IMG taking residency spots in USA

[studentdoct4281]

why are people who get cheaper education overseas taking residency spots of US educated doctors who have invested into the system. Happens a lot in New York and Florida I’ve noticed. And not just primary care

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[libertyyne]

Because they are the best people for the job. Cost of education has no bearing on residency selection or outcomes.

I would also look at the pubmed pages of the Fmgs/IMGS that are not in primary care.

There are 6+billion people outside of the United States. It is not difficult to imagine that there are many intelligent hard working Fmgs that can outcompete some us medical students.

 

[raiderette]

Did you not like the information you received the last time you posted on this topic?
Foreign trained doctors

 

[MSTP18]

Of the 5% of people who don't match, 2.5% (i.e. 50% of the 5%) could be predicted based on red flags. I'm not really convinced that doctors trained outside the USA are stopping a significant number of worthy American trained doctors from getting into residency.

 

[alprazoslam]

On initial glance I get salty too thinking there are some progs that don’t take like DOs but take foreign grads. But then again I look back and remember some convos I have had with classsmates.


Occasionally FMG are better for the job.

 

[alprazoslam]

why are people who get cheaper education overseas taking residency spots of US educated doctors who have invested into the system. Happens a lot in New York and Florida I’ve noticed. And not just primary care

I heard building a wall around residencies work. FMGs will even pay for it

 

[libertyyne]

On initial glance I get salty too thinking there are some progs that don’t take like DOs but take foreign grads. But then again I look back and remember some convos I have had with classsmates.


Occasionally FMG are better for the job.

Those are sweatshops that abuse hour limits etc for cheap labor, no sane american grad with other options really wants to go there.

 

[DO2015CA]

Those are sweatshops that abuse hour limits etc for cheap labor, no sane american grad with other options really wants to go there.

Depends. For the vast majority of programs yes. But there are some top tier programs that take a FMG because they are truly stunning with publications to back it up.

 

[libertyyne]

Depends. For the vast majority of programs yes. But there are some top tier programs that take a FMG because they are truly stunning which publications to back it up.

We are talking about im programs that are full of FMGs not the occasional FMG rockstar that places at MGH, who are undoubtedly more competitive than a vast majority of applicants.

 

[PhillyMed777]

I would much rather take great fmgs than continue to lower the standards of getting into medicine in this country by flooding the market with endless DO spots. The fmgs I worked with are hard working, dedicated, and dont take anything for granted

 

[DO2015CA]

I would much rather take great fmgs than continue to lower the standards of getting into medicine in this country by flooding the market with endless DO spots. The fmgs I worked with are hard working, dedicated, and dont take anything for granted

Hopefully you’ll have your way and DOs will be absorbed soon enough

 

[DO2015CA]

We are talking about im programs that are full of FMGs not the occasional FMG rockstar that places at MGH, who are undoubtedly more competitive than a vast majority of applicants.

Fair enough. The programs I interviewed at that had a significant amount of FMG/IMG were all at the bottom of my rank list and it had nothing to do with the personnel. There are reasons they fill with International students.

 

[Goro]

why are people who get cheaper education overseas taking residency spots of US educated doctors who have invested into the system. Happens a lot in New York and Florida I’ve noticed. And not just primary care

Because those residencies either can't get US grads into them, or take stellar FMGs (who are different from IMGs)

 

[alprazoslam]

I would much rather take great fmgs than continue to lower the standards of getting into medicine in this country by flooding the market with endless DO spots. The fmgs I worked with are hard working, dedicated, and dont take anything for granted

I agree. Hate to say it but I have yet to meet somebody who does fantastic in med school and barely got into a DO school. Even though some ADCOMS are laughable and I know people that did well in gpa and mcat that got rejected when they should not have but anyone with half a brain should get in somewhere. Much better than the 1/100th brain needed for np school at least

Don’t even get me started on the SMP crowd

 

[PhillyMed777]

Hopefully you’ll have your way and DOs will be absorbed soon enough

We are not "absorbing you." We are limiting and regulating the quality of post graduate training spots, all of which will now be held to acgme standards.
This however, does not stop random low quality DO schools with low admissions criteria to continue to be opened to fill the gap between total applicants and total post graduate spots until it is completely filled up. I am afraid this will hinder more dedicated people from other countries from having any spots at all in the future. Currently #us MD and # DO spots much below the total #pgy1 spots, that is why fmgs can come here.

 

[libertyyne]

We are not "absorbing you." We are limiting and regulating the quality of post graduate training spots, all of which will now be held to acgme standards.
This however, does not stop random low quality DO schools with low admissions criteria to continue to be opened to fill the gap between total applicants and total post graduate spots until it is completely filled up. I am afraid this will hinder more dedicated people from other countries from having any spots at all in the future.

The next call is going to be for residency expansion after the pool gets filled up. I have never contributed to a cause before, but I will spend my hard earned money to oppose any residency expansion efforts that any organization is going to advocate for after the DO schools flood the pool.

 

[PhillyMed777]

The next call is going to be for residency expansion after the pool gets filled up. I have never contributed to a cause before, but I will spend my hard earned money to oppose any residency expansion efforts that any organization is going to advocate for after the DO schools flood the pool.

Seriously whatever happened to standards to get into medical school? I always thought doctors should easily be A students in premed. This shouldn't be the reason they get into medical school, it should just be expected you can easily outcompete swaths of less dedicated party animals in undergrad. Now i personally have seen students who scored in C ranges for core science requirements get into DO schools. Not because they were oppressed but because they frankly didnt care. What kind of message is this sending to 18 yo soon to be premeds?

By contrast the fmgs i work with have dedicated their lives to becoming the best physicians possible. They have overcome mountains of obstacles. They are hungry to show us how talented they are.

 

[DO2015CA]

We are not "absorbing you." We are limiting and regulating the quality of post graduate training spots, all of which will now be held to acgme standards.
This however, does not stop random low quality DO schools with low admissions criteria to continue to be opened to fill the gap between total applicants and total post graduate spots until it is completely filled up. I am afraid this will hinder more dedicated people from other countries from having any spots at all in the future. Currently #us MD and # DO spots much below the total #pgy1 spots, that is why fmgs can come here.

I am not staying that’s on the books as of yet. I am merely reading the writing on the wall. First residency training, then not requiring OMM for AOA certification, combined with DOs caring less and less about being unique. In the next 20-30 years it’s not out of the realm of possibility to take over the DO schools to increase their level of rigor and clinical training.

Edit: a consequence will also slow the DO expansion. If MD accrediting body cares about that right now, idk. But if they ever start to care then there will be a swath of DOs that are all for it.

 

[libertyyne]

I am not staying that’s on the books as of yet. I am merely reading the writing on the wall. First residency training, then not requiring OMM for AOA certification, combined with DOs caring less and less about being unique. In the next 20-30 years it’s not out of the realm of possibility to take over the DO schools to increase their level of rigor and clinical training.

Edit: a consequence will also slow the DO expansion. If MD accrediting body cares about that right now, idk. But if they ever start to care then there will be a swath of DOs that are all for it.

I think the way things are going, it is possible that DO schools will hit a roadblock where step 1 becomes a defacto requirement. This is going to put some quality pressure on DO schools , the same that has been on MD schools from the get go. I strongly suspect Comlex only matches into anything but the least competitive fm programs is going to be a thing of the past. ~1/3 of the DO pool doesnt take step and you dont have to work hard to figure out which quartile of the pool are in this population.
So the problem may sort itself out. Frankly , I am not going to be very empathetic to DO students who wont match if they arent taking step. If it is a quality control measure for MD schools it should serve the same purpose for DO schools.

 

[DO2015CA]

I think the way things are going, it is possible that DO schools will hit a roadblock where step 1 becomes a defacto requirement. This is going to put some quality pressure on DO schools , the same that has been on MD schools from the get go. I strongly suspect Comlex only matches into anything but the least competitive fm programs is going to be a thing of the past. ~1/3 of the DO pool doesnt take step and you dont have to work hard to figure out which quartile of the pool are in this population.
So the problem may sort itself out. Frankly , I am not going to be very empathetic to DO students who wont match if they arent taking step. If it is a quality control measure for MD schools it should serve the same purpose for DO schools.

My thoughts are that if the AOA won’t require OMM sections for board exams then The comlex should not require OMM sections either. This should lead to everyone taking the USMLE regardless of the school and do away with the comlex. That means the cash cow dries up for comlex exam fees, So it becomes hard to believe this will happen.

 

[libertyyne]

My thoughts are that if the AOA won’t require OMM sections for board exams then The comlex should not require OMM sections either. This should lead to everyone taking the USMLE regardless of the school and do away with the comlex. That means the cash cow dries up for comlex exam fees, So it becomes hard to believe this will happen.

They could do step 1 and then just have an exam focused on omm to augment.

 

[jhamaican]

you are aware that they try to balance the scale out by limiting IMG job options after graduation right?

I don't know all the details, but something like 3 years in an "underserved area" such as VA, rural area etc...

 

[Goro]

If you fools don't stop trying to make this into yet another MD vs DO thread , I'll be reporting and getting mods to lock this .

 

[Raryn]

you are aware that they try to balance the scale out by limiting IMG job options after graduation right?

I don't know all the details, but something like 3 years in an "underserved area" such as VA, rural area etc...

No.

IMGs are typically US Citizens who went to school abroad - most commonly in the Carib, but also Mexico in addition to people that went to Eastern Europe, India, wherever because it was cheaper, faster, or just easier to get in.

FMGs are typically non-US citizens who went to school abroad, usually because they went to school in their native countries.

If a non-US citizen or permanent resident does a residency, they must do so on a visa. There's a number of different visa types, but the overwhelming majority who aren't married to a US citizen already do it on a J1 or H1. H1 visas give no restrictions on where the resident can work after completion of training other than their new employer must be able to also sponsor the visa until they can end up with a green card (permanent residency).

J1 visas, which is what you're thinking of, are technically visas without immigration intent. That is, the resident actually certifies that they are coming to the US for training *with the intention of returning to their home country afterwards*. In fact, they're required to physically return to their home country for 2 years after completion of their residency before they can come work in the states.

Obviously, many people on J1 visas have zero desire to move back to their home country for 2 years, so they seek to waive this requirement. The US Government gives them an opportunity to do that - if they agree to work for three years in an underserved community or for the government itself. It gets a little bit complicated by what is designated "underserved" (particularly when the number of spots is limited per state - there's equal number of spots designated for CA as WY, so CA is a lot pickier) and a number of other requirements (such as the home country's government actually having to agree to the waiver of the "go home" requirement).

 

[sella.turcica]

If a non-US citizen or permanent resident does a residency, they must do so on a visa.

You do realize that a permanent resident (green card holder) doesn't need a visa, don't you?

 

[Raryn]

You do realize that a permanent resident (green card holder) doesn't need a visa, don't you?

My fault for the confusing clause, I added permanent resident while editing and didn't realize it wasn't clear.

Consider it "If a non-(US citizen or permanent resident) does a residency"

 

[studentdoct4281]

Just wait until your an attending looking for a job in desirable places. A lot of spots will be filled by them and there won’t be openings. My buddy who’s a gen surgeon explained this to me

 

[sella.turcica]

Just wait until your an attending looking for a job in desirable places. A lot of spots will be filled by them and there won’t be openings. My buddy who’s a gen surgeon explained this to me

Bombed Step 1, huh?

 

[libertyyne]

Just wait until your an attending looking for a job in desirable places. A lot of spots will be filled by them and there won’t be openings. My buddy who’s a gen surgeon explained this to me

What? This makes no sense what so ever. It is not FMGs taking your job in desirable areas. It is ALL other grads, there is a large maldistribution problem of physicians in america where they are densely populated in desirable areas and are scarce in rural underserved areas.

 

[Little Green Mensch]

I'm not worried about hordes of FMGs takin' our jerbs, but if we want to level the playing field, we should explore ways of making American medical education cheaper. I would say that American medical education is substantially more expensive without being that much better than, say, European medical education.

For instance, most countries start students in medical school straight out of high school. You can say all you want about how people need "more time to mature," etc. but the fact of the matter is that these medical students become good doctors, and two years sooner than American med students. Because they don't have to pay for a separate degree before even starting med school, their education costs are lower.

Also, because student loans are infinitely available for medical school, and because people overestimate the likelihood of getting PSLF, there is minimal downward pressure on med school tuition. Doing something to address the rising debt burden of American physicians would be huge.

 

[libertyyne]

I'm not worried about hordes of FMGs takin' our jerbs, but if we want to level the playing field, we should explore ways of making American medical education cheaper. I would say that American medical education is substantially more expensive without being that much better than, say, European medical education.

For instance, most countries start students in medical school straight out of high school. You can say all you want about how people need "more time to mature," etc. but the fact of the matter is that these medical students become good doctors, and two years sooner than American med students. Because they don't have to pay for a separate degree before even starting med school, their education costs are lower.

Also, because student loans are infinitely available for medical school, and because people overestimate the likelihood of getting PSLF, there is minimal downward pressure on med school tuition. Doing something to address the rising debt burden of American physicians would be huge.

They also have a 50/50 shot of landing a residency anywhere. Or their residency training at home doesnt count for anything. I agree that medical education should be cheaper. But nothing is literally stopping you from going to other countries and going to medical school in places like eu, asia, south america or africa.

Cost of medical education has nothing to do with match. Should private school grads be given preference ? How about oos students at state schools?

FMGS literally are disadvantaged culturally, economically, and socially and have a poor shot of landing a residency here. Plus they are for the most part filling unfilled spots .


If US Grads cant compete against the average FMG/IMG it says a lot more about the US grad than it does about the FMG/IMG.

 

[Little Green Mensch]

Cost of medical education has nothing to do with match. Should private school grads be given preference? How about oos students at state schools?

FMGS literally are disadvantaged culturally, economically, and socially and have a poor shot of landing a residency here. Plus they are for the most part filling unfilled spots .


If US Grads cant compete against the average FMG/IMG it says a lot more about the US grad than it does about the FMG/IMG.

I am aware that the deck is stacked against both FMGs and IMGs. Some of this is reasonable, some of it is not.

I'd encourage you to have a little empathy for the American medical students who, after being told that they had a pretty good shot at getting a residency, took on massive amounts of debt only to not match and see a guy who paid tons less for med school get a spot.

The cost of medical education has a lot to do with how catastrophic failing to match can be. If American M.D. grads didn't have quite as much debt, it wouldn't be quite as big a deal. As it is currently, however, you pretty much have to make it through residency to be able to pay off your debts (or be in income-based repayment forever). Student loans aren't dischargeable in bankruptcy.

I don't think every med student should be entitled to a residency spot. No matter the admissions system, there will be some medical students who will not make good doctors. I do think, however, that we should try to make the consequences of failure a little less punishing.

 

[libertyyne]

I am aware that the deck is stacked against both FMGs and IMGs. Some of this is reasonable, some of it is not.

I'd encourage you to have a little empathy for the American medical students who, after being told that they had a pretty good shot at getting a residency, took on massive amounts of debt only to not match and see a guy who paid tons less for med school get a spot.

The cost of medical education has a lot to do with how catastrophic failing to match can be. If American M.D. grads didn't have quite as much debt, it wouldn't be quite as big a deal. As it is currently, however, you pretty much have to make it through residency to be able to pay off your debts (or be in income-based repayment forever). Student loans aren't dischargeable in bankruptcy.

I don't think every med student should be entitled to a residency spot. No matter the admissions system, there will be some medical students who will not make good doctors. I do think, however, that we should try to make the consequences of failure a little less punishing.

94% of us MD grads match, after placement the number is higher. The problem you are stating does not impact a majority of students who have no red flags. No one is entitled to anything in this life, least of all a residency spot. People walk into medical school knowing the risk of not matching, like all things in life there is always a risk of failure. Part of that is people who legit did not match in derm or ortho or other competitive specialties. They knew the risk applying and will be fine in soap. I just dont think we should be catering our system to the lowest common denominator. College costs hundreds of thousands and yet does not guarantee job placement. Medical school has a much higher rate of job placement.


I agree that student loans are problematic , and the cost of education should be controlled. But that really has no bearing on job placement after graduation.

Plus what about IMGS that spend more money compared to the US grad and they fail to match afterwards. Should they also be given preference?

 

[Tozanzibarbymotorcar]

I would much rather take great fmgs than continue to lower the standards of getting into medicine in this country by flooding the market with endless DO spots. The fmgs I worked with are hard working, dedicated, and dont take anything for granted

Hey, just bec we go to a DO school doesn’t mean we didn’t work hard, etc. So no need to be an asshat about that.

I see the need for FMGs and i like the idea of FMGs being able to study here and then go back to make a difference in their countries of origin. There is the argument of tax payer dollars being spent to support FMGs who want to practice here when they are done when we have enough MD/DOs who do not match and put a tremendous burden on our system when they can’t make ends meet. This has been brought up in the past.

 

[libertyyne]

Hey, just bec we go to a DO school doesn’t mean we didn’t work hard, etc. So no need to be an asshat about that.

I see the need for FMGs and i like the idea of FMGs being able to study here and then go back to make a difference in their countries of origin. There is the argument of tax payer dollars being spent to support FMGs who want to practice here when they are done when we have enough MD/DOs who do not match and put a tremendous burden on our system when they can’t make ends meet. This has been brought up in the past.

It is cheaper for taxpayers to import doctors.

 

[Onewhen]

IMGs don't take positions from US grads. Almost all programs give preference to US grads. In order for an IMG to "take" a position from an AMG a scenarior like that is usually the case: IMG has 260s, 30 papers, 4 books, etc while the AMG has failed step exams twice and has mediocre letters of recommendations. Many programs would still give the US preference in such cases believe it or not, which is understandable...there's nothing wrong with caring for your own.

 

[whoknows2012]

Not really. There are a few great programs in NYC that AMGs from my school clamoured to get, but got outright rejections from.

And these programs are a perfect example of PDs that graduated from SGU/Ross/Mexico outright selecting for students from their own Alma mater

Something doesn’t add up there. “Great” programs selecting Caribbean Grads over AMGs. I’d love to know which “great” programs these are and how you have such inside knowledge that said Caribbean grads took those spots

 

[libertyyne]

Not really. There are a few great programs in NYC that AMGs from my school clamoured to get, but got outright rejections from.

And these programs are a perfect example of PDs that graduated from SGU/Ross/Mexico outright selecting for students from their own Alma mater

If you go to a DO school, you shouldnt really be surprised, the northeast is not the friendliest of DO areas. Those places taking FMGs are still sweatshops.

 

[NicMouse64]

If the IMG/FMG can pass STEP 1,2,3 why are we hating on them? They will be better practitioners than any Non-Physician Providers. Some very intelligent and hard working foreign grads want to come to the United States to practice medicine after having successful careers in medicine in other countries. Seems like a net positive for our country to let them come and practice here.

 

[Chibucks15]

If the IMG/FMG can pass STEP 1,2,3 why are we hating on them? They will be better practitioners than any Non-Physician Providers. Some very intelligent and hard working foreign grads want to come to the United States to practice medicine after having successful careers in medicine in other countries. Seems like a net positive for our country to let them come and practice here.

But they took er jobs!!! (south park inflection)

 

[NicMouse64]

But they took er jobs!!! (south park inflection)

That's an interesting counter-argument bro. I'm saying we should welcome FMGs with open arms.

 

[Chibucks15]

That's an interesting counter-argument bro. I'm saying we should welcome FMGs with open arms.

there was tremendous sarcasm there...idk how you missed it. I'm not disagreeing

 

[whoknows2012]

If the IMG/FMG can pass STEP 1,2,3 why are we hating on them? They will be better practitioners than any Non-Physician Providers. Some very intelligent and hard working foreign grads want to come to the United States to practice medicine after having successful careers in medicine in other countries. Seems like a net positive for our country to let them come and practice here.

Bc uninformed medical students fear something they know nothing about.

 

[whoknows2012]

If you go to a DO school, you shouldnt really be surprised, the northeast is not the friendliest of DO areas. Those places taking FMGs are still sweatshops.

If this also became a do vs Caribbean md argument well then that poster is obviously conflating two arguments bc that’s not what the OP intended on the argument being...

 

[alprazoslam]

FMG stole my bike

 

[NicMouse64]

If this also became a do vs Caribbean md argument well then that poster is obviously conflating two arguments bc that’s not what the OP intended on the argument being...

I don't even get the hate against caribbean students. if they can pass boards (which includes CS) then they have proven they have what it takes to practice medicine. The schools are sharks, yes, but at least they (the students) are putting in the effort to be physicians instead of taking the short cut and lobbying for full practice rights like some other professions I will not name. Caribbean grads, DO, FMG, USMD, boards are there for a reason (I hope). The demonization of outside grads and superiority complex over others who have gone to medical school is dumb and unnecessary.

 

[whoknows2012]

I don't even get the hate against caribbean students. if they can pass boards (which includes CS) then they have proven they have what it takes to practice medicine. The schools are sharks, yes, but at least they (the students) are putting in the effort to be physicians instead of taking the short cut and lobbying for full practice rights like some other professions I will not name. Caribbean grads, DO, FMG, USMD, boards are there for a reason (I hope). The demonization of outside grads and superiority complex over others who have gone to medical school is dumb and unnecessary.

Don’t disagree but the previous poster was obviously conflating two arguments

 

[Goro]

If the IMG/FMG can pass STEP 1,2,3 why are we hating on them? They will be better practitioners than any Non-Physician Providers. Some very intelligent and hard working foreign grads want to come to the United States to practice medicine after having successful careers in medicine in other countries. Seems like a net positive for our country to let them come and practice here.

Two different issues. Residencies don't want to deal with the visa issues that FMGs come with.

The pool of US applicants from the Caribbean is viewed differently by Program Directors. The DDx for a Caribbean grad is pretty off-putting: bad judgment, bad advice, egotism, gullibility, overbearing parents, inability to delay gratification, IA's, legal problems, weak research skills, high risk behavior. This is not to say that all of them still have the quality that drew them into this situation. There is just no way to know which ones they are. Some PD's are in a position where they need to, or can afford to take risks too! So, some do get interviews.

Bad grades and scores are the least of the deficits from a PD's standpoint. A strong academic showing in a Caribbean medical school does not erase this stigma. It fact it increases the perception that the reason for the choice was on the above-mentioned list!

Just about everyone from a Caribbean school has one or more of these problems and PDs know it. That's why their grads are the last choice even with a high Step 1 score, except at the sweatshop type programs mentioned above.

 

[afib123]

I don't think there's anything wrong with FMGs in general and in a global world, anyone with skills should be able to practice anywhere.
But there definitely needs to be quality control in what kind of medical schools these applicants come from. There are so many rules that a medical school in the US need to follow in order to pass their LCME accreditation.

Knowing the quality of medical schools in outside countries (being an immigrant myself), I am not too sure people practicing in one of those schools without any quality control should be allowed to practice here just by passing their boards. If passing boards is the only criteria to be able to enter residency, medical school wouldn't need to be so expensive. Everyone can just study from home and spend a year or two on the wards. But there is so much evaluation that is happening in the 3rd and 4th year to make sure students are reaching expectations in their clinical skills and bedside manner before entering medical school.

I am not sure if that kind of rigorous quality control is happening in ALL the students going to medical schools outside of the US. So, I say that FMGs should most definitely be able to practice in the US but should be coming from a medical school that passes some sort of accreditation done by the LCME to see that their standards are at least matching to that of US medical schools.

 

[nimbus]

If passing boards is the only criteria to be able to enter residency, medical school wouldn't need to be so expensive. Everyone can just study from home and spend a year or two on the wards.

Bingo! This is basically true for the preclinical years.