Internship with IMG's

[Lobo]

Hi everyone,

As an IMG who is also waiting for the MATCH, I would like to know your most honest opinion about the participation of IMG's in U.S. residency programs. Please, feel free to express your thoughts about the advantages and disadventages of sharing the work with peolple from different cultures and languages. I am really curious about how U.S. grads see us and what I should expect from the working environment in a standard program. I will appreciate your, thoughts.


GL to all of us

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[dkwyler94]

Hi everyone,

As an IMG who is also waiting for the MATCH, I would like to know your most honest opinion about the participation of IMG's in U.S. residency programs. Please, feel free to express your thoughts about the advantages and disadventages of sharing the work with peolple from different cultures and languages. I am really curious about how U.S. grads see us and what I should expect from the working environment in a standard program. I will appreciate your, thoughts.


GL to all of us

I'll give you my opinion first, and then try to say what I have seen from people on this forum.
My opinion is it is great to have some IMG's in rotations. I will start IM this fall, and would have to problem if there were some in the program. I believe the diversity in culture and perceptions to medical care is an advantage to everyone involved. Also, I have found many IMG's with whom I have worked in medical school are really top notch. Many were some of the best from their countries, one I interviewed with had been an attending for 5 years. It makes the rest of us kinda' look bad.

I do think some have negative opinions toward IMG's. Some insecure med students will not apply to a program with IMG's. Some insecure residency programs brag that their program is 100% US MD's (ex. UofColorado). To some extent, I believe this is because some programs have have a hard time filling, and use IMGs to fill. As such, when a program has many IMG's in may be perceived as weaker for this reason. I'll admit, I was hesitant on the interview trail when I interviewed and found I was the only US citizen of the entire group.

That is my thoughts

 

[Kate D]

As such, when a program has many IMG's in may be perceived as weaker for this reason. I'll admit, I was hesitant on the interview trail when I interviewed and found I was the only US citizen of the entire group.

That is my thoughts

Here's a funny thing... I'm an IMG and had the same thoughts when I saw that I was surrounded by IMGs on an interview day. How crazy is that? I guess we all want the same things - a quality program that will teach us what we need to know to be good doctors.

 

[pretzel]

Awesome that IMGs are in the U.S. match, and really looking forward to working with any. Pros -- IMGs are very experienced, since I guess Europeans, Australians become attendings in their mid-20s (no 4-year college before med school like in the U.S. -- we are OLD when we become attendings), so would be great to go to for help.

Cons -- rarely, have gotten some European attitude about how lacking in depth and culture and worldliness Americans are, how materialistic we are, and how our health care system doesn't work like it does in European countries. I actually agree with several of these affronts, so my problem is not that I disagree -- there is a weakness to every strength. My problem is that if an IMG does not like the U.S., I don't know why he took a top spot that a U.S. M4 would have really liked. If I took a top spot from a European program, the last thing I would do is badmouth Europeans in any way.

I emphasize that the negative attitude is rare, but I have run across it both on the floors and in the lab from enough people that I comment on it.

 

[Lobo]

I'll give you my opinion first, and then try to say what I have seen from people on this forum.
My opinion is it is great to have some IMG's in rotations. I will start IM this fall, and would have to problem if there were some in the program. I believe the diversity in culture and perceptions to medical care is an advantage to everyone involved. Also, I have found many IMG's with whom I have worked in medical school are really top notch. Many were some of the best from their countries, one I interviewed with had been an attending for 5 years. It makes the rest of us kinda' look bad.

I do think some have negative opinions toward IMG's. Some insecure med students will not apply to a program with IMG's. Some insecure residency programs brag that their program is 100% US MD's (ex. UofColorado). To some extent, I believe this is because some programs have have a hard time filling, and use IMGs to fill. As such, when a program has many IMG's in may be perceived as weaker for this reason. I'll admit, I was hesitant on the interview trail when I interviewed and found I was the only US citizen of the entire group.

That is my thoughts

dkwyler94,

Thanks for your honest comments. I had a similar impression during the interview season about programs with many IMG's. I believe the problem with those programs is not the IMG's themselves, but the fact that the program cannot fill all the spots without calling them. I have spoken to a lot of people from other countries in the interview days. Some of them, like me, have been living here for a while, and some are just coming form abroad. I think that IMG's in general want to enter the system so badly, that they will accept going anywhere after making the hard decision to leave their countries. That might explain why some weak programs fill their spots with us.

Anyway, I think everybody wins when we are able to share experiences.

10 days and counting down...

 

[CityIvy]

i've worked with IMG's in both university programs and community programs and i have to say that it is like night and day. i was very impressed with the IMG residents from the university program. many of them had amazing physical exam skills that a lot of U.S. graduates don't utilize and take for granted b/c of the accessibility and availability of technology. however, i have found many of the community hospital IMG residents to be subpar. often times, the attendings felt like they had to spend more time teaching the residents when they would rather be teaching the students. that being said, though, i would have no problems working with an IMG resident provided that this person is competent and knowledgable. i've learned not to underestimate someone simply b/c he/she is an IMG. a lot of them are really great doctors!

 

[DocYak]

My two cents--I've worked with several fine IMG attendings and several mediocre ones, which I can also say about US school grads. I did, however, have multiple attendings advise me to be wary of programs with lots of IMGs, because in their experiences, many had visa problems that led to more work being shifted onto residents without visa problems. Perhaps this has changed with the work limits, et cetera.

 

[germanIMG]

My two cents--I've worked with several fine IMG attendings and several mediocre ones, which I can also say about US school grads. I did, however, have multiple attendings advise me to be wary of programs with lots of IMGs, because in their experiences, many had visa problems that led to more work being shifted onto residents without visa problems. Perhaps this has changed with the work limits, et cetera.

not sure if I understand how the respective visa status of a resident is affecting his/hers workload.
No IMG can enter residency with at least a J1 for the duration of his training. So there shouldn't be any issues whatsoever. Sounds more like a child horrorstory. Sorry.
It underlines though a general perception, that programs with high numbers of IMG are less competive and desirable. So much, that even IMGs themselves share this notion.
In the end it boils down to a very simple statement: There are good and capable MDs and there are not so good, less capable ones. One would be hard pressed to find any significant correlation between capabilities and nationality, as much as this is also true for different schools in the US.

What does effect the interaction between an IMG and an AMG in a given residency, and to some degree explains the reluctance towards IMGs, is:

1. the language barrier
2. the medical terminology or jargon barrier... we first have to get used to all these acronyms
3. unfamilarity with the US Health system
4. cultural barrier...makes it sometimes difficlut to bond with an IMG from a less familiar cultural background

2-3 should only be a problem in the first half of intern year

 

[irlandesa]

agree with most of the above sentiments; some of the very best residents I've worked with are IMG's, and I was VERY impressed with those I met at UMass (a very FMG friendly program that ended up in my top 3; I'm a US allopathic grad-to-be). I think that problems betwen MD, DO's, and FMG residents tend to be more prevalent for residents who are in the minority group at a given program. For example, I felt a little isolated at one interview where I was essentially the only allopathic student there, and I have no doubt the opposite situation can be true at other programs; cliquishness is going to exist no matter where you go. I've run into a few unfortunate USIMG's and DO' residents who feel the need to go on the defensive about how they are just as good, if not better than the snooty allopaths and/or lie about their educational background. Like the person who mentioned the disparaging remarks European grads made about US doctors, I don't really understand why such individuals want to go to a well-respected university affiliated program if they dislike the presumed MD snobbery so much. In the past I definitely had some negative attitudes toward IMG's b/c I heard horror stories about mean IMG's at one of our school's affiliates, but fortunately, have had other experiences to counteract that since then..

 

[Lobo]

agree with most of the above sentiments; some of the very best residents I've worked with are IMG's, and I was VERY impressed with those I met at UMass (a very FMG friendly program that ended up in my top 3; I'm a US allopathic grad-to-be). I think that problems betwen MD, DO's, and FMG residents tend to be more prevalent for residents who are in the minority group at a given program. For example, I felt a little isolated at one interview where I was essentially the only allopathic student there, and I have no doubt the opposite situation can be true at other programs; cliquishness is going to exist no matter where you go. I've run into a few unfortunate USIMG's and DO' residents who feel the need to go on the defensive about how they are just as good, if not better than the snooty allopaths and/or lie about their educational background. Like the person who mentioned the disparaging remarks European grads made about US doctors, I don't really understand why such individuals want to go to a well-respected university affiliated program if they dislike the presumed MD snobbery so much. In the past I definitely had some negative attitudes toward IMG's b/c I heard horror stories about mean IMG's at one of our school's affiliates, but fortunately, have had other experiences to counteract that since then..

I agree with the fact that no matter the nationality, there will be always well skilled and not so well skilled doctors and residents. It sounds also rude to me having someone coming from another country who spends most of the time in a bad mood and complaining about the negative aspects of medicine as a foreign. My real concern is that when IMG's get into busy programs, they have to deal with the linguistic barriers mentioned by IMGgerman, including the jargons, the new system, and at the same time get the work done in a way they can learn something. Intuitively, it is very challenging to do that in a not friendly environment. That said, US grads should not pay the price for the extra work caused by someone who is going very slowly upwards the learning curve.

I just hope that our adaptation period goes as smoothly as possible and does not harm our enthusiasm. Obviously, it depends enormously on each one's motivations.

Lobo

 

[stephew]

just so all you US med grads keep looking smart as you are:an IMG is a US citizen who's gone to a foreign med school, like me. An FMG is a non-Us citizen who's gone to a non-US med school (usually in their home country). Frequently used interchangably and incorrectly.

What happens is that once you hit the floors no one cares where youre from. Do a good job and they like you. Do a poor job and god help you. Nothing is worse that a doc who doesnt pull his weight

Good luck to you all match day. I remember the stress of it all. And pull your weight when you hit the floors.
All the best,
S

 

[shellfish]

just so all you US med grads keep looking smart as you are:an IMG is a US citizen who's gone to a foreign med school, like me. An FMG is a non-Us citizen who's gone to a non-US med school (usually in their home country). Frequently used interchangably and incorrectly.
S

maybe used incorrectly because everyone is told something different? when i started medical school, they told us that IMG was replacing the term FMG as being more politically correct..."foreign" having negative connotations, making the US appear centrist.

 

[sjkpark]

Awesome that IMGs are in the U.S. match, and really looking forward to working with any. Pros -- IMGs are very experienced, since I guess Europeans, Australians become attendings in their mid-20s (no 4-year college before med school like in the U.S. -- we are OLD when we become attendings), so would be great to go to for help.

It is almost impossible for someone in Australia to become an "attending" (called "consultant" in Australasia) in their mid-20s. Australasian specialty training programmes are much longer in duration, with very high fail rates in the fellowship exams. Sure, many people qualify at the age of 23-24, but the shortest specialty programme takes around 7 years. Most people are in their mid-30s to early-40s when they become consultants.

 

[germanIMG]

It is almost impossible for someone in Australia to become an "attending" (called "consultant" in Australasia) in their mid-20s. Australasian specialty training programmes are much longer in duration, with very high fail rates in the fellowship exams. Sure, many people qualify at the age of 23-24, but the shortest specialty programme takes around 7 years. Most people are in their mid-30s to early-40s when they become consultants.

this is actually true as well for most of europe. Exceptions are Russia and to a certain degree England, albeit subspecialty training in Enland is very restricted due to the general practitioner system, and someone who got trained in subspecialty most likely would not enter US residency training.
for example in germany med school is minimum of 6 years ( likely longer depending on your doctoral thesis), IM is another 6 years and subspecialty would be additional 2-3 years. So the youngest attending in Germany would be 31 years without subspecialty and usually you will need that to become attending.
Realistically people are between mid 30s to 40, in University setting where research is required, usually around 40

 

[BellKicker]

Awesome that IMGs are in the U.S. match, and really looking forward to working with any. Pros -- IMGs are very experienced, since I guess Europeans, Australians become attendings in their mid-20s (no 4-year college before med school like in the U.S. -- we are OLD when we become attendings), so would be great to go to for help.

Yeah, like the previous two posters have said, the above is incorretc. Especially residency training just takes a lot longer; at least in Northern Europe, where I'm from. Attendings under 40 are actually quite rare in some specialties. I'm in this match cycle and if there's an overwhelming feeling it's that I was always older than the American applicants. It's not really that it takes longer to become a doc over there, but somehow people, including myself, are just a little older. For me, it was a few years traveling, for others it's a change of careers.

As an IMG, I will admit one of the criteria I was looking for in a program was no/few IMGs. I think it would be cool to work with people from different cultures, don't get me wrong, but I just assumed that the programs with fewer IMGs were stronger/more competitive. I asked one PD about it; his program was probably 75% IMG, mostly Caribbean grads. He was honest about it, actually. He said that the reason he had so many IMGs was that he couldn't attract enough AMGs. Ironically, he said the Caribs (they were mostly from Ross) were excellent doctors, often better than the AMGs. What he didn't like was how it looked to applicants, the way the program appeared weak.

 

[pretzel]

All of you would know better than me. The Aussie guy was 26 and had just became an attending before coming to the States, and the two Greek docs were both 27 and had already finished residencies, but wanted to match in U.S. residencies. I don't know details of training in Europe and Australia though. I met one English guy who said that you take your O or A levels at age 16, and then you start in on medicine, if that's what you're destined to do. He said it's earlier than in the U.S., where we go to college for 4 years and then start on career training at 21-22. Maybe I misunderstood, or maybe they were just brilliant. It seems that grads from abroad appear to be unusually talented.

Steph, I thought the term was now IMG as well, not FMG, but I could be very wrong.

By your definition of FMG and IMG, I know this will sound strange, but I might actually question a strong program more if it took a few IMGs every year, as opposed to FMGs.

It is actually very common, that the top medicine programs will take a few FMGs who were remarkably high achieving in their home countries, who have superb USMLE scores, who have already completed a residency, and who have done extensive research (Ph.D.s are not unusual in this cohort) or public health or international health work, often far more than U.S. grads who match at the same place. During any interviews, however, I did not see (in any of the medicine programs' lists of PGY1 through PGY3) one IMG in any roster. I could have missed an IMG on a roster, but I also didn't meet one IMG on the interview trail.

Obviously proven by your experience, IMGs can match at the very top programs in anything, but the stats are greatly in disfavor. As seen repeatedly on this forum, there are many fantastic U.S. grads with impeccable scores and strong publications and letters who are denied even interviews.

I do not judge anyone on paper until I see them in person anyway, so IMG or FMG doesn't matter at all to me. There is always a reason that any IMG or FMG matches well.

 

[sjkpark]

All of you would know better than me. The Aussie guy was 26 and had just became an attending before coming to the States, and the two Greek docs were both 27 and had already finished residencies, but wanted to match in U.S. residencies. I don't know details of training in Europe and Australia though. I met one English guy who said that you take your O or A levels at age 16, and then you start in on medicine, if that's what you're destined to do. He said it's earlier than in the U.S., where we go to college for 4 years and then start on career training at 21-22. Maybe I misunderstood, or maybe they were just brilliant. It seems that grads from abroad appear to be unusually talented.

If that Aussie guy was internal medicine doc, the above scenario implies that he went to med school at age 15 or younger. Well we do have some people who started when they were 16. Most people start between the age of 17 and 19.

If he used the word "attending", that might mean something different, like senior registrar (i.e. passed FRACP Part I). 'Cos we never ever use the word here. Then that scenario is entirely possible.

 

[pretzel]

Oh, see -- I'm not familiar with European or Aussie training so I wrote sloppily. Thanks for teaching me. The Aussie guy had finished his residency. I only assumed that that meant that he could now be an attending like in the U.S., so my fault.

In Australia, if you start at age 16, what is the normal length of training for each stage, what is your title after each stage, and at what point can one independently practice as what Americans call "attendings"?

 

[Apollyon]

If he used the word "attending", that might mean something different, like senior registrar (i.e. passed FRACP Part I).

But I thought a "senior registrar" is still an house officer - still in training, even if this is the whole career. In other words, "senior registrar" still isn't "consultant". Or, is the "senior registrar" like a "junior consultant"? The question is, is the senior registrar independent, or does s/he have a consultant boss over them?

 

[BellKicker]

All of you would know better than me. The Aussie guy was 26 and had just became an attending before coming to the States, and the two Greek docs were both 27 and had already finished residencies, but wanted to match in U.S. residencies.

Ok, I was not aware of that. It just goes to show that Europe is far from being a homogenous unity. I was speaking of Scandinavia and there's no doubt that specialization takes a lot longer there than in the US.

 

[sjkpark]

My point was, it is relatively impossible to attain FRACP status (minimum requirement for consultant position: "The Boss") at the age of 26. It is only possible if one went to medical school at age 15, did a 5 year programme (only possible in 2 Australian schools - Newcastle and Monash - rest are 6 years) and went straight into FRACP training, which is 6 years long.

It used to be possible to count PGY1 year towards FRACP training. However, it is no longer possible to go straight into FRACP training after medical school - you need at least 1 year of internship.

But I thought a "senior registrar" is still an house officer - still in training, even if this is the whole career. In other words, "senior registrar" still isn't "consultant". Or, is the "senior registrar" like a "junior consultant"? The question is, is the senior registrar independent, or does s/he have a consultant boss over them?

Yes you are right. Senior registrar, at least in New Zealand, means that they passed FRACP Part I exam, which is sat in the 3rd year of FRACP training, (with relatively high fail rate), and is in their advanced training (usually subspecialty, although you can "subspecialise" in general internal medicine).

And you have to be careful when using the word "house officer." In Australasia, house officer means that they are junior medical officers not yet in training programme. In New Zealand people are usually "house officers" for 2 years then they go into training programmes, in which point they become "registrars".

Registrars have consultant boss over them, although they run the hospital. Consultants usually have some private patient load and/or university teaching committments.

I just wanted to point out that:
1) It is VERY VERY rare to become a consultant at the age of 26. They have to be considered a child prodigy.
2) Although in UK/Australasia we go to medical school straight after school, that doesn't mean that we become consultants any earlier than our NA counterparts.

I'll be graduating at the age of 25. Man, I'm old.

 

[BellKicker]

I'll be graduating at the age of 25. Man, I'm old.

I guess I'm museum material, then.