you've been brainwashed like so many before us.

Let me tell you about my day: I'm on Neurosurgery, we did two VP shunt placements and two cranioplasties. All four guys were Iraq vets with battle injuries. The VP shunts will prevent hydrocephalus recurrence and hopefully get them to wake up. The other two will let the guys walk around without a helmet, and hopefully reverse some of their neuro deficits. That's one day's worth of work.

Tell me what the GP saw in clinic today that made that kind of impact on someone's life?

Sheesh.. are you listening to yourself? Truly? I suppose if a GP saw 50 people that day. Adjusted insulin on at least 4 people and gave beta blockers to another 4... well he saved the lives of 8 out of 50 right there who could have ended up with an MI and possibly die. From my angle, the GP impacted 50 people in that one day.... How many of you bad asses did it take to save 4 people and how long did it take you? No wonder neurology is picking up on intraventional procedures. Maybe we can get some efficiency improvement.

 

[colbgw02]

It would be helpful, at least to me, if we started using more correct terminology. A general practioner and a primary care physician are not synonymous.

I agree with the others. The numbers just don't pan out in favor of the surgeons. You improve mortality and morbidity a lot more by controlling cholesterol and blood pressure than you do by shunting someone or doing a CABG. If you extrapolate that further, then we're all far behind the public health folks. Clean water, clean food, and vaccinations have done exponentially more than anything that the rest of us do.

 

[mlw03]

If you extrapolate that further, then we're all far behind the public health folks. Clean water, clean food, and vaccinations have done exponentially more than anything that the rest of us do.

that is absolutey correct. i've heard arguments that santitation programs have done far more to improve the otherall health of people than any doctor ever did, and it's probably true.

this shouldn't be about who does "more" - to the family of the 4 people the neurosurgeon worked on, he's done a ton, and he should be proud of his work. hopefully what they did will help those 4 people. but clearly other docs have a major impact too and to compare them is just silly.

 

[Daisey]

IMG, FMG, US grad - who gives a $#!%!!! It all boils down to the same thing. Any medical grad whether they are foreign or American who wants to work in the US will land a residency. And any doc working in the US in any particular field, regardless of where their degree is from, does the same job, works the same hours, and makes the same money. Its just a difference of taking the usual path or the unbeaten path to get where they want to go. I've yet to know a patient to ask, "Are you a US grad or a foreign grad?" There are good and bad doctors in every field regardless of where they were schooled.

 

[Bring It On]

do you think I give a "crap" about where this doctor went to medical school?? Some of you need to get "real".....I want to know how many times he has performed this procedure, I look at the STATE MEDICAL BOARD for any law suits againist him and/or complaints....I DON'T CARE WHERE HE WENT TO MEDICAL SCHOOL.....END OF STORY!!! Maybe some of you should be studying.....now😀

 

[Tired]

Sheesh.. are you listening to yourself? Truly? I suppose if a GP saw 50 people that day. Adjusted insulin on at least 4 people and gave beta blockers to another 4... well he saved the lives of 8 out of 50 right there who could have ended up with an MI and possibly die. From my angle, the GP impacted 50 people in that one day.... How many of you bad asses did it take to save 4 people and how long did it take you? No wonder neurology is picking up on intraventional procedures. Maybe we can get some efficiency improvement.

Neat. Which 8 of the 50 did you save? Because statistics aside, I can name the four people who didn't die yesterday because we operated on them. Can you do the same? And of course your "8 of 50" is based off of carefully designed analyses done by the drug companies you serve . . .

All nonsense aside, I'm happy you're impressed with your ability to follow JNC7 guidelines. No wonder the NPs are taking over your turf, since it's all just algorithms and statistics anyway.