let's explore a common theme . . .

[Arctic Char]

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so we all know about the debates and unending posts regarding IMG/FMg's and the stigma attached to MD's from overseas. but one thing that i haven't seen explored is: WHY? india, china, i understand. they simply have a drastically different educational structure. but Germany, the UK, and most notably Israel have excellent medical education (and israel has questionably superior technology than the US).

so why does such a stigma exist, especially considering the USMLE is a generalized barometer of one's knowledge base. is it because of suspicions of an applicant's ability to adjust to a new hosptial system? that is the only thing i can think of. i don't know, i am at a loss.

it reminds of a famous line about religions: why is everything so cool just because its from another country?

likewise, why is someone considered inferior just because they come from another country?

 

[Poety]

so we all know about the debates and unending posts regarding IMG/FMg's and the stigma attached to MD's from overseas. but one thing that i haven't seen explored is: WHY? india, china, i understand. they simply have a drastically different educational structure. but Germany, the UK, and most notably Israel have excellent medical education (and israel has questionably superior technology than the US).

so why does such a stigma exist, especially considering the USMLE is a generalized barometer of one's knowledge base. is it because of suspicions of an applicant's ability to adjust to a new hosptial system? that is the only thing i can think of. i don't know, i am at a loss.

it reminds of a famous line about religions: why is everything so cool just because its from another country?

likewise, why is someone considered inferior just because they come from another country?

I wouldn't say this is the general theme at all institutions. I think in reality we as humans just have an issue accepting things that are different from us, we will always find something or someone to not like or to ostracize. Its quite unfortunate because I think that a lot of FMG's have a very unique perspective they can bring to US medicine. For example, a resident I know trained in the Phillipines and was discussing how there, it is still quite common to keep the mentally ill locked in cages without protection from the elements. What does this offer to our medical society? A perspective on patient care we may not have had (they are pursuing research in this area and getting US grads involved), and a resident that is dedicated to protecting the rights of the mentally ill (both here and overseas). I'm not saying these things can't be found in US grads, but I do think unless you saw this first hand, you'd have no where near the devotion or drive to protect patients rights as this person does.

Its ironic that many medical doctors consider themselves to be so worldly and intellectually driven, yet they can't even see past their own prejudices. I've been guilty of doing it myself at times, but I try to identify when I have issues and address them immediately. I think medicine as a whole should be a more worldly profession, especially since the entire idea is supposed to be to help people as a whole.

This is not to say that I think FMG's should overrun a specific specialty, because here again,whenever you saturate any specialty with one type of trained individual over another, I think you lose diversity. Institutions should seek a balanced program with both FMG's and US grads as long as both are equally qualified. What I think is the saddest occurence is that people think residencies that have a lot of FMG"s or DO's are less competitive or no good -thats just downright insulting to all of the people that hold these degrees but is none-the-less a common idea.

 

[Miklos]

likewise, why is someone considered inferior just because they come from another country?

IMO, primarily because IMGs (in whatever form) are perceived as unwanted competition by many US grads, who feel entitled to "their" residency spot.

[I will merely point out in passing that IMGs very rarely and only under near exceptional circumstances outcompete US grads for competitive spots.]

As for me, I've decided to judge (yes, we all do that, whether we admit it or not) physicians strictly based on their abilities regardless of their "sheepskin".

 

[Arctic Char]

IMGs very rarely and only under near exceptional circumstances outcompete US grads for competitive spots

thats the crux of the question though. yes, thats the trend. but the question is why? are PD's just tunnel-sighted by the familiarity of US transcripts? i'm sure that has a lot to do with it.

i only ask because i have recently read so much about medicine in Israel and how fanstastic it is. their curriculi seem so advanced in the training of patient care in parallel with advanced technology. their hospitals have more beds, and do more procedures, and are all the while more efficient than in the US. i mean, i read this and feel like i should go there to train!

 

[Poety]

Perhaps you could go there and do part of your training - there is an option for international electives for some residency programs - just check Frieda and it will say it on the survey whether they allow them or not. I think just getting a residency in another country is a bit more difficult though - but I'm not sure. If you're matching this year, you should talk to the PD's at the programs you're applying to, I'm sure they'd have some insight into this.

MIKLOS: "IMO, primarily because IMGs (in whatever form) are perceived as unwanted competition by many US grads, who feel entitled to "their" residency spot."

I don't know that I agree with this, since it seems some US grads don't even seek positions that are primarily (or should I say historically) filled by FMG's, do you really think they would percieve them as competition? As I had stated before, it seems more like a lot of US grads attempt to avoid those residency positions. This I've gotten from reading a lot of the posts here, and from talking to a few applicants, this definitely is not something I've run into consistently though.

However, I will say (and I will NOT disclose which program it was) - a program did NOT want me to interview on a specific day that they were having FMG's interview and the coordinator slipped up by telling me this- I was SHOCKED to hear this, and mortified that some of my counterparts would actually "not consider a place because they have a lot of FMG's" 😱

 

[Hurricane]

However, I will say (and I will NOT disclose which program it was) - a program did NOT want me to interview on a specific day that they were having FMG's interview and the coordinator slipped up by telling me this- I was SHOCKED to hear this, and mortified that some of my counterparts would actually "not consider a place because they have a lot of FMG's" 😱

So what do they do with their FMG residents on interview days? Hide them in the closet?

 

[mosche]

I tend to agree with Miklos (i.e. FMGs/IMGs increase the competition). I also think that it also extends to DOs, PAs, and even to psychologists -- though there are other considerations as well.

Why?

We all want to graduate and make the money that those who have gone before us have made. With the increasing influence of HMOs and the reduced compensation from Medicaid/Medicare, I think that we view any additional influences on our desired incomes as a threat. Thus, Pathologists and Radiologists hate outsourceing. Psychiatrists vehemently oppose psychologists wanting to perscribe medications -- though the arguement tends to focus on "medical training", which IS LEGITIMATE, but could be easily rectified by incorporating it into psychology training.

BTW, I'm not trying to start a war!!!!! I'm just giving my observations/opinion, and I am very aware that I may be wrong! 👍 👎

 

[Poety]

I tend to agree with Miklos (i.e. FMGs/IMGs increase the competition). I also think that it also extends to DOs, PAs, and even to psychologists -- though there are other considerations as well.

Why?

We all want to graduate and make the money that those who have gone before us have made. With the increasing influence of HMOs and the reduced compensation from Medicaid/Medicare, I think that we view any additional influences on our desired incomes as a threat. Thus, Pathologists and Radiologists hate outsourceing. Psychiatrists vehemently oppose psychologists wanting to perscribe medications -- though the arguement tends to focus on "medical training", which IS LEGITIMATE, but could be easily rectified by incorporating it into psychology training.

BTW, I'm not trying to start a war!!!!! I'm just giving my observations/opinion, and I am very aware that I may be wrong! 👍 👎

TROUBLE MAKER MOSCHE!!! just kidding 😀 Mosche, isn't my avatar CUTE? hehe <wink wink>

However Mosche, I don't know that there really is an overabundance of docs that we're competing for salaries for whether they are IMG or US grad - I think there is a definite need for physicians across the board.

Hurricane: I KNOW RIGHT? I can't say much, except that this program apparently even has a lot of FMG's, something which is odd since they did not want to interview both at the same time?! Perhaps its because of some comments US grads have made that make FMG's feel uncomfortable? I have no idea, but I was surprised and quite honestly offended that it occured at all because I would HATE for someone to think that most US grads are like that, which I hoep they are not - and btw, I let the coordinator know I have NO PROBLEM interviewing with FMG's because it doesn't matter - a good doc is a good doc is a good doc is a good doc - I don't care who you are or what your title (DO, MD, US grad, FMG, IMG-foreign national) who cares as long as you are good to patients and know your stuff!

 

[Solideliquid]

I think most of the stigma is being attached to IMG's from caribbean schools.

First off, many people attach the idea that IMGs from caribbean schools are inferior. Not to say that many schools in the caribbean are better than the US schools, I will say that a small number of caribbean schools are as good as many mid-level schools in the US. And I will go as far as saying the top three caribbean schools are better than some of the low-end US schools IMHO.

Boards can be a problem for some coming out of caribbean schools, the problems arise from the school not being able to spoon feed the students USMLE material as the US schools do. I think if an IMG or FMG passes the USMLE boards there shouldnt be any stigma about his or her education.

Poety - HOW CUTE!!!

 

[Poety]

Poety - HOW CUTE!!!

<blush> thanks 😀 <beaming mom>

 

[mosche]

I agree with the "stigma" arguement. I think that this same arguement extends to DO schools as well. In the general residency forum there is a thread in which one student asks whether she/he will be able to get into a competitive residency if she/he decides to go to a DO school. The answer is: Probably. However, there are PDs out there who, out of ignorance or out-right bias, would discount a top-notch DO student into their program, in favor of a lower calibur MD student, because they view DO schools as sub-par.

But I still think that there is some truth to the salary paradigm. When discussing bias, reality is often relegated to a tertiary consideration. So, while there may be plenty of room for everyone to play, perception is another issue.

 

[Poety]

But I still think that there is some truth to the salary paradigm. When discussing bias, reality is often relegated to a tertiary consideration. So, while there may be plenty of room for everyone to play, perception is another issue.

What tertiary consideration Mosche? I'm a simpleton here and I got lost with this statement 😳

 

[mosche]

What tertiary consideration Mosche? I'm a simpleton here and I got lost with this statement 😳

i.e. No one want's to admit that they are all about the money; so, people put up smoke screens to hide the real issue. Thus, they offer arguements like: "IMGs are not as well trained", "DO schools are for those who can't get into an MD program", etc.... Such arguements force their victims --IMGs and DOs-- to defend themselves against the attacks, and the real issue is never addressed. Therefore, it has become a "tertiary" consideration at best.

 

[Poety]

i.e. No one want's to admit that they are all about the money; so, people put up smoke screens to hide the real issue. Thus, they offer arguements like: "IMGs are not as well trained", "DO schools are for those who can't get into an MD program", etc.... Such arguements force their victims --IMGs and DOs-- to defend themselves against the attacks, and the real issue is never addressed.

Ok, but I'm confused as to why this would be an argument, do people think they aren't going to get a job or something? Who is putting up the smoke screen? Residency programs? I don't see how this would apply to the US grads, I know I know, I'm just not getting it sorry!

 

[mosche]

The OP asked about the stigma. I posit that the stigma is actually entrenched by those who fear that their pocket-books will be negatively affected should the stigma cease to exist.

Heck, I dunno -- I'm just a bored fourth year who has nothing more to do on a Saturday night that speculate about silly stuff on SDN!

BTW, I read your IM, and I will NOT be held responsible for your inability to understand my dribble -- you are a mother, therefore you should have already passed "Dribble 101"!

 

[Poety]

The OP asked about the stigma. I posit that the stigma is actually entrenched by those who fear that their pocket-books will be negatively affected should the stigma cease to exist.

Heck, I dunno -- I'm just a bored fourth year who has nothing more to do on a Saturday night that speculate about silly stuff on SDN!

BTW, I read your IM, and I will NOT be held responsible for your inability to understand my dribble -- you are a mother, therefore you should have already passed "Dribble 101"!

so I'm not the only one stuck on here for lack of something better to do? You got baby makin you could be doing right? Then you could be just like me, sitting here with a little one sleeping next to you. And by the way, I felt the SAME way after I posted that thread about illegal questions, you ever go back and go, what was I thinkin?

 

[mosche]

so I'm not the only one stuck on here for lack of something better to do? You got baby makin you could be doing right? Then you could be just like me, sitting here with a little one sleeping next to you. And by the way, I felt the SAME way after I posted that thread about illegal questions, you ever go back and go, what was I thinkin?

Shhh! Don't say "baby makin". People read this stuff ya' know!

 

[Miklos]

i only ask because i have recently read so much about medicine in Israel and how fanstastic it is. their curriculi seem so advanced in the training of patient care in parallel with advanced technology. their hospitals have more beds, and do more procedures, and are all the while more efficient than in the US. i mean, i read this and feel like i should go there to train!

I have trouble believing this from a strictly financial standpoint. Although the U.S. wastes a lot of money delivering healthcare, it still spends 14.2% of GDP on healthcare versus 9.1% in Israel. In addition, Israel's GDP per head is roughly half of the US at direct exchange rates.

http://www.who.int/countries/isr/en/
http://www.who.int/countries/usa/en/

That's not to say that there aren't excellent facilites in Israel. The question then is whether you are then comparing the best of Israel with the "average" US facility.

 

[Miklos]

I think most of the stigma is being attached to IMG's from caribbean schools.

Much of it is, but I believe that it goes much farther than that. As many of the non-US IMGs are from developing countries, one always wonders about an element of racism.

 

[Solideliquid]

Much of it is, but I believe that it goes much farther than that. As many of the non-US IMGs are from developing countries, one always wonders about an element of racism.

That may be true, but I think most caribbean schools cater mostly to US-citizens far more than people from that actual island or other countries.

 

[Miklos]

That may be true, but I think most caribbean schools cater mostly to US-citizens far more than people from that actual island or other countries.

Right, but what I meant was that the majority of IMGs are not US-IMGs.

See http://www.nrmp.org/res_match/tables/table2_05.pdf

For last year, there were 5,564 active applicants in the match who were "true" IMGs (or using the terminology of the NRMP, non-US FMGs) versus merely 2,091 US IMGs (NRMP: US FMGs).

If we look at the geographical distribution of the IMGs, the best public source I've found is an old annual report by the ECFMG.

Applicant Profile Exhibit 4 shows the number of Standard ECFMG Certificates issued in 2002. Of the 5,429 Standard ECFMG Certificates issued in 2002, India and Dominica had the largest number of recipients based upon country of medical school; 1,180 (21.7%) of the recipients were graduates of Indian medical schools and 393 (7.2%) received their medical degrees in Dominica.

From 1969 through 1981, nationals from India had formed the largest group of certificate recipients when citizenship was considered. Beginning in 1982, citizens of the United States graduating from medical schools abroad received more certificates than citizens of India. However, in 1989 the trend reversed and continued through 1998. From 1989 through 1998, citizens of India were again the largest group of certificate recipients. In 1999, the trend again reversed, and more certificates were issued to citizens of the United States than to Indian citizens. This trend continued in 2002, when 1,427 (26.3%) certificates were issued to U.S. citizens and 1,139 (21.0%) were issued to Indian citizens.

Note that this is a straight comparison between Indian citizens and US IMGs. When accounting for all the other countries, many of which are in the developing world, US IMGs are (no matter where their med school) a minority in comparison to the true IMGs.

U.S. Citizens Pursuing ECFMG Certification There is much interest in U.S. citizens who receive their medical education abroad. The number of such students is not known. The number of U.S. citizens taking ECFMG examinations, however, increased from 685 in January of 1973 to 5,026 for the last one-day ECFMG Examination administered in February 1984. The number decreased to 2,534 for the first administration of the Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS) in July 1984 and reached a maximum for FMGEMS of 3,580 in July 1986. The last administration of FMGEMS in July 1993 included 731 U.S. citizens. For the first administrations of USMLE Step 1 and Step 2 in 1992, there were 1,549 and 524 U.S. citizens, respectively, who took the ECFMG-administered examinations.

In 2002, ECFMG registered 4,186 U.S. citizens for Step 1. The number of U.S. citizens registered for Step 2 in 2002 was 2,520. U.S. citizens comprised 20.0 percent of the total Step 1/Step 2 registrants in 2002. The largest numbers of U.S. citizen Step 1 and Step 2 registrants were students/graduates of medical schools in Mexico (837), Dominica (821), Grenada (798), Netherlands Antilles (738), and the Dominican Republic (398).

Performance data for U.S. citizen international medical students and graduates taking USMLE Step 1 and Step 2 are provided in Exhibit 1.

 

[Solideliquid]

Wow, that was great research!!!

How can you find all that stuff at this late hour? I'm debating going to the kitchen for a glass of water lol.

 

[Miklos]

Wow, that was great research!!!

How can you find all that stuff at this late hour? I'm debating going to the kitchen for a glass of water lol.

Well, I've got a couple advantages going. First, I'm on Central European Time. Second, I must admit that I've posted that bit of info at least 10 times on other fora.