Matching Gen Surg with low scores vs not matching with high scores

[Doctor]

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Your advice is still poor. It doesn't particularly matter if the med school you attend costs less money if it doesn't get you where you need to be.

Look at the NRMP data on general surgery: http://www.nrmp.org/data/chartingoutcomes2009v3.pdf

You keep throwing out "240" as your benchmark for Step 1 scores - well amongst IMGs with 240 or greater on their Step 1 - 32 matched and 64 did not match. So even if you achieve that admirable score, you are still looking at basically a 1/3 shot. Whereas US MDs with >240 have >95% odds of matching.

Going to the caribbean or to another non-american school jeopardizes your chances of matching at a US surgical residency; it is a foolish decision. There is a reason that virtually no one turns down a US med school for the carib or another non-US school.

You are tilting at windmills for unknown reasons here.

Fair enough, those aren't great odds. GenSurgery is getting more competitive. Based on those numbers, I'd have to agree... bad advice! But it looks like it'd still be a great financial strategy to go for the cheapest school going into something like Family or Meds. (Yet then the reimbursements are low enough that you'd be even better off letting the Army pay for your med school and working 4 years for them... either way paying $40k tuition for 4 years to get a job 7 years out that pays $160k... is a road to... financial ruin.)

 

[Moonglow]

If you attend medical school overseas/offshore, you face a tremendous series of obstacles to successfully graduating and gaining a residency slot in the US.

Several dozen US mid-rated academic and community IM programs fill ~90% of their categorial slots with IMGs. One example, almost all of these IM residents received their MD's at foreign schools:

http://www.medicine.nevada.edu/residency/lasvegas/internalmed/meettheresidents.asp

South Florida programs willingly take MDs from South and Central American schools (native spanish speakers).

As far as US surgery residency slots, most do go to US grads. But there are certain programs (eg. in Texas) that reserve some slots for Mexican medical school grads.

 

[SouthernSurgeon]

Several dozen US mid-rated academic and community IM programs fill ~90% of their categorial slots with IMGs. One example, almost all of these IM residents received their MD's at foreign schools:

http://www.medicine.nevada.edu/residency/lasvegas/internalmed/meettheresidents.asp

South Florida programs willingly take MDs from South and Central American schools (native spanish speakers).

As far as US surgery residency slots, most do go to US grads. But there are certain programs (eg. in Texas) that reserve some slots for Mexican medical school grads.

None of that changes the fact that it is substantially harder to match from an international school.

 

[Moonglow]

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[JackADeli]

What I don't get is why there is even an argument. In high school, I never met anyone saying they just wanted to go to the cheapest college/university. On the contrary, folks worked hard to figure out where their financial aid would come from to attend "top" universities. Everyone could have gone for the local community college and pay under 5k a semester. But, when it comes to education, folks are not seeking cut rate, bottom dollar, discounted higher education. Yes, they want cheaper top universities but will pay if the cost is not cheaper. Again, when you are at a large intellectual/academic center, there are so many opportunities and experiences that you just won't find on an isolated island with one academic persuit... i.e. study the basic science text for medical school and USMLE exams. Such an environment, surrounded by folks that are under-achievers (for whatever reason) does not generally stimulate growth, creative thinking, and advanced discover with or without applications of new technologies....

You can get an education at all levels at less expensive centers. But, I don't know anyone at this time that decides on their future based on a plan for a discounted education. I believe my growth and education were benefitted by the experiences and "frills" that come with attending a major US university.

JAD

 

[Doctor]

What I don't get is why there is even an argument. In high school, I never met anyone saying they just wanted to go to the cheapest college/university.

For one thing, in high school you never met anyone who had a degree in economics or even finance yet. For another, all your high school friends were probably relying on Daddy to pay for college... whereas most (certainly not all) medical students pay their own way. There's a different incentive involved when it comes to saving Daddy some money or saving yourself a lifetime of student loans hanging over your head.

As I've alluded to a number of times, medicine is different from every other field in that reimbursement is completely standardized. You make good points about why you would choose a better, more expensive school for yourself... but the reasoning is mostly not monetary in nature. You feel you would experience more self-growth there, benefit from being surrounded by achievers, etc. It's a reasonable choice, but perhaps not the only reasonable choice.

As colleges and grad schools get more and more expensive year by year by year, certainly we can lay aside the notion that everyone should go to the highest ranked school they get into, no matter the cost... especially in regard to undergrad and med schools. [In b-schools on the other hand, you just can't get into investment banking without graduating from a top 10 school... so it may always remain true there.]

This all being said, General Surgery is so competitive now from the NRMP data that SouthernIM linked to... all noble thoughts of self-growth, etc. aside... falling from 95% odds to 35% odds with the same USMLE score is horrible. That means there's a very large economic penalty to this idea now, so I have to eat some crow. General Surgery isn't exactly Emergency Medicine anymore with these IMG graduates. *nom nom nom nom*

 

[SLUser11]

That means there's a very large economic penalty to this idea now, so I have to eat some crow. General Surgery isn't exactly Emergency Medicine anymore with these IMG graduates. *nom nom nom nom*

Props to owning up to it. Most people keep digging a while longer. I guess it is a natural reaction when backed into a corner.

Going back to your original statement, there is an inequality that exists between US allopathic grads and IMGs. While there are plenty of excellent doctors who trained outside the US, some vastly superior to their allopathic colleagues, there are also plenty of average and below average doctors from the same areas.

Caribbean students obsess over step 1, since it is their ticket to the big leagues, and many of them bust their butts and do well, regardless of their actual long-term work ethic or underlying clinical abilities.

Anybody can work hard for a short period of time for a single test, but how many of them will have sustained excellence? When the awesome ones and the sucky ones all have excellent Step 1 scores and generically positive LORs and grades, how are program directors going to know the difference?

Faced with that conundrum, most PDs will choose a more consistent product, which translates literally to choosing the US grad over the IMG. Sometimes this choice is unfair, but usually it works out the way it should.