Large hospital full of IMG’s

[notEinstein]

Hi everyone. I’m not a resident but I was asked not to post this in the pre-med forum so I’m asking my question here

I was doing some research and noticed that a 500+ bed hospital near me is nearly exclusively staffed by IMG residents. I was under the impression that match rates are significantly more difficult with IMG, but but this hospital appears to have 90% of their resident staff as IMG’s.

Is this abnormal or am I wrong?

https://education.rochesterregional.org/residencies/rgh-internal/current-residents/

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[GoSpursGo]

It is hard to match as an IMG. That said, there are some “workhorse” programs which are generally not attractive to US MD/DO grads but will take some of the passable IMGs.

It still is relatively difficult for an IMG to match, but when they succeed they often wind up at a program like that

 

[notEinstein]

It is hard to match as an IMG. That said, there are some “workhorse” programs which are generally not attractive to US MD/DO grads but will take some of the passable IMGs.

It still is relatively difficult for an IMG to match, but when they succeed they often wind up at a program like that

Ahh, thank you!

 

[comp1]

It's abnormal yes, but not exactly rare. I always assumed the IMGs who did match were going to generally be concentrated at high rates in specific facilities as opposed to randomly sprinkled everywhere. Taking IMGs can be an administrative headache, not all are US citizens and even if they are, licensure issues are more complicated. It's a lot easier to manage the visa and other issues if you do it all the time than if you just happen to want to do it for that one special applicant.

 

[Spikebd]

This is likely a troll post, but I’m bored.

These types of programs should be closed. They’re almost always concentrated in NY/NJ/PA/OH, and are generally considered poor training programs. The people running these programs are pimps and they use these desperate IMGs as scut workers, but the IMGs get a US residency slot so they suck it up. It’s not the IMGs fault, it’s the system that lets these scummy northeastern programs suck the GME money dry.

 

[Spikebd]

It's abnormal yes, but not exactly rare. I always assumed the IMGs who did match were going to generally be concentrated at high rates in specific facilities as opposed to randomly sprinkled everywhere. Taking IMGs can be an administrative headache, not all are US citizens and even if they are, licensure issues are more complicated. It's a lot easier to manage the visa and other issues if you do it all the time than if you just happen to want to do it for that one special applicant.

I’d never go to a hospital like this as a patient unless I had no other choice. This type of setup is a disservice to that local community.

 

[dozitgetchahi]

This is likely a troll post, but I’m bored.

These types of programs should be closed. They’re almost always concentrated in NY/NJ/PA/OH, and are generally considered poor training programs. The people running these programs are pimps and they use these desperate IMGs as scut workers, but the IMGs get a US residency slot so they suck it up. It’s not the IMGs fault, it’s the system that lets these scummy northeastern programs suck the GME money dry.

I agree.

The big problem with these “sweatshop” programs is that they often provide little to no “education”. They take IMGs who have trained elsewhere and use them as cheap physician labor. They don’t really teach much. They work the daylights out of the residents. Wash, rinse, repeat. I agree that they are a blight on the US GME landscape and that most of them should be shut down.

 

[Spikebd]

I agree.

The big problem with these “sweatshop” programs is that they often provide little to no “education”. They take IMGs who have trained elsewhere and use them as cheap physician labor. They don’t really teach much. They work the daylights out of the residents. Wash, rinse, repeat. I agree that they are a blight on the US GME landscape and that most of them should be shut down.

honestly this program director clearly discriminates against US citizens. A roster of essentially 100% IMGs is likely discrimination against USMDs and DOs. I’d support an investigation into the program by the ACGME.

I’m NOT blaming these residents, it’s not their fault. The system just shouldn’t allow for this type of situation to occur.

 

[operaman]

Just looked at the list and almost none of these are IMGs. These are what are generally characterized as FMGs (foreign medical grads). FMGs are usually strong students from abroad who go to good medical schools in their home country and want to gain US licensure so come and train here. IMGs are usually US students who get suckered into paying a Caribbean school $$$$$ and get a substandard education.

Many of the schools listed are extremely good medical schools - one of my co residents at one of the top ENT programs in the country came from one of these schools. I have some friends on faculty at other US schools and a couple I know practicing abroad who trained at some of the others and they’re super sharp people doing high level academic medicine.

Not sure why this program is almost entirely FMG. Does seem likely there may be some degree of exploitation going on, or could be they struggle to find US students to fill the slots. The PD also appears to be an FMG so there’s surely some personal bias as well.

 

[notEinstein]

Just looked at the list and almost none of these are IMGs. These are what are generally characterized as FMGs (foreign medical grads).

I had no idea foreign medical doctors aren’t international. I thought it was all the same.

Is an IMG only when a US citizen goes to a foreign school? And FMG is only when a foreign citizen goes to their own foreign medical school, but then has residency in the US? if so, how can you tell these are not US citizens?

I suppose I should change my question: Is a hospital staffed by exclusively foreign medical graduate residents abnormal?

The weird thing is that this hospital is only 20 minutes from a top 30 medical university, and 1 hour from two state medical universities. You would think they would have more than 1 US resident just by proximity alone.

 

[notEinstein]

This is likely a troll post, but I’m bored.

These types of programs should be closed. They’re almost always concentrated in NY/NJ/PA/OH, and are generally considered poor training programs. The people running these programs are pimps and they use these desperate IMGs as scut workers, but the IMGs get a US residency slot so they suck it up. It’s not the IMGs fault, it’s the system that lets these scummy northeastern programs suck the GME money dry.

I promise it’s not a troll post. The reason I actually asked is because one of the medical universities that I am applying to mentioned that they do some of their rotations through this hospital. Then when I googled the hospital and saw all the residents were IMG’s/FMG’s (including a caribbean school), I realized that I had never seen anything like it in all of my other research.

 

[dozitgetchahi]

Just looked at the list and almost none of these are IMGs. These are what are generally characterized as FMGs (foreign medical grads). FMGs are usually strong students from abroad who go to good medical schools in their home country and want to gain US licensure so come and train here. IMGs are usually US students who get suckered into paying a Caribbean school $$$$$ and get a substandard education.

Many of the schools listed are extremely good medical schools - one of my co residents at one of the top ENT programs in the country came from one of these schools. I have some friends on faculty at other US schools and a couple I know practicing abroad who trained at some of the others and they’re super sharp people doing high level academic medicine.

Not sure why this program is almost entirely FMG. Does seem likely there may be some degree of exploitation going on, or could be they struggle to find US students to fill the slots. The PD also appears to be an FMG so there’s surely some personal bias as well.

Doesn’t change my point in the slightest. These types of programs pick up graduates who didn’t train in the US. FMG, IMG, Carib or not. Whatever. It’s generally the same vibes and the same “sweatshop” environment and the same blight on GME. In fact, most of these types of programs focus on true “FMGs” who are on visas because they are more vulnerable.

The fact that there are a few “top notch” FMGs who match at good places and do “high level medicine” doesn’t invalidate anything stated above. Most FMGs that train in the US aren’t going to those places.

 

[dozitgetchahi]

I had no idea foreign medical doctors aren’t international. I thought it was all the same.

Is an IMG only when a US citizen goes to a foreign school? And FMG is only when a foreign citizen goes to their own foreign medical school, but then has residency in the US? if so, how can you tell these are not US citizens?

I suppose I should change my question: Is a hospital staffed by exclusively foreign medical graduate residents abnormal?

The weird thing is that this hospital is only 20 minutes from a top 30 medical university, and 1 hour from two state medical universities. You would think they would have more than 1 US resident just by proximity alone.

As I stated above, calling these people “IMGs” or “FMGs” is basically a distinction without a difference in these situations. Both of these types of graduates tend to match into the same types of crappy programs in the US.

The answer to why no local US MD/DO graduates can be found at this program is likely that everyone at those schools knows this program sucks, and won’t touch it with a 10 foot pole. (For specialties like FM or IM, a rough but imperfect way to gauge program quality is to see how many FMGs they’re matching. If a program is almost entirely composed of FMGs, that is not a good sign.) It’s not not “abnormal” to find a hospital that is almost entirely staffed by these types of graduates. It just means that it is likely a bad program, without much teaching, with an emphasis on using residents to do ****loads of scut work because they’re cheap labor. (It is not the kind of program you want to match to someday, if that’s the question behind your question.)

 

[notEinstein]

(It is not the kind of program you want to match to someday, if that’s the question behind your question.)

Thank you. This is where I was going with it. I appreciate your answer.

 

[gutonc]

As I stated above, calling these people “IMGs” or “FMGs” is basically a distinction without a difference in these situations. Both of these types of graduates tend to match into the same types of crappy programs in the US.

The answer to why no local US MD/DO graduates can be found at this program is likely that everyone at those schools knows this program sucks, and won’t touch it with a 10 foot pole. (For specialties like FM or IM, a rough but imperfect way to gauge program quality is to see how many FMGs they’re matching. If a program is almost entirely composed of FMGs, that is not a good sign.) It’s not not “abnormal” to find a hospital that is almost entirely staffed by these types of graduates. It just means that it is likely a bad program, without much teaching, with an emphasis on using residents to do ****loads of scut work because they’re cheap labor. (It is not the kind of program you want to match to someday, if that’s the question behind your question.)

No disagreement here but I will add on that places like this tend to be pretty great places to be a med student for clinical rotations. My US MD school was a hospital like this (although it was shifting as I left from 5-10% US grads as IM residents to 30-40%) and most of the other hospitals we rotated in were even more IMG/FMG heavy for their residents, many of them exclusively so. What was great about this as a student was a huge amount of autonomy and the ability to do a lot more than at many other places. By the time I finished M4, I'd put in more A-lines and central lines than I ever did as a resident, done fracture reductions in the ED, put in chest tubes in the SICU and a bunch of thoras and paras. I had way more procedures as a med student in a place like this than I did as a resident in an almost exclusively US grade mid-tier academic IM program.

So while I do think these can be miserable places to be a resident, they are often pretty awesome places to be a med student.

 

[operaman]

I had no idea foreign medical doctors aren’t international. I thought it was all the same.

Is an IMG only when a US citizen goes to a foreign school? And FMG is only when a foreign citizen goes to their own foreign medical school, but then has residency in the US? if so, how can you tell these are not US citizens?

I suppose I should change my question: Is a hospital staffed by exclusively foreign medical graduate residents abnormal?

The weird thing is that this hospital is only 20 minutes from a top 30 medical university, and 1 hour from two state medical universities. You would think they would have more than 1 US resident just by proximity alone.

Yeah in my mind they’re quite different. IMGs tend to be the dregs of US students who couldn’t get into med school here and got sucked by Caribbean place. While FMGs went to foreign schools and don’t have the same standard of LCME accreditation and basic minimum teaching standards, many foreign medical schools are actually quite strong. Go to any international meeting and you’ll see tons of docs doing cutting edge work who didn’t study in the US.

Your other question though still holds - a program of almost only FMGs is definitely an anomaly and a major red flag for any applicant with options. Since the PD is an FMG, this one may be partly for personal reasons. But there’s a huge expense in terms of money and paperwork and risk with visa status to have non-citizen FMGs, so it does make you wonder why a program doesn’t match any US MD/DO students.

 

[comp1]

The ethical questions here are interesting. I'm less interested in what are called IMGs above. But if FMG residents were practicing attendings in their home country, they probably SHOULD be more independent and require less further "education," right? These programs would, in a kind of perverse way, be tailored to the needs and abilities of most FMGs, right? Theoretically this is kind of the point of the ACGME milestones project, right? A tightly related issue is the protectionism that is inherent and kind of unique to US graduate medical education. That said, if we ARE going to place FMGs in US residencies, it's not logical to expect them to need the same amount and kind of education as a newly minted US MS4. If we were being logical about this, there would be highly abbreviated FMG programs that focused on US culture and billing issues. I'm not sure that we can really view heavily worked FMGs as bleeding GME education dry. Most likely the FMGs produce a lot more per Medicare dollar than the US grads if these programs are as people above are describing them. Plus, unlike undergrads who come to the US, there is almost no chance the FMGs will go back to their home country to practice after finishing training here. In a way this is kind of like citizenship for military service.

 

[NotAProgDirector]

The distinction between IMG and FMG is largely an SDN phenomenon. In general, IMG refers to US citizens who do not get into US medical schools and attend a foreign school -- usually in the Carib / Aus / Israel (before that pathway was closed). FMG refers to non-US citizens who attend a school in their home country and then come here for residency. Outside of SDN, you'll find the terms used relatively interchangibly.

Painting all programs that have majority IMG/FMG grads as "bad" is unwarranted. I'm certain there are some programs that just exploit residents for grunt work. I am not certain that this is one of them. Measuring program quality is extremely difficult -- and perhaps impossible. There are many highly qualified IMG/FMG physicians in the US.

One way that US students assess program quality is by looking at the number of foreign grads. That metric is certainly flawed. Regardless, once a program has >50% foreign grads, it tends to end up with all foreign grads. PD's discover that interviewing US grads is mostly a waste of time as they match elsewhere (by choice), and they simply stop doing so.

Labeling all IMG's (i.e. US citizens attending foreign medical schools) as "dregs" is likewise unwarranted. Yes, they were unable to get into a US medical school. But the application process to US medical schools is imperfect, and there are more "qualified" people than spots. Top performers out of the Carib do as well, if not better, than US MD's in their clinical and academic work IMHO.

 

[dozitgetchahi]

The ethical questions here are interesting. I'm less interested in what are called IMGs above. But if FMG residents were practicing attendings in their home country, they probably SHOULD be more independent and require less further "education," right? These programs would, in a kind of perverse way, be tailored to the needs and abilities of most FMGs, right? Theoretically this is kind of the point of the ACGME milestones project, right? A tightly related issue is the protectionism that is inherent and kind of unique to US graduate medical education. That said, if we ARE going to place FMGs in US residencies, it's not logical to expect them to need the same amount and kind of education as a newly minted US MS4. If we were being logical about this, there would be highly abbreviated FMG programs that focused on US culture and billing issues. I'm not sure that we can really view heavily worked FMGs as bleeding GME education dry. Most likely the FMGs produce a lot more per Medicare dollar than the US grads if these programs are as people above are describing them. Plus, unlike undergrads who come to the US, there is almost no chance the FMGs will go back to their home country to practice after finishing training here. In a way this is kind of like citizenship for military service.

I don’t agree with a lot of this.

Medical education is not the same everywhere in the world, and you can’t assume that people know what they’re doing just because they completed training somewhere else. I’ve encountered very good “IMG/FMGs”, and very bad ones.

The protectionism exists in US GME because it *should* exist. We should not flood our medical system with foreign doctors (as some states are now trying to do) as that will suppress incomes for US trained doctors who had to take a ****load of loans out to become fully trained physicians. (Actually the whole FMG thing never should have been “a thing” in the US anyway; it happened primarily because the AMA used questionable information to fight against medical school expansion in the 70s and 80s, arguing that there would be a surplus of doctors. Congress realized this was not the case, and established other pathways enabling FMGs being trained in the US. But in reality, we should have expanded our own medical schools and generated an adequate number of own homegrown graduates anyway. These sweatshop places would largely not exist if they did not have FMG labor to pray on.)

Bottom line is that the FMGs are just largely being used as dirt cheap physician labor. Opening up a bunch of “education” slots just so certain cheap ass hospitals can continually use residents to act as cheap pseudo-attendings is ridiculous, and not at all in the spirit of the GME system. And by the way - a not insignificant number of these FMGs DO go back to their home countries after training (I know of at least one in my IM program that did, plus two in my rheumatology fellowship as well, and one of the hospitals I did 4th year med school rotations in had several residents graduate and start working in Canada. I’ve heard of lots of other examples too.) Training people who have no intention of staying in the country is a total loss for stakeholders in the US GME system.

 

[j4pac]

I remember auditioning for a job. They only had one physician overseeing an inpatient hospital, and a part-time IM doc helping. I didn’t love the idea of being on call q2d so I declined. I kid you not…less than three years later said department started a residency program with four seats per year. With those four seats they guarantee four workers when they had difficulty recruiting one physician for the salary of those four residents.

 

[CrispyWonTon]

I’d never go to a hospital like this as a patient unless I had no other choice. This type of setup is a disservice to that local community.

I guess the hospital staffed by independently practicing APRNs will suffice for you.

 

[Socrates25]

These hospitals are definitely dregs. They refuse to hire a phlebotomy team and make the interns do every single blood draw in the hospital. Furthermore these hospitals are very short staffed on nurses, so they force interns to do nursing duties such as patient transport, completing nursing logs for stuff like vitals/IO

 

[the argus]

Geez...lots of ridiculous comments in this thread. Too many to even try and respond to.

You guys realize that >8000 FMG/IMG, whatever you want to call them, get PGY1 spots every year, right? It's almost 25% of the PGY1 work-force on a yearly basis. The vast majority go to programs where they are the most numerous graduate type. Literally hundreds of hospitals.

You can call them sweatshops or whatever condescending term you want, but the reality is that this workforce allows these hospitals to remain open/functioning and provide care to a huge percentage of the US population. Often the poorest and most disenfranchised among us.

You should focus all this negative energy towards fixing this ridiculous healthcare system we have created in the US. We spend more on healthcare than anyone else yet have hospitals closing on a daily basis because they are so broke. We have an undergraduate medical education system who chooses exclusivity over access, who refuses to increase enrollment to meet the needs of our populace, forces thousands of qualified US citizens to go abroad for their medical training every year, and requires the graduate medical system to import thousands of foreign nationals each year.

And then we trash the underfunded and understaffed hospitals who have to employ this foreign-trained workforce, like there is some alternative. Awesome thread...

 

[NewYorkDoctors]

these hospitals are usually serving the poor and underserved areas of large cities. I'm not certain AMGs from top medical schools want to be working in these un-glamorous places.... unless it is Columbia's milstein hospital (to take a NYC example)

the underserved population need doctors too. gotta fill them up somehow.

 

[LucidSplash]

these hospitals are usually serving the poor and underserved areas of large cities. I'm not certain AMGs from top medical schools want to be working in these un-glamorous places.... unless it is Columbia's milstein hospital (to take a NYC example)

the underserved population need doctors too. gotta fill them up somehow.

Source?

 

[NewYorkDoctors]

Source?

lol. this is not a randomized controlled trial.

if it were, then I would get rejected at the first step of the peer review process

anecdotal on the ground working at these hospitals before

but if one were to just google map the various IM residencies in New york city, find their rosters, find IMG / FMG heavy (im just naming some off the top of my head but NYP Brooklyn Methodist, Jamaica Hospital,, Flushing hospital, Harlem Hospital, Lincoln Memorial, Bronx lebanon...) these are usually in lower SES places.

 

[LucidSplash]

lol. this is not a randomized controlled trial.

if it were, then I would get rejected at the first step of the peer review process

anecdotal on the ground working at these hospitals before

but if one were to just google map the various IM residencies in New york city, find their rosters, find IMG / FMG heavy (im just naming some off the top of my head but NYP Brooklyn Methodist, Jamaica Hospital,, Flushing hospital, Harlem Hospital, Lincoln Memorial, Bronx lebanon...) these are usually in lower SES places.


View attachment 390715

I thought you were referring to more than just NYC hospitals. Which would definitely make this untrue. For NYC, still not convinced these are all safety net hospitals.

 

[NewYorkDoctors]

I thought you were referring to more than just NYC hospitals. Which would definitely make this untrue. For NYC, still not convinced these are all safety net hospitals.

right fair enough

anyway i dont disagree with any of the points above. I agree that these are low education "labor" mills

I was merely referring to how if these hospitals and their residents went away, then there would be EVEN worse quality of care in these locations.

I also am aware we need residency spots for the new AMG graduates (in the recent 10-20 years a lot of new AMG med schoools opened up)

but do those AMG graduates really want IM with little chance of fellowship at some inner city run down hospital? i dunno... they all want ortho or something

 

[FrustratedFamDoc]

I was at such a hospital from 2007-2009 for my last 2 years of med school in NYC. The above accounts describe the IM program to a T. The other residency programs were actually pretty good. Surgery residents were from Cornell.

IM residents were worked to death. They were frequently attendings where they came from, but had to start all over when they came here. My intern I was assigned to scutted me bad, having me coming in at 5 am to get all the overnight and morning lab results for his patients. There was a lecture at lunch where a few apple polisher residents would try to stand out with asking “I recently read in an article” questions. I eventually ducked out on that dude. But yes, the interns did their own transport and lab draws.

My very first day of my trauma surgery rotation. I’m already a little nervous since I’ve never even seen a trauma before. 10 am. First. Day.

“Trauma team to the emergency room.” So all of us (students) exchange the holy crap this is real look. We hustle to the trauma bay. My very first patient is the chief resident of the IM program. He jumped off the 8th floor of the parking deck. Scuffed him up a bit. Gen/ortho/neurosurg all working on dude at the same time in the OR. All any of us got to do was make continuous runs to the blood bank. 22 units in total I think.

He miraculously survived but had a completed attempt several months later. Sad.

 

[massive1]

Categorizing these IMG programs as "good" or "bad" is missing the bigger picture.

Once a program has "gone IMG," for other IMGs wanting to come to America, it's a "good program."

They will be around many other trainees like themselves, with similar customs, eating similar foods, etc.

And from their IMG residency, most will be successful in obtaining a fellowship, at an "IMG fellowship" somewhere.

In terms of the actual teaching and learning aspect, is there any residency that does this well?

I think having access to patients with diverse pathology, and your own motivation to learn, is what creates a good physician. It's up to you.

U.S. grads do have the option of an ivory tower residency (where everything is so specialized that they can't do sh1t), or a shot at one of the lifestyle specialties (ophtho, etc).

Speaking as a U.S. grad however, those IMG programs you don't want don't want you either.

They pick the candidates they can relate to, and who they believe will accept every indignity the residency offers rather than crawling back home.

 

[TeddyBoomBoom]

Also… this trickles down (up?) to attending levels also.

Sound Physicians, anyone?

I’m a US DO ED doc partnered in a domestic SDG, but I know a fair number of what sdn would call FMGs that work as hospitalists for Sound Physicians.

Some companies like to traditionally hire docs on visas so they own them. If they quit their job they lose the visa and have to leave the country. Super shady.

In my personal experience, most of these “FMG” docs are great doctors, and I enjoy working with them. But they’re basically hostages.

I would be super hesitant on picking a residency that was super heavy on non-domestic residents, but my concern would be the quality of the residency, not the candidates themselves.