It seems like a lot of US residency spots are filled by foreigners.

[urbanclassic]

Just to start, I have nothing against foreigners, my parents are foreigners and most foreigners I know are extremely hard-working, smart and humble people. But I have noticed that there are a lot of foreign-born and -medically educated residents at my school. What is up with that? Are the Americans not smart/qualified enough to get into US residencies?! Maybe it's just my school?! Any ideas or input?

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[235009]

there are more spots than there are american grads

there are a lot of undesirable spots that american grads don't want and therefore don't apply to. In order to fill those spots those programs turn to foreign grads.

 

[VisionaryTics]

Just to start, I have nothing against foreigners, my parents are foreigners and most foreigners I know are extremely hard-working, smart and humble people. But I have noticed that there are a lot of foreign-born and -medically educated residents at my school. What is up with that? Are the Americans not smart/qualified enough to get into US residencies?! Maybe it's just my school?! Any ideas or input?

Judging by the question, it's your school.

 

[SilverCat]

there are more spots than there are american grads

there are a lot of undesirable spots that american grads don't want and therefore don't apply to. In order to fill those spots those programs turn to foreign grads.

Not necessarily. I know of one urology residency which accepted someone who graduated from a foreign med school. Last I heard, urology was not considered an undesirable residency for American grads.

 

[HatWobble]

Not necessarily. I know of one urology residency which accepted someone who graduated from a foreign med school. Last I heard, urology was not considered an undesirable residency for American grads.

SkinMD's assertion is true, generally. Of course, there will be foreign medical graduates in every specialty. Your n=1 anecdote does not disprove his/her claim.

 

[D elegans]

 

[KinasePro]

Not necessarily. I know of one urology residency which accepted someone who graduated from a foreign med school. Last I heard, urology was not considered an undesirable residency for American grads.

Probably was an already-practicing foreign urologist or surgeon who wanted american licensure and was willing to re-train though the US residency pathway. Not that uncommon, there are a few of these on faculty at my school in other competitive fields like derm, ENT, neurosurg, etc...

 

[Anastomoses]

the match numbers say there are foreigners getting spots but there shouldn't be a disproportionate number of foreigners compared to Americans. Do you just mean you're noticing "a lot of IMGs" or do you mean more IMGs than AMGs?

 

[cheruka]

I met a young rad-onc physician last year who was from a foreign country. His English and communication skills were poor but he must have done real well in academics. Universities and hospitals still accept international grads if they think they are the right candidates and they are worth the gamble. No question.

 

[SilverCat]

SkinMD's assertion is true, generally. Of course, there will be foreign medical graduates in every specialty. Your n=1 anecdote does not disprove his/her claim.

See, I've heard many say what SkinMD says- foreign grads take the places most AMGs don't want. At the same time, I've worked at a school --considered top tier-- with a couple foreign grads as residents. But you never see American IMG grads in these residencies, or even American DO grads. It seems like the hospitals are willing to take foreign- born doctors and train them, but refuses any Americans who are not US MDs. I just feel like it doesn't seem like a level- playing field.

Granted, this is just my observations from working in a couple of hospitals, and I would never try to make sweeping claims based on this. I may very well be wrong.

 

[survivordo]

See, I've heard many say what SkinMD says- foreign grads take the places most AMGs don't want. At the same time, I've worked at a school --considered top tier-- with a couple foreign grads as residents. But you never see American IMG grads in these residencies, or even American DO grads. It seems like the hospitals are willing to take foreign- born doctors and train them, but refuses any Americans who are not US MDs. I just feel like it doesn't seem like a level- playing field.

Granted, this is just my observations from working in a couple of hospitals, and I would never try to make sweeping claims based on this. I may very well be wrong.

This is life, get used to it. Fully utilize every little advantage you have.

Survivor DO

 

[DrSnips]

See, I've heard many say what SkinMD says- foreign grads take the places most AMGs don't want. At the same time, I've worked at a school --considered top tier-- with a couple foreign grads as residents. But you never see American IMG grads in these residencies, or even American DO grads. It seems like the hospitals are willing to take foreign- born doctors and train them, but refuses any Americans who are not US MDs. I just feel like it doesn't seem like a level- playing field.

Granted, this is just my observations from working in a couple of hospitals, and I would never try to make sweeping claims based on this. I may very well be wrong.

If you are seeing foreign IMGs at a top tier program, they are likely top notch applicants with impressive CVs. Foreign IMGs usually trained abroad because that is their home country. American IMGs usually trained abroad because they didn't have the stats to become US MDs. Thus, being an American IMG makes it very difficult to get into a top tier program.

 

[235009]

See, I've heard many say what SkinMD says- foreign grads take the places most AMGs don't want. At the same time, I've worked at a school --considered top tier-- with a couple foreign grads as residents. But you never see American IMG grads in these residencies, or even American DO grads. It seems like the hospitals are willing to take foreign- born doctors and train them, but refuses any Americans who are not US MDs. I just feel like it doesn't seem like a level- playing field.

Granted, this is just my observations from working in a couple of hospitals, and I would never try to make sweeping claims based on this. I may very well be wrong.

to clarify my initial post...

my initial response was a generalization as to why "a lot" of spots are filled by foreigners. the vast majority are taking undesirable spots that US grads don't want.

yes, there are some instances where programs pick foreign grads over US MDs. These foreign grads are typically from a well respected overseas school, are top of their class, sometimes have a PhD. So basically they're highly qualified. There are also instances when some programs prefer these foreign grads to DOs. One example is NYU IM which explicitly states on it's website that they do not consider DOs but has a few residents who are foreign grads.

 

[myhandsarecold]

You probably go to an average med school that don't attract American medical graduates. Our programs make it a point not to take in foreigners and osteopaths due to risk of hurting their reputation. If you browse enough, foreigners tend to take rural, community, primary care spots versus ROAD, metropolitan programs, academic research centers.

Try to transfer to a better school

 

[WilliamsEph]

Seems unethical for a hospital to train a foreigner in any residency when residency training is funded by us citizen tax dollars.

 

[Fox800]

You probably go to an average med school that don't attract American medical graduates. Our programs make it a point not to take in foreigners and osteopaths due to risk of hurting their reputation. If you browse enough, foreigners tend to take rural, community, primary care spots versus ROAD, metropolitan programs, academic research centers.

Try to transfer to a better school

1970's are calling, they want their program director back.

 

[Pons Asinorum]

1970's are calling, they want their program director back.

Freaking hilarious.

 

[Textbookversion]

1970's are calling, they want their program director back.

Best post of the month.

 

[asdf4321]

You probably go to an average med school that don't attract American medical graduates. Our programs make it a point not to take in foreigners and osteopaths due to risk of hurting their reputation. If you browse enough, foreigners tend to take rural, community, primary care spots versus ROAD, metropolitan programs, academic research centers.

Try to transfer to a better school

What an unpleasant person. Where is your program, exactly?

 

[Pons Asinorum]

What an unpleasant person. Where is your program, exactly?

I can not lie - it bugs me when people who aren't in medical school and know nothing of medical school (accepted but not yet matriculated pre-meds) put "Medical Student" as their status and flood the Allo board this time of year. Been said a million times, but I couldn't not.

Back to normal thread operations.

 

[Fox800]

What an unpleasant person. Where is your program, exactly?

Exactly. He/she should enlighten us so we can avoid applying to such a malignant program ran by a d-bag.

 

[zoner]

Exactly. He/she should enlighten us so we can avoid applying to such a malignant program ran by a d-bag.

 

[45408]

Exactly. He/she should enlighten us so we can avoid applying to such a malignant program ran by a d-bag.

Well, take a look at prestigious/competitive specialties/programs and see how many IMGs or DOs you see in their residency programs. The answer is usually: not many, if any at all. You can argue that this shouldn't be how it is, but you'd be wrong to argue that it's not how it is. Exceptions don't break the general rule.

 

[AnthonyBourdain]

Seems unethical for a hospital to train a foreigner in any residency when residency training is funded by us citizen tax dollars.

US citizen med students have paid very little into the tax system and many have cost the government money (subsidized loans in undergrad, attended public schools, etc). As long as the foreign trained docs stay and pay taxes here, they are probably contributing just as much, if not more as us tax wise.

If a IMG out performs me and gets a residency spot I wanted, yeah I'd be mad but more at myself than anyone else. They usually are held to higher standards.

 

[Stellar Clouds]

Maybe it's just at my school, but most of the IMGs I have met (with the exception of those in FM/IM), have completely finished residencies in their home country. They are great to work with because they have the knowledge of an attending, but you get to spend so much more time with them. I'm sure the attendings love them too since they don't have to supervise them as much.

 

[IamaBanana]

Well, take a look at prestigious/competitive specialties/programs and see how many IMGs or DOs you see in their residency programs. The answer is usually: not many, if any at all. You can argue that this shouldn't be how it is, but you'd be wrong to argue that it's not how it is. Exceptions don't break the general rule.

There's a difference between not taking any and stating specifically that you don't accept their applications. As a DO student, I can't get mad when I apply for a spot and get scooped by some top tier MD school grad with the same stats as I. Well, I can get mad but not at the PD. That sucks, but it's the way of the world. What's BS is to say that simply because the applicants are DO or IMG or USIMG they are by rule not up to snuff. A lot of real competitive spots will entertain an application but simply haven't found someone from those categories that is comparable to their regular mix of candidates. Two applicants with 95th percentile USMLE, good clinical grades, research, yaddayadda but one went to JH? I'd take him too. I'm not going to sit here and say that all of us are rockstars and should be snatching top tier spots because we're not (I have the classmates to prove it) but to say that we can't be is poopoo and this lady's PD is a jerk.

 

[mvenus929]

See, I've heard many say what SkinMD says- foreign grads take the places most AMGs don't want. At the same time, I've worked at a school --considered top tier-- with a couple foreign grads as residents. But you never see American IMG grads in these residencies, or even American DO grads. It seems like the hospitals are willing to take foreign- born doctors and train them, but refuses any Americans who are not US MDs. I just feel like it doesn't seem like a level- playing field.

Not saying this is specifically the case at your school, but just to throw another perspective out there... just because a school is a top 30 or whatever doesn't mean all their residency programs are considered 'top-tier'. Just because the IM department is very strong doesn't mean the psych department is, or visa versa. My school has a number of foreign grads in the psych department, but very few in Peds or IM.

As far as it not being a level playing field.. it's not. Some schools are better than others, and some students are better than others. And yes, even some IMGs are better that US grads. Shocking, I know.

Seems unethical for a hospital to train a foreigner in any residency when residency training is funded by us citizen tax dollars.

Why? Medicare provides money to train residents who then treat medicare enrollees. These 'foreigners' then generally stay in the US and work, providing further care to these same people.

 

[Anastomoses]

Ehhh, just be a badass and stop worrying about the other guy. The squeeze isn't that bad that we have to start fighting for spots yet.

 

[Medstart108]

See, I've heard many say what SkinMD says- foreign grads take the places most AMGs don't want. At the same time, I've worked at a school --considered top tier-- with a couple foreign grads as residents. But you never see American IMG grads in these residencies, or even American DO grads. It seems like the hospitals are willing to take foreign- born doctors and train them, but refuses any Americans who are not US MDs. I just feel like it doesn't seem like a level- playing field.

Granted, this is just my observations from working in a couple of hospitals, and I would never try to make sweeping claims based on this. I may very well be wrong.

Hmmm lets see American DOs tend to be people who couldn't get into MD school. So lower on the totem pole. Would you as a residency program director take someone who was top of his class at the best university in his country with Step scores to prove it over someone from DO school with average step scores?

 

[Didierdrogba]

Hmmm lets see American DOs tend to be people who couldn't get into MD school. So lower on the totem pole. Would you as a residency program director take someone who was top of his class at the best university in his country with Step scores to prove it over someone from DO school with average step scores?

Of course if the applicant is exceptional compared to other applicants, yes take the foreigner. But if the American DO and the foreign MD have similar profiles, the PD should take the American 100% of the time, because this is our country, and we should employ/ fulfill the interests of our own citizens first. Keep in mind that on average, foreign MD/ MBBS grads have worse board exam outcomes compared to those of US DO's.

 

[Wordead]

Of course if the applicant is exceptional compared to other applicants, yes take the foreigner. But if the American DO and the foreign MD have similar profiles, the PD should take the American 100% of the time, because this is our country, and we should employ/ fulfill the interests of our own citizens first. Keep in mind that on average, foreign MD/ MBBS grads have worse board exam outcomes compared to those of US DO's.

A lot of the foreign MDs were people that were already practicing in their country. No matter how exceptional a graduating M4 is, they're not going to be better than someone with years of experience. Boards score dont matter in these cases.

Apples to oranges.

 

[Didierdrogba]

A lot of the foreign MDs were people that were already practicing in their country. No matter how exceptional a graduating M4 is, they're not going to be better than someone with years of experience. Boards score dont matter in these cases.

Apples to oranges.

Medstart was talking about step scores and class performance, hence..

Even then, given enough time, the M4 will be experienced eventually right? I dunno, I just think we ought to keep positions filled by Americans if we can.

 

[Wordead]

Medstart was talking about step scores and class performance, hence..

Even then, given enough time, the M4 will be experienced eventually right? I dunno, I just think we ought to keep positions filled by Americans if we can.

Sure, ideally, but if you're a program director, do you pick the guy you know is going to be almost as good as some of your attendings and has a 0% chance of failing or an american just because he's an american?

In the end, the duty is to the patients and to turn out good doctors. Protecting our own is important but probably lower on the priorities list.

And yeah, a M4 will eventually be good, hopefully - though some will have to remediate or fail residency or whatever too. Proven commodity > potential.

 

[Law2Doc]

Maybe it's just at my school, but most of the IMGs I have met (with the exception of those in FM/IM), have completely finished residencies in their home country. They are great to work with because they have the knowledge of an attending, but you get to spend so much more time with them. I'm sure the attendings love them too since they don't have to supervise them as much.

The problem is you can't always take someone trained in one system with certain administrative and patient expectations and cultural norms and just plug them into another system seamlessly. And given the liability risks involved in the US as compared to elsewhere, attendings tend to actually want some level of being in the loop and supervision with their residents, and want them trained "their" way -- what you don't want is to find out th next morning tht there was an issue, nd someone handled something themselves in a way you aren't comfortable with or comfortable defending in court. These foreign grads are sometimes people who do amazingly on tests, but on average from what I've seen, the attendings actually prefer to work with the products of US schools as their training was better geared toward the expectations of US residencies. Yes schools will sometimes take a flyer on someone unbelievably credentialed, and so you will see exmples of such in every specilalty,but don't kid yourself that nationally there is attending demand for more IMGs.

 

[Medstart108]

Of course if the applicant is exceptional compared to other applicants, yes take the foreigner. But if the American DO and the foreign MD have similar profiles, the PD should take the American 100% of the time, because this is our country, and we should employ/ fulfill the interests of our own citizens first. Keep in mind that on average, foreign MD/ MBBS grads have worse board exam outcomes compared to those of US DO's.

I agree. If they have similar profiles then take the American. Its not even just about being American, its the fact that they are likely more familiar with the US system, having done 2 years rotations vs most likely a clinical elective or two.

 

[Anastomoses]

Uhh, whatever. After culling the best options...Interview the candidates and take who feels right. Next.

 

[alamo4]

Seems unethical for a hospital to train a foreigner in any residency when residency training is funded by us citizen tax dollars.

Most people who train in the US stay here, for a whole host of reasons including both better pay and the fact that it is just easier to stay in a particular medical system once licensed and boarded there, so you don't have to repeat any part of residency or take additional exams.

It's a great way for the US to grab the best and brightest from around the world. If anything, it's unethical the other way, with the US "stealing" great medical students who trained in public universities, often from developing countries with physician shortages.

If you're interested in what life as a FMG resident is like, I suggest you read My Own Country by Abraham Verghese. It's a great book for the summer.

http://www.amazon.com/My-Own-Country-Doctors-Story/dp/0679752927

 

[asdf4321]

I can not lie - it bugs me when people who aren't in medical school and know nothing of medical school (accepted but not yet matriculated pre-meds) put "Medical Student" as their status and flood the Allo board this time of year. Been said a million times, but I couldn't not.

Back to normal thread operations.

It's predominantly because I've been accepted and have nothing to do for the next two months besides memorize the internet and pretend like I'm working by having 5-10 applications open at my cubicle at any one time. Don't be so high and mighty. I will flood any forum I see fit and put whatever I want as my status.

 

[Didierdrogba]

I agree. If they have similar profiles then take the American. Its not even just about being American, its the fact that they are likely more familiar with the US system, having done 2 years rotations vs most likely a clinical elective or two.

Oh, btw isn't the whole point of residency programs training new doctors? What's the point of having our tax money pay for "training" someone who isn't even American and knows all the clinical stuff already (unless the foreigner is doing something underserved)? Kinda counter intuitive.

 

[Medstart108]

Oh, btw isn't the whole point of residency programs training new doctors? What's the point of having our tax money pay for "training" someone who isn't even American and knows all the clinical stuff already (unless the foreigner is doing something underserved)? Kinda counter intuitive.

I think the idea is really multifaceted:

1. If the person is returning home - spreading of American medical training, many people take ideas from the US and implement them in their own countries

2. American Dream - maintaining the idea that America is still an immigrant nation and needs/wants the best of everywhere to come to its shores

3. If the person is staying - 20-30 years of being a doctor

I don't know why they make people do residencies if they know all the clinical stuff. I guess its just cheap labor: 50k a year for 80-100 hours per week or 300k a year for 50-60 hours per week

 

[45408]

I don't know why they make people do residencies if they know all the clinical stuff.

Or do they? You don't really know what kind of training they had, since they're not accredited by our governing bodies. I also haven't gotten the impression that they already know everything and are just going through the motions. Some of my IMG colleagues have said that the "American way" is often very different than how it's done in their home country, so there's a lot to re-learn.

 

[Law2Doc]

...
I don't know why they make people do residencies if they know all the clinical stuff. ...

as I mentioned above, IMGs often have good medical knowledge and experience but have almost no advantage clinically functioning in the US system. Medical practice isn't the same everywhere. There are cultural differences. There are patient expectation differences. There are patient right differences. There are differences in professionalism, on expectations on residents. There are legal differences and concepts of "loading the boat" and CYA that are foreign to foreign trained doctors. There are hour differences. There may be a language barrier for some. In many ways they have a much steeper learning curve Than the typical US med school grad. So no, let's not assume "they know all the clinical stuff" just because they were already a clinician elsewhere. Apples and oranges.

 

[Medstart108]

as I mentioned above, IMGs often have good medical knowledge and experience but have almost no advantage clinically functioning in the US system. Medical practice isn't the same everywhere. There are cultural differences. There are patient expectation differences. There are patient right differences. There are differences in professionalism, on expectations on residents. There are legal differences and concepts of "loading the boat" and CYA that are foreign to foreign trained doctors. There are hour differences. There may be a language barrier for some. In many ways they have a much steeper learning curve Than the typical US med school grad. So no, let's not assume "they know all the clinical stuff" just because they were already a clinician elsewhere. Apples and oranges.

Yeah you are right.

 

[cheruka]

Yeah you are right.

I worked with Amercan IMGs who went to overseas and returned because they could not get into US med schools. Most did not have a solid educational background or procedure skills. They did not even attempt to teach because they had such a steep learning curve. IMGs from other countries seem to have the medical knowledge but lack an understanding of the American culture. That is why most of these community hospitals prefer DO students.