Lots of FMGs in a program bad?

[suckerfree]

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I interviewed at a program in a major city that had a lot of FMGs and DOs. However the resident of which they were the most proud had 15 first author publications and was going to do a fellowship at NIH. The program has cytopath, hemepath, and surg path fellowships in house and does over 40 k specimens per year. All of the department faculty were extremely nice and the department itself seemed like a very nice environment. The residents also seemed extremely intelligent. My question is this...as a US MD grad, I really liked the program a LOT but can't help but wonder if it would be wise to go to a program with a lot of FMGs. Usually that is an indication that there may be something wrong and they weren't able to attract domestic grads. But in path residency, I don't really see how it is relevant...I mean, some of the FMGs are MD Phd's, they come from excellent schools from their home countries...all in all I feel like some of the FMGs are better than the average US grad. Having very intelligent fellow path residents will no doubt make make for a more intellectual atmosphere and it would be an asset, I think. So if I like the program, would it be unwise for any reason to rank them highly? Please note, I'm not bashing FMGs at all. I really, really respected everyone there and I'm seriously considering this program, I really liked it and they were building all new facilities, etc. I figured that with those fellowships, the training must be very good also even if I don't decide to do a surg path or heme path fellowship. Thanks!

 

[106174]

Some points to think about regarding your question:

* Pathology is a field that attracts a lot of FMGs.
* A program having FMGs does not necessarily indicate any weakness. Instead, it may be a reflection of the residency selection committee's preferences. Some committees will just not rank FMGs over AMGs, even if the latter may have better credentials than the former. By contrast, some programs see beyond the medical school of origin, specially after a significant amount of work has been done in the US.
* You are right in considering this in your decision making process but put it low in your list of criteria. If you really like the program and the city it is in, then you should not let the number of FMGs deter you from ranking it highly.
* Some of the best pathologists around are FMGs - Juan Rosai, Alberto Ayala, Victor Prieto, Omar Sangueza, Sabine Kohler, Klaus Busam, and many more.
* At UTSW, we have a number of FMGs but based on the applicant pool of recent years, we may actually have less and less of them. The AMGs applying to Path nowadays are extremely competitive.

 

[b&ierstiefel]

I don't think that should have too much bearing on your decision. So over the past several years (or more), there have been more interest amongst the AMGs towards pathology. So that represents a sense of transition.

I believe the issue mainly stems from the starting point of this transition. When program directors were initially faced with this, what issues made them prefer AMGs over FMGs if that were the case? Was it prejudice? Was it that the AMGs simply had better qualifications? Or were there external factors that weighed into the decision such as visa issues (not too familiar with these issues though myself)? Or broadly speaking, does it require a program more work to get an FMG into the system (something a program would rather not do if given the choice)? That's what I wonder...I don't know what the answer is.

Whatever the case may be, now we have programs that are FMG rich and those programs that don't have FMGs. I think there is an element of people jumping to conclusions and those conclusions being propagated...the most obvious one being that "an FMG rich program must be undesirable". Initially where these programs became stratified by this parameter, maybe this wasn't the popular mode of thought? Who knows? I don't. But now, this is a notion that is being propagated.

For you, it is good that you are being cognizant of this. This is too big for you to change but if you go to an FMG-rich program, you're going to have to accept that you will be getting crap from the folks who have propagate the notion that "FMG-rich programs aren't as good".

Ultimately, you're going to have to train somewhere. You'll probably do a fellowship...do a good one. Then go get a kickass job. Then you can look back at all of this and chuckle.

 

[suckerfree]

The program seemed to offer as much or as little research opportunity as the student wants, it is in a top 10 US city, they pay well, will have all new grossing stations in a new building, the people were nice, graduates of the residency came back after fellowship training away to return to become faculty, the hospital has a busy transplant service, they see whipples every week for surg path specimens, the residents say they do pot lucks once a week, there is an on site exercise facility that is the best in the city at this hospital...just a few of the reasons i'm considering it highly. Also, is it safe to assume that if they have surg path and heme path fellowships in house, the teaching for these subjects is likely to be the best among the subjects that they teach? Thanks!

 

[pathstudent]

it is also worth pointing out that some of the guiding lights in patholgy are FMGs who did pathology residency in the US.

Abul Abbas, Ramzi Cotran, Vinay Kumar and Nelson Fausto among many many others come to mind. in fact i would sat fmgs are far more likely to be dedicated to a career in academics, which, IMO, is a more admirable and honorable career goal and a higher caliber of pathology, but that being said most big name programs are loaded with amg residents nowadays. I wonder what the future holds.

It wasn't that long ago when there would only be as few as 100 AMGs going into pathology (that is less than 1 per medical school).

 

[mlw03]

The program seemed to offer as much or as little research opportunity as the student wants, it is in a top 10 US city, they pay well, will have all new grossing stations in a new building, the people were nice, graduates of the residency came back after fellowship training away to return to become faculty, the hospital has a busy transplant service, they see whipples every week for surg path specimens, the residents say they do pot lucks once a week, there is an on site exercise facility that is the best in the city at this hospital...just a few of the reasons i'm considering it highly. Also, is it safe to assume that if they have surg path and heme path fellowships in house, the teaching for these subjects is likely to be the best among the subjects that they teach? Thanks!

sounds like you're really psyched about this program, whichever it is. you don't need us to validate it. i think your assumption, at least for heme, is a safe one. having a fellowship means solid teaching and high-quality specimens in that subject area.

 

[pathstudent]

Although, like I said, even though some of the brightest stars in academic pathology are FMGs, I think people assume that FMGs equate with undesirable residency.

It might be because, things like categorgical surgery, radiology, plastic surgery, dermatology, and ortho etc... fills to 100% capacity almost exclusively with AMGs. I have rotated at large county hospitals where almost all the peds residents and internal medicine residents are fmgs, but the radiology residents, optho residents, and derm residents are still AMGs.

But whatever, pathology is different, and it is ironic that a number of FMGs mold all of american and hence the world's medical education via the robbins pathology text.

 

[gbwillner]

... they see whipples every week for surg path specimens, the residents say they do pot lucks once a week,...just a few of the reasons i'm considering it highly. Also, is it safe to assume that if they have surg path and heme path fellowships in house, the teaching for these subjects is likely to be the best among the subjects that they teach? Thanks!

I'm wondering why it's important that a program sees Whipples every week.

 

[b&ierstiefel]

I'm wondering why it's important that a program sees Whipples every week.

It's not. People make such a big deal out of Whipple specimens. The disease entities encountered in the context of grossing Whipple specimens is quite limited. Plus, the most common reason why we see Whipples in the first place is usually associated with poor prognosis and high mortality (of course, morbidity/mortality associated with the Whipple surgery itself isn't trivial either) regardless of how the specimen is signed out.

 

[suckerfree]

in regards to the whipples...i have heard that at a few programs so far every time time, i assume, they want to characterize their surgery department as performing high level surgeries and thus providing good surge path training fodder.

This program also touted that they have a very active transplant service. I thought it would be pretty cool...i'd live in chinatown, never cook dinner again, have a nice view of the city, commute 20 minutes to work each day, exercise at their rediculous facilities, and then I'd be able to come home in the evening and chill/read/chill/read/sleep.

 

[chromogranin]

of course, i have no idea what program you are specifically talking about. however, this scenario is one that is common, at least at the many of the institutions i applied to, and i am not always sure what to make of it as well. i hedge at times, but i try to rationalize it by telling myself that the point of the match is to rank according to percieved fit and that theoretically, this is the institution that i will best be able to learn.

at my home (med school) institution, there are fmg residents as well. many of these residents have completed prior training in their country of origin. oftentimes, i find that these residents are the ones most open to teaching and are a benefit to the other residents in the program.

 

[Arctic Char]

i'd love to know what program you are speaking of. sounds like a greta place . . . PM me if you don't want to share publically

 

[mlw03]

the only issue i would ever have with FMGs is language barrier, IF the fellow residents in question spoke very poor english. communicating with your colleagues is a must. so to the OP, if you felt like you could communicate, and get along fairly well with these fellow FMG residents, then i say who cares.

 

[LADoc00]

really depends on what your goals are...At issue is whether predominant FMG training programs will track you into jobs you are looking for.

For me, I wanted as many options afterward as I could get so I choose to pass on programs with more than 1-2 FMGs per class. Looking back on it, I dont think I wouldve been handicapped much attending almost any ACGME accred. training program but that is me, others would be different.

Facts: Many if not most high end private prac groups do not interview FMGs, aside from those originating in English speaking countries like the UK.

Many FMGs will end up taking jobs in certain settings like HMOs, Vet Hospitals or other government positions.

That is saying nothing about an individual FMG or AMG, but the trend in general.

Lots of ways to look at this. In general, the more FMGs a program had, the less desirable it was considered, but this maybe incorrect thinking.

 

[vegasdo]

As far as DOs are concerned you should definitely not think less of programs with them. I am a DO applicant this year and have had very few prorgrams deny me interviews because I am a DO. The only programs were the ones in regions where there simply were not many practicing DOs in the area, therefore, they are unfamilar with them. People tend to be afraid of things that they are not familiar with. On the other hand, many reputable programs have given me interviews and tell me that they interview DOs because they have current residents or past residents that they have been extremely happy with. Also, I am sure most MDs in this day and age have had experience working with DOs and feel that they are more than competent. I hope so anyways.

I also want to add that the main reason you don't see many DOs in pathology programs is that they simply choose not to go into the field. I am the only one in my class of 80 applying this year and I believe it is similar at other osteopathic schools. This is mainly because there are currently no osteopathic pathology residency programs which means DO applicants will have to take both steps of the USMLE along with COMLEX in order to get into a good program.

 

[schrute]

As far as DOs are concerned you should definitely not think less of programs with them. I am a DO applicant this year and have had very few prorgrams deny me interviews because I am a DO. The only programs were the ones in regions where there simply were not many practicing DOs in the area, therefore, they are unfamilar with them. People tend to be afraid of things that they are not familiar with. On the other hand, many reputable programs have given me interviews and tell me that they interview DOs because they have current residents or past residents that they have been extremely happy with. Also, I am sure most MDs in this day and age have had experience working with DOs and feel that they are more than competent. I hope so anyways.

I also want to add that the main reason you don't see many DOs in pathology programs is that they simply choose not to go into the field. I am the only one in my class of 80 applying this year and I believe it is similar at other osteopathic schools. This is mainly because there are currently no osteopathic pathology residency programs which means DO applicants will have to take both steps of the USMLE along with COMLEX in order to get into a good program.

I Agree.
Especially along the lines of your second paragraph: there's ~200 in my graduating class and I'm the only one doing pathology (that I'm aware of), though I think part of that is because students don't get exposed to that field of medicine...all they have is bad memories from histology or path courses the 1st 2 yrs and therefore don't even explore the field. Which is fine with me...I think path is the best kept secret of medicine.

 

[suckerfree]

I reached no conclusion, only asked a question as to what sense to make of a program w/ a lot of FMGs.

I have reached the conclusion that this program is definitely going to be a top consideration for me.

Also, regarding DOs...my brother is a DO, I have the highest respect for them just like I have the highest respect for any doctor who is good in their work. I am convinced that training for medicine is mostly you get out of if what you put into it, whether you go to an "average"/non ivy league program vs. an ivy league program, I think unlocking one's full potential can be done at both places.

Good luck to everyone!

 

[ScopeHound]

I went to a heme fellowship with most of the residents being FMGs. At first, I was skeptical given the number of fmgs, but the fellowship was excellent and it landed me a nice job now. I found that this program takes fmgs usually before the match and the fmgs it takes are people who have completed a path residency in other countries. Ask yourself who would be better at grossing, helping sign out cases, etc ... - a us medical school grad or a fmg that has already completed pathology training in another country and is essentially a practicing pathologist. From day one, these guys have had more training and are essentially better. There was one resident who had already done over 200 autopsies before starting residency. I observed 2 autopsies before starting residency and did 60 my whole 4 years. There were some first year FMG residents that I thought were better than the surg path fellows. The english speaking and communications aspect is a big setback for them, which is why once you get to the third and fourth years, the early advantage they have goes away. Since most grossing is done in the first 2 years of residency, some programs have found fmgs better for this. By fourth year, the knowledge base is just about equivalent, but the communication aspect will hold some of them back from getting the most competitive jobs.

Essentially if you like the program, don't let the fmg ratio fool you into thinking it is a weak program. They may actually have more shrewd administrators.

 

[jux]

My main concern would be that they teach and help you especially at the start. Some programs with many resident FMGs (who were previously pathology attendings) have higher expectations of their residents starting knowledge base and may not be used to a resident who just graduated from medical school.

 

[paleman]

i am in the dermpath world - not many fmgs.. many many fmgs are excellent pathologists and -during my training- were some of the most helpful and hardworking.. i would not worry about %fmgs when picking a residency. fmgs to have a tough time post fellowship though- you gotta "give good phone" to the clinicians to be an asset to a private practice and if english ain't your mother tongue can be tough..