IMG/FMG in General Surgery

[Born2baDoctor]

Would it be easy for a FMG to get into a ACGME General Surgery Program if they graduate from a reknowned school such as Oxford in England?

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[Blade28]

The FMG's med school MAY make a tiny difference, all else being the same. However, I think an FMG is still an FMG in many PD's eyes.

 

[johnny_blaze]

Everyone prefers their own “home grown” graduates over FMGs. Think about it if the situation was reversed… would the snobs at oxford really care if you were a U.S grad? Probably not.

(i dont really think oxford if full of snobs... in case anyone gets offended)

 

[Winged Scapula]

Would it be easy for a FMG to get into a ACGME General Surgery Program if they graduate from a reknowned school such as Oxford in England?

Perhaps "easier" would be the appropriate term here. Some institutions in the US, particularly big names and those with lots of international faculty/connections, might be more attracted to the relative prestige that Oxford provides, but I wouldn't count on it being "easy" (for anyone, AMG or FMG).

 

[medisid]

what if the applicant has MRCS???????what r his chances?????
but not an oxford grad.

 

[Winged Scapula]

what if the applicant has MRCS???????what r his chances?????
but not an oxford grad.

Again, I still think you will find it more difficult. Surgery programs have more than enough US grads to fill their spots. While MRCS is prestigious, some programs may still be loathe to take you on as you may be resistant to training in new ways and have Visa issues they'd rather not tackle.

However, you'll never know unless you try, so its worth doing so, IMHO.

 

[chemamr]

if you love surgery, it's your passion and you want to study your residency in U.S.A., then you MUST try it. Approx. 20% of surgery residents in U.S.A. are IMGs, so it can be done.

 

[Blade28]

if you love surgery, it's your passion and you want to study your residency in U.S.A., then you MUST try it. Approx. 20% of surgery residents in U.S.A. are IMGs, so it can be done.

Really? Didn't realize it was so high. Where did you get this number from?

 

[mysophobe]

According to the NRMP, 16.7% of the positions filled were taken by non-US seniors, but that includes US physicians, US foreign grads, foreign grads, Canadian grads, osteopaths, and 5th-pathway. So, how many of those are actually foreign grads?

 

[Blade28]

Yeah, 20% seemed awfully high.

 

[mysophobe]

Maybe we're interpreting his post incorrectly. Perhaps he meant 20% of all surgery positions are filled by IMGs, i.e., pgy-1 to pgy-5, rather than 20% of positions are taken by IMGs each year.

 

[CattleprodSurg]

Obtaining a surgical residency for the truely foreign medical graduate is not easy. You will have to show you are better than locally grown graduates in order to match.
It will be necessary to outshine prospective American students on the interview trail. You will not get nearly as many interviews as your counterparts from the USA even if you have equal or better USMLE scores, better clinical experience or judgement or research and publications.
There is unquestionably a bias against FMGs in surgery and surgical subspecialties.
There are many reasons for this:
1. Part of the unwritten ranking laws of USA residencies is a measure of how few FMGs they accept. This makes the program look more prestigous on cursory examination by prospective students.
2. There may be pressure from above ie. the deans office to favour American graduates.
3. There is justifiable political pressure not to easily accept FMGs in the age of out-sourcing, illegal immigration and local unemployment. Why should a program director give a job to a foreigner when there are usually many qualified local students applying for the position?
4. There are some foreign medical schools that DO produce inferior medical graduates. Knowledge base is weak, they have difficulty making critical decisions and passssing board exams.
5. Many FMGs cannot speak English well and struggle to interact culturally with Americans.
6. Some program directors and Chiarmen have been burned by FMGs in the past and will not hire another unless forced to.

The list continues on and on.

Having said that many well known America surgeons are FMGs themselves from as diverse parts of the world as Australia, Pakistan, the UK, Africa and South America. Most PDs do not consider Canadians as FMGs (my observation in a limited environment). Also there are currently residents in the USA who are indeed FMGs although it is not nearly 20% - that is a laughable statistic.
Although it seems like an uphill battle I encourage any foreigner who is interested in studying in the best surgical educational environment in the world to try come to the USA.
Many of you do not know about the preliminay positions available. These are positions without guarantee of further surgical training after 1-2 years and most Americal graduates would not dream of taking. But for a hungry foreigner these are outstanding opportunities to demonstrate your clinical accumen, work in and American environment and possibly take the spot of an American graduate who drops out. The attrition rate of Surgery residents is in the order of 10 - 20 %. So you have a fair chance of landing a spot somewhere after proving yourself clinically.

There are also research opportunities in surgery where you may be able to make some contacts and work your way into the system.

Finally it is possible to rotate in surgery as a student for a month at a time where you can once more try to show your abilities as a competent physician.

I am proud to be a PGYIII at a well known surgery residency in the USA getting the best training in the world.
I am also a FMG from a country 2 plane flights and 28 hours away from the USA. An immigrant in an American Surgery residency is part of the American dream.

I am willing to advise anyone who is interested in training here. feel free to contact me -
Good luck in you quest - don't give up

 

[Dr. V]

I can second the preliminary route because our program categorically matched a FMG that completed his prelim year here.

I know they ranked him very, very high to assure this because I know of several good quality American grads that ranked the program very high and didn't get a spot here. I have no inside information as to exactly where he was ranked, but I do know those people fell below where they had us ranked meaning the FMG was ranked higher by our program than they were.

Edit: My thoughts are that he was ranked in the top five (we have five spots) so as to ensure his match but I don't know that for a fact.

I realize that it may not "look" as good on paper to future candidates as if they had went ahead and filled with all American grads. However, the fact that they ranked him so high just tells me that he was an excellent intern and they were honorable enough to give him the spot he earned by working hard and proving himself. I'm kinda proud of that fact actually. It confirms my feelings that this is a very stand up program.

I am sure there are programs that would not follow through, but I know of at least one that did.

 

[neutropenic]

When I did my GS rotation, many many of the PGY4s and 5s were IMGs both from foreign lands and US citizens who went to Carib schools, but none of the PGY1s or the incoming class (PGY 0s) were IMGs. We don't have DOs at my school's program, so I would say it's harder for IMGs both of the US-->Carib variety and those who grew up and went to medical school in Kerblackistan these days.

 

[chemamr]

i agree, it's difficult and it's getting harder to get a spot in surgery.
20% is regarding the total number of active residents, no matter which year of residency they are. That's the reason. It was 25% 1-2 years ago, so it's really getting harder. But it's possible, I know several real IMGs who are doing their residency in the states.

 

[Blade28]

I know it's possible - we all know IMGs in G Surg. But 20% just seems very, VERY high.

 

[Pilot Doc]

I know it's possible - we all know IMGs in G Surg. But 20% just seems very, VERY high.

OK - here's the data

Each year, there are around 1050 categorical spots. 850 or so generally match by US Seniors. As a previous poster mentioned - lots of people are neither US Seniors nor IMGs. 20% is the absolute limit on IMG's - presumably the number of foreign-born, foreign-trained, non-citizen, non-native English speaking surgery residents is far less than 20%.

 

[tRmedic21]

OK - here's the data

Each year, there are around 1050 categorical spots. 850 or so generally match by US Seniors. As a previous poster mentioned - lots of people are neither US Seniors nor IMGs. 20% is the absolute limit on IMG's - presumably the number of foreign-born, foreign-trained, non-citizen, non-native English speaking surgery residents is far less than 20%.

So then the "#U.S." column doesn't include DOs?

 

[neutropenic]

So then the "#U.S." column doesn't include DOs?

No in this instance it means U.S. allopathic seniors. DOs are "independent candidates" like IMGs.

http://residency.wustl.edu/

is an interesting source of info.

US MATCH STATISTICS

Competitiveness(*)

2006 : High
2005 : High
2004 : High
2003 : High

Competitiveness is based on the percentage of U.S. seniors who match in each specialty.

2006 2005 2004 2003
# Categorical/ Advanced positions available for U.S. Seniors 1047 1051 1004 1049
% U.S. Seniors matched* 74 84 *81 *82
# Unfilled Categorical/ Advanced Positions 1 7 2 9
#Unmatched U.S. seniors 300 139 201 175



; Over 80% of U.S. seniors ranking general surgery programs ranked ONLY this specialty. From the published National Residency Matching Program statistics, and additional data provided by the NRMP

 

[Leukocyte]

Competitiveness(*)

2006 : High
2005 : High
2004 : High
2003 : High

Competitiveness is based on the percentage of U.S. seniors who match in each specialty.

2006 2005 2004 2003
# Categorical/ Advanced positions available for U.S. Seniors 1047 1051 1004 1049
% U.S. Seniors matched* 74 84 *81 *82
# Unfilled Categorical/ Advanced Positions 1 7 2 9
#Unmatched U.S. seniors 300 139 201 175

Yep, the good old 2003. "Black 2003" for all of us surgey wanting FMGs. Was it not 2003 the year they began enforcing the working hours rule? 🙁

 

[SeanpMD]

Obtaining a surgical residency for the truely foreign medical graduate is not easy. You will have to show you are better than locally grown graduates in order to match.
It will be necessary to outshine prospective American students on the interview trail. You will not get nearly as many interviews as your counterparts from the USA even if you have equal or better USMLE scores, better clinical experience or judgement or research and publications.
There is unquestionably a bias against FMGs in surgery and surgical subspecialties.
There are many reasons for this:
1. Part of the unwritten ranking laws of USA residencies is a measure of how few FMGs they accept. This makes the program look more prestigous on cursory examination by prospective students.
2. There may be pressure from above ie. the deans office to favour American graduates.
3. There is justifiable political pressure not to easily accept FMGs in the age of out-sourcing, illegal immigration and local unemployment. Why should a program director give a job to a foreigner when there are usually many qualified local students applying for the position?
4. There are some foreign medical schools that DO produce inferior medical graduates. Knowledge base is weak, they have difficulty making critical decisions and passssing board exams.
5. Many FMGs cannot speak English well and struggle to interact culturally with Americans.
6. Some program directors and Chiarmen have been burned by FMGs in the past and will not hire another unless forced to.

The list continues on and on.

Having said that many well known America surgeons are FMGs themselves from as diverse parts of the world as Australia, Pakistan, the UK, Africa and South America. Most PDs do not consider Canadians as FMGs (my observation in a limited environment). Also there are currently residents in the USA who are indeed FMGs although it is not nearly 20% - that is a laughable statistic.
Although it seems like an uphill battle I encourage any foreigner who is interested in studying in the best surgical educational environment in the world to try come to the USA.
Many of you do not know about the preliminay positions available. These are positions without guarantee of further surgical training after 1-2 years and most Americal graduates would not dream of taking. But for a hungry foreigner these are outstanding opportunities to demonstrate your clinical accumen, work in and American environment and possibly take the spot of an American graduate who drops out. The attrition rate of Surgery residents is in the order of 10 - 20 %. So you have a fair chance of landing a spot somewhere after proving yourself clinically.

There are also research opportunities in surgery where you may be able to make some contacts and work your way into the system.

Finally it is possible to rotate in surgery as a student for a month at a time where you can once more try to show your abilities as a competent physician.

I am proud to be a PGYIII at a well known surgery residency in the USA getting the best training in the world.
I am also a FMG from a country 2 plane flights and 28 hours away from the USA. An immigrant in an American Surgery residency is part of the American dream.

I am willing to advise anyone who is interested in training here. feel free to contact me -
Good luck in you quest - don't give up

THX FOR THE VERY INFORMATIVE AND DETAILED INFO.

 

[M.Furfur]

.

 

[driedcaribou]

I haven't gone through the application process yet but from my observations, I would like to say that the Americans are actually quite justified to discriminate against those who have went to medical school overseas.

The quality of medical schools varies quite a bit and what you learn as a student and what you experience is different.

For example, the American and Canadian medical students are truly immersed in medicine because they are on-call etc. You may not find that in many other countries in the world.

Also, it's hard for US program directors to know what they're getting when they sign up people if they've come from another country based on paper alone.
They don't know your personality. You could be a genius on paper but a real bastard at work. You'd antagonize all the staff and make life difficult for everyone.

That's all I really wanted to say without going into a huge rant.

 

[Winged Scapula]

While it doesn't include stats, the September 5 issue of JAMA is their annual GME issue and has tables on applicants, those accepted by specialty and whether AMG or FMG. You might find it interesting.

 

[Winged Scapula]

Awesome, however, does AMG include DOs? If so, it won't matter as you won't be able to see the breakdown.

I don't think so...I think its divided by US allopathic grads, US osteo and non-US grads. But that's from memory...I haven't looked at the tables recently. There are separate tables based on citizenship status as well. I tried to log in and check but for some reason the JAMA server is down.

There's a discussion about the issue and what it contains in the Caribbean forum...you might find that interesting. Here's the link: http://forums.studentdoctor.net/showthread.php?t=445600