One thing about Caribbean schools…

[deleted1077853]

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Is there actual evidence and/or research based proof as to why Caribbean students are considered less desirable and less competent than their US counterparts? I’ve seen a lot of the opinions surrounding it come from 4 general “buckets”:

1. Admissions committees are more lax and some don’t even consider MCAT scores or GPAs, which attracts a certain “undesirable” population of students.
2. The quality of basic science and clinical education is subpar to what US students have.
3. The institutions themselves are for-profit degree mills (the for-profit part is right, but the degree mill part isn’t).
4. Match rates are lower compared to US programs.

I’m genuinely wondering why the medical community can’t accept the fact that students who successfully completed a Caribbean education are just as good as any other graduate. Considering most residency directors filter applicants based on Step 1 score regardless of the medical school you came from, I find it hard to believe that Caribbean students that make it past the initial cut are then unfairly judged based on personal opinion and industry-wide assumptions. Everyone takes the exact same Step 1/Step 2/Step 3/board certification exams, so there doesn’t seem to be any objective reason for Caribbean students to be considered inferior to their US counterparts.

The problem of those schools being considered offshore for-profit degree mills can be easily solved if US regulatory and government bodies work to properly accredit and certify the program, thus removing the question of illegitimacy.

If “subpar students” attending an “offshore for-profit degree mill” is a red flag for PDs then of course there will be a low match rate. Creating a stigma surrounding a group and then using the consequences of that as ammunition against them is a pretty low blow, if you ask me.

There’s plenty of solutions to this problem and it doesn’t take much effort to enact them. At the end of the day, what’s the harm in including more qualified and competent students in the clinical workforce? Why are they actively being pushed away?

 

[Bonne Nuit]

The problem of those schools being considered offshore for-profit degree mills can be easily solved if US regulatory and government bodies work to properly accredit and certify the program, thus removing the question of illegitimacy.

Why do you think a US accrediting body would have any legal ability to regulate an educational institution located in another country?

 

[deleted1077853]

Why do you think a US accrediting body would have any legal ability to regulate an educational institution located in another country?

Caribbean students are able to get US federal loan money to fund their education because they’re recognized as accredited institutions by the Department of Education. A student going to Europe for medical school doesn‘t have that privilege. So the foundations are already there. Strengthen the recognition so PDs and residency programs have no question as to the legitimacy of the institution.

 

[Bonne Nuit]

Caribbean students are able to get US federal loan money to fund their education because they’re recognized as accredited institutions by the Department of Education. A student going to Europe for medical school doesn‘t have that privilege. So the foundations are already there. Strengthen the recognition so PDs and residency programs have no question as to the legitimacy of the institution.

Thanks for answering. So are you proposing that the US government pressure the local/multinational accrediting agencies to improve their standards, or would you like to see these schools accredited by a US entity like the LCME?

I don’t disagree with your line of thinking, but I’m trying to understand how that could practically work.

 

[Goro]

Is there actual evidence and/or research based proof as to why Caribbean students are considered less desirable and less competent than their US counterparts? I’ve seen a lot of the opinions surrounding it come from 4 general “buckets”:

1. Admissions committees are more lax and some don’t even consider MCAT scores or GPAs, which attracts a certain “undesirable” population of students.
2. The quality of basic science and clinical education is subpar to what US students have.
3. The institutions themselves are for-profit degree mills (the for-profit part is right, but the degree mill part isn’t).
4. Match rates are lower compared to US programs.

I’m genuinely wondering why the medical community can’t accept the fact that students who successfully completed a Caribbean education are just as good as any other graduate. Considering most residency directors filter applicants based on Step 1 score regardless of the medical school you came from, I find it hard to believe that Caribbean students that make it past the initial cut are then unfairly judged based on personal opinion and industry-wide assumptions. Everyone takes the exact same Step 1/Step 2/Step 3/board certification exams, so there doesn’t seem to be any objective reason for Caribbean students to be considered inferior to their US counterparts.

The problem of those schools being considered offshore for-profit degree mills can be easily solved if US regulatory and government bodies work to properly accredit and certify the program, thus removing the question of illegitimacy.

If “subpar students” attending an “offshore for-profit degree mill” is a red flag for PDs then of course there will be a low match rate. Creating a stigma surrounding a group and then using the consequences of that as ammunition against them is a pretty low blow, if you ask me.

There’s plenty of solutions to this problem and it doesn’t take much effort to enact them. At the end of the day, what’s the harm in including more qualified and competent students in the clinical workforce? Why are they actively being pushed away?

Quoting the wise gyngyn:
The pool of US applicants from the Caribbean is viewed differently by Program Directors. The DDx for a Caribbean grad is pretty off-putting: bad judgment, bad advice, egotism, gullibility, overbearing parents, inability to delay gratification, IA's, legal problems, weak research skills, high risk behavior. This is not to say that all of them still have the quality that drew them into this situation. There is just no way to know which ones they are. Some PD's are in a position where they need to, or can afford to take risks too! So, some do get interviews.

Bad grades and scores are the least of the deficits from a PD's standpoint. A strong academic showing in a Caribbean medical school does not erase this stigma. It fact it increases the perception that the reason for the choice was on the above-mentioned list!

Just about everyone from a Caribbean school has one or more of these problems and PDs know it. That's why their grads are the last choice even with a high Step 1 score.

There was a time when folks whose only flaw was being a late bloomer went Carib, but those days are gone. There are a number of US med schools that will reward reinvention.

 

[deleted1077853]

Quoting the wise gyngyn:
The pool of US applicants from the Caribbean is viewed differently by Program Directors. The DDx for a Caribbean grad is pretty off-putting: bad judgment, bad advice, egotism, gullibility, overbearing parents, inability to delay gratification, IA's, legal problems, weak research skills, high risk behavior. This is not to say that all of them still have the quality that drew them into this situation. There is just no way to know which ones they are. Some PD's are in a position where they need to, or can afford to take risks too! So, some do get interviews.

Bad grades and scores are the least of the deficits from a PD's standpoint. A strong academic showing in a Caribbean medical school does not erase this stigma. It fact it increases the perception that the reason for the choice was on the above-mentioned list!

Just about everyone from a Caribbean school has one or more of these problems and PDs know it. That's why their grads are the last choice even with a high Step 1 score.

There was a time when folks whose only flaw was being a late bloomer went Carib, but those days are gone. There are a number of US med schools that will reward reinvention.

I understand where you’re coming from. However, those qualities which you listed are not relevant when assessing a student in the context of a residency or other clinical position. The interviewer’s job is to assess the student based their achievements in medical training, not by their own assumptions of how they got to the school they did. Which brings me back to my point that those Caribbean students who make it past the initial score filter are then unfairly judged based on these preconceived notions of being gullible or having overbearing parents (two examples). The assessment should be fair and objective.

 

[deleted1077853]

Thanks for answering. So are you proposing that the US government pressure the local/multinational accrediting agencies to improve their standards, or would you like to see these schools accredited by a US entity like the LCME?

I don’t disagree with your line of thinking, but I’m trying to understand how that could practically work.

Well I think that I’d like to see schools accredited by a US entity for sure. Just like large undergraduate institutions have study abroad or certified international branches of their school in different countries, I envision Caribbean schools doing something similar in the sense of benefiting from a US accreditation entity while still being an independent unit. It’s not a mystery that students who go to the islands have intentions of practicing back in the US, so having entities extend their oversight to select schools in the Caribbean would strengthen the legitimacy and accessibility of these places.

 

[Taddy Mason]

…those qualities which you listed are not relevant when assessing a student in the context of a residency or other clinical position. The interviewer’s job is to assess the student based their achievements in medical training…

Lol - no. I like how as a med student/potential residency applicant you’re defining the job of residency program interviewers. Academic performance is just one piece of the picture. Those qualities are all related to broader, problematic, and pervasive issues that can impact residency performance, residency programs, and an individual’s ability to safely and professionally practice medicine. The chances of those issues being present from a Caribbean grad (who’s overall educational experience both in basic sciences and clinical rotations is subpar compared to a US grad which adds additional variance) are substantially higher because of the circumstances that likely led them down that path. Why should residency programs take that gamble when there’s an ample pool of qualified applicants where running into those issues and variance in educational experience is overall lower?

Board scores say little about an individual beyond their ability to take standardized tests. Two real life examples:
1 - the one person to be dismissed from my residency class for substantial competency and professionalism issues that persisted with little to no improvement despite extensive remediation had 250+ Step scores.

2 - during residency interviews this week, I interviewed an applicant with Step scores in the 270s, AOA, and a fairly impressive application - at least on paper (sans personal statement). The applicant had glaring personality issues and I couldn’t wait for the interview to end. Turns out I wasn’t alone. One of the interviewers who interviewed this applicant actually ended the interview after 15min because she couldn’t take anymore and had firmly made her decision and literally everyone who interviewed her/him had marked the applicant as “do not rank” before we met as group to discuss and rate applicants at the end of the day.

Granted the individuals in the two examples above were a graduate and soon be graduate of established US MD programs, given the factors that commonly lead individuals to pursue the Carib route it’s much more likely to run into potential scenarios like those above with that pool of applicants.

 

[operaman]

I understand where you’re coming from. However, those qualities which you listed are not relevant when assessing a student in the context of a residency or other clinical position. The interviewer’s job is to assess the student based their achievements in medical training, not by their own assumptions of how they got to the school they did. Which brings me back to my point that those Caribbean students who make it past the initial score filter are then unfairly judged based on these preconceived notions of being gullible or having overbearing parents (two examples). The assessment should be fair and objective.

Oh I would strongly argue that not only are those other factors highly relevant in residency selection, but they are much more important than step scores and the like. We want people who will be good residents, and those personal character flaws that lead so many south of the border are major issues in a resident. Just because they managed to memorize the Krebs cycle doesn’t mean their underlying mental illness or poor judgement have magically disappeared.

I also see no merit to fairness and objectivity. I want to find great residents who can handle 5 years of rigorous training and have the resilience to face surgical residency. I want people in the OR with me at 2am who are fun and interesting enough to make being in the OR that late a little less painful. None of those soft factors are found in objective measures. Anyone who goes Caribbean has impaired judgement and likely some serious personality issues. Screening them out allows us to focus more on people with more potential. I’m ok with missing an occasional diamond in the Caribbean rough.

 

[ACSurgeon]

OP-

Why do you think we shouldn’t prioritize people who went to school in this country for the residency spots in this country? The medical education establishment owes its own students a chance to make it all the way through before taking people from outside the system.

Regarding quality: there’s no comparison of the average clinical experience, mentorship, research etc that US MDs get compared to Caribbean students. This is crucial to residency programs. Spending two years with academic faculty and residents is very different than spending two years jumping from state to state with mostly non-academic physicians who might just ignore you the entire time. Now, I say average because with expansion of US schools some students end up with some very stupid rotations, but it seems on average most students at least have some exposure to good rotations and schools take feedback about “bad rotations” seriously.

Regarding the discussion of having the US accredit the Caribbean schools: this would never work. Caribbean schools are just trying to make a buck. They couldn’t meet US standards. And there isn’t enough high quality clinical experiences for the Caribbean students. Finally, the US could easy create more medical school seats, but there are real reasons they don’t. Quality control, not saturating the market, number of residency spots etc etc.

The Caribbean has always been risky, and in the last few years it has become so much worse as US med schools have increased their seats dramatically.

 

[Browns99]

I’m genuinely wondering why the medical community can’t accept the fact that students who successfully completed a Caribbean education are just as good as any other graduate.

Well, because it's true in their beliefs. You cannot compare most Caribbean grads with US MD/DO grads, that's just a fact. On average, a US MD/DO grad is better trained & prepared for residency, produce higher tests scores, accepted into more research slots and the list goes on.

 

[howdoiknow]

Lots of Caribbean schools basically teach you only for Step 1 from day one. At my MD school we spend at least 30+ hours/week in the clinic, learning about socioeconomic factors of medicine, etc. Caribbean students also get 6-12 months more time before they have to take Step 1 compared to my school and other MD schools with an 12-18 month pre-clinical. Yet, we still DESTROY them since even the best Caribb school "SGU" only averages ~220 IIRC and that's after you weed out like 40% of the low-performing students by M2

If I was a PD I'd rather take a 225 student from my school (most of class scores >230) than a 235-240 from SGU, for example. Also, lots of my classmates have "interesting" stories/experiences (part of it is what got them accepted) and not just some 3.2/495 who just wanted an easy 250k 9-5 job and decided to go to the Caribbean (yes IK medicine is just a job but just saying)

 

[howdoiknow]

I understand where you’re coming from. However, those qualities which you listed are not relevant when assessing a student in the context of a residency or other clinical position. The interviewer’s job is to assess the student based their achievements in medical training, not by their own assumptions of how they got to the school they did. Which brings me back to my point that those Caribbean students who make it past the initial score filter are then unfairly judged based on these preconceived notions of being gullible or having overbearing parents (two examples). The assessment should be fair and objective.

I HATE using anecdotes but I don't know of a single Caribbean grad who doesn't have overbearing parents or some other serious flaw (egotism, inability to delay gratification) and I know 15+. Some of them are amazing attendings now but not all will make it to this stage. One person I know of ran off to AUA despite us offering to look over his app and see how we can help him get into a US school.

A few students who flunked out of my SMP program went to the Caribbean. They had DO stats but didn't want to do it because they wanted the pretty MD letters (two such students had MD parents who forbid them applying DO). Sorry but I don't want a doctor who can't even make their own decisions as an adult.

 

[deleted1077853]

Lol - no. I like how as a med student/potential residency applicant you’re defining the job of residency program interviewers. Academic performance is just one piece of the picture. Those qualities are all related to broader, problematic, and pervasive issues that can impact residency performance, residency programs, and an individual’s ability to safely and professionally practice medicine. The chances of those issues being present from a Caribbean grad (who’s overall educational experience both in basic sciences and clinical rotations is subpar compared to a US grad which adds additional variance) are substantially higher because of the circumstances that likely led them down that path. Why should residency programs take that gamble when there’s an ample pool of qualified applicants where running into those issues and variance in educational experience is overall lower?

Board scores say little about an individual beyond their ability to take standardized tests. Two real life examples:
1 - the one person to be dismissed from my residency class for substantial competency and professionalism issues that persisted with little to no improvement despite extensive remediation had 250+ Step scores.

2 - during residency interviews this week, I interviewed an applicant with Step scores in the 270s, AOA, and a fairly impressive application - at least on paper (sans personal statement). The applicant had glaring personality issues and I couldn’t wait for the interview to end. Turns out I wasn’t alone. One of the interviewers who interviewed this applicant actually ended the interview after 15min because she couldn’t take anymore and had firmly made her decision and literally everyone who interviewed her/him had marked the applicant as “do not rank” before we met as group to discuss and rate applicants at the end of the day.

Granted the individuals in the two examples above were a graduate and soon be graduate of established US MD programs, given the factors that commonly lead individuals to pursue the Carib route it’s much more likely to run into potential scenarios like those above with that pool of applicants.

Yes, I agree that glaring personality issues in any applicant should be a cause of concern but purely based off the fact that your two examples were students from established US MD programs goes to show that those red flags can be in anyone. I know plenty of US MD/DO students that have wildly inflated egos, deal with overbearing parents, and are gullible and lead to believe they can survive in medical school and fall flat on their face from day 1 (and then end up changing career paths entirely). Not to mention that they feel entitled to everything simply because they got into their program of choice. It can happen anywhere. But what's not right is forming generalized assumptions of a Caribbean applicant's character. It's one thing to be objective and touch on the reasons as to why they got to a Caribbean school, but for PDs and interviewers to take that as a sign of gullibility, weakness, or egotism is incredibly shallow. I'd say that every single applicant who walks through the interview doors should be assumed to be gullible, have overbearing parents, and have an incredibly inflated ego. It's only fair.

And yes, board scores say little about an individual's ability other than passing a standardized exam. So if you and others on this thread insist that PDs are looking for people who can survive the rigors of residency, make the environment a little more fun (in the words of operaman) or have stellar research and clinical experience (referring to howdoiknow), why are board scores the first and most important cut? Don't you think that process might be excluding students who may have scored lower than the filter but possess those desirable qualities of being a good resident? On the same token, don't you think that a few select people who make it past the filter will end up showing their rude and entitled side?

 

[Captain_Falcon]

Yes, I agree that glaring personality issues in any applicant should be a cause of concern but purely based off the fact that your two examples were students from established US MD programs goes to show that those red flags can be in anyone. I know plenty of US MD/DO students that have wildly inflated egos, deal with overbearing parents, and are gullible and lead to believe they can survive in medical school and fall flat on their face from day 1 (and then end up changing career paths entirely). Not to mention that they feel entitled to everything simply because they got into their program of choice. It can happen anywhere. But what's not right is forming generalized assumptions of a Caribbean applicant's character. It's one thing to be objective and touch on the reasons as to why they got to a Caribbean school, but for PDs and interviewers to take that as a sign of gullibility, weakness, or egotism is incredibly shallow. I'd say that every single applicant who walks through the interview doors should be assumed to be gullible, have overbearing parents, and have an incredibly inflated ego. It's only fair.

And yes, board scores say little about an individual's ability other than passing a standardized exam. So if you and others on this thread insist that PDs are looking for people who can survive the rigors of residency, make the environment a little more fun (in the words of operaman) or have stellar research and clinical experience (referring to howdoiknow), why are board scores the first and most important cut? Don't you think that process might be excluding students who may have scored lower than the filter but possess those desirable qualities of being a good resident? On the same token, don't you think that a few select people who make it past the filter will end up showing their rude and entitled side?

If a program has 12 seats each year and they receive over 500 applications, 400 of which are US MD/DO, why should they go out of their way to use one of their 100 interviews on a Caribbean student? I don't think you've been able to answer that question

 

[Matthew9Thirtyfive]

Yes, I agree that glaring personality issues in any applicant should be a cause of concern but purely based off the fact that your two examples were students from established US MD programs goes to show that those red flags can be in anyone. I know plenty of US MD/DO students that have wildly inflated egos, deal with overbearing parents, and are gullible and lead to believe they can survive in medical school and fall flat on their face from day 1 (and then end up changing career paths entirely). Not to mention that they feel entitled to everything simply because they got into their program of choice. It can happen anywhere. But what's not right is forming generalized assumptions of a Caribbean applicant's character. It's one thing to be objective and touch on the reasons as to why they got to a Caribbean school, but for PDs and interviewers to take that as a sign of gullibility, weakness, or egotism is incredibly shallow. I'd say that every single applicant who walks through the interview doors should be assumed to be gullible, have overbearing parents, and have an incredibly inflated ego. It's only fair.

And yes, board scores say little about an individual's ability other than passing a standardized exam. So if you and others on this thread insist that PDs are looking for people who can survive the rigors of residency, make the environment a little more fun (in the words of operaman) or have stellar research and clinical experience (referring to howdoiknow), why are board scores the first and most important cut? Don't you think that process might be excluding students who may have scored lower than the filter but possess those desirable qualities of being a good resident? On the same token, don't you think that a few select people who make it past the filter will end up showing their rude and entitled side?

What you’re ignoring is that going to the Carib is a risky decision because of all the issues associated with it. So right off the bat, a Carib student is different from a USMD/DO because they took a pretty big gamble with hundreds of thousands of dollars and their future.

 

[deleted1077853]

OP-

Why do you think we shouldn’t prioritize people who went to school in this country for the residency spots in this country? The medical education establishment owes its own students a chance to make it all the way through before taking people from outside the system.

Regarding quality: there’s no comparison of the average clinical experience, mentorship, research etc that US MDs get compared to Caribbean students. This is crucial to residency programs. Spending two years with academic faculty and residents is very different than spending two years jumping from state to state with mostly non-academic physicians who might just ignore you the entire time. Now, I say average because with expansion of US schools some students end up with some very stupid rotations, but it seems on average most students at least have some exposure to good rotations and schools take feedback about “bad rotations” seriously.

Regarding the discussion of having the US accredit the Caribbean schools: this would never work. Caribbean schools are just trying to make a buck. They couldn’t meet US standards. And there isn’t enough high quality clinical experiences for the Caribbean students. Finally, the US could easy create more medical school seats, but there are real reasons they don’t. Quality control, not saturating the market, number of residency spots etc etc.

The Caribbean has always been risky, and in the last few years it has become so much worse as US med schools have increased their seats dramatically.

So as a response to medical schools not wanting to saturate the market and maintain some level of QC, they've tightened their expectations to all time highs. Any gap in education or slight deviation from their expected GPA/MCAT scores is an automatic denial or waitlist decision. And this is what drives people to other schools like DO programs and Caribbean MD programs to seek a medical education. Don't you think that people that even went to DO schools had less than desirable GPAs/MCAT scores/extracurriculars to the point that they had to pursue an osteopathic degree instead of allopathic? Why aren't we forming assumptions about their character then?

 

[deleted1077853]

If a program has 12 seats each year and they receive over 500 applications, 400 of which are US MD/DO, why should they go out of their way to use one of their 100 interviews on a Caribbean student? I don't think you've been able to answer that question

Last time I checked, they get paid and are expected to interview every qualified student regardless of the school they came from. If they're excluding well qualified students purely based on the school or program they went to then there's something seriously wrong with this field that attempts to value diversity and equity. So they're not going out of their way to interview another 100 Caribbean students that have stellar LORs, great USMLE scores, and a decent personality. It's their job. It's the decisions that come after that which bother me. It should be an objective decision and not based on personal opinion or assumptions of the applicant's character.

 

[howdoiknow]

So as a response to medical schools not wanting to saturate the market and maintain some level of QC, they've tightened their expectations to all time highs. Any gap in education or slight deviation from their expected GPA/MCAT scores is an automatic denial or waitlist decision. And this is what drives people to other schools like DO programs and Caribbean MD programs to seek a medical education. Don't you think that people that even went to DO schools had less than desirable GPAs/MCAT scores/extracurriculars to the point that they had to pursue an osteopathic degree instead of allopathic? Why aren't we forming assumptions about their character then?

There are about 10 or so DO schools that have TONs of students with 510/3.7+ but anyways getting into any DO school (even the brand new ones) is an order of magnitude more difficult than getting into SGU/Ross.

 

[ACSurgeon]

So as a response to medical schools not wanting to saturate the market and maintain some level of QC, they've tightened their expectations to all time highs. Any gap in education or slight deviation from their expected GPA/MCAT scores is an automatic denial or waitlist decision. And this is what drives people to other schools like DO programs and Caribbean MD programs to seek a medical education. Don't you think that people that even went to DO schools had less than desirable GPAs/MCAT scores/extracurriculars to the point that they had to pursue an osteopathic degree instead of allopathic? Why aren't we forming assumptions about their character then?

My post was focused on the quality of clinical rotations and the number of residency seats that dictate we prioritize people who stayed part of the US educational system before we take people who are trying to enter through a different route. I said nothing about character.

Given the limited number of seats at US medical schools, there has to be a way to sort the applicants and take the “best”. We can argue about what metrics should be prioritized and why, but that doesn’t change the fact that thousands of people every year will not get accepted to US medical schools. Then they have a choice: try again next year, take a huge risk and go to an offshore school, or change careers. For those who chose to take the Caribbean risk, it should be a well thought out risk and accept that risk.

 

[Captain_Falcon]

Last time I checked, they get paid and are expected to interview every qualified student regardless of the school they came from. If they're excluding well qualified students purely based on the school or program they went to then there's something seriously wrong with this field that attempts to value diversity and equity. So they're not going out of their way to interview another 100 Caribbean students that have stellar LORs, great USMLE scores, and a decent personality. It's their job. It's the decisions that come after that which bother me. It should be an objective decision and not based on personal opinion or assumptions of the applicant's character.

The problem is, of those 500 students the vast majority of them are qualified. You cannot interview every good medical student for such few residency positions. Say those 100 Caribbean students that have stellar LORs and great USMLE scores and a decent personality ---> you don't think those residency programs can find 101 US MD/DO students that fit that bill and had their medical school training stateside?

 

[deleted1077853]

What you’re ignoring is that going to the Carib is a risky decision because of all the issues associated with it. So right off the bat, a Carib student is different from a USMD/DO because they took a pretty big gamble with hundreds of thousands of dollars and their future.

Not ignoring that at all. I understand there are risks with Caribbean schools. But those risks are created by the very people that rule the space and then go onto weaponize it against them. Caribbean students that come from properly accredited schools (i.e. the main three of SGU/Ross/AUC) should have access to decent clinical rotation sites. Instead, those clinical sites have purposely excluded them and lower-name hospitals pick up those students to fill their spaces. So naturally that will be seen as a big risk.

 

[ACSurgeon]

Last time I checked, they get paid and are expected to interview every qualified student regardless of the school they came from. If they're excluding well qualified students purely based on the school or program they went to then there's something seriously wrong with this field that attempts to value diversity and equity. So they're not going out of their way to interview another 100 Caribbean students that have stellar LORs, great USMLE scores, and a decent personality. It's their job. It's the decisions that come after that which bother me. It should be an objective decision and not based on personal opinion or assumptions of the applicant's character.

No one is paid to interview candidates. Actually academic faculty are very much underpaid to do their clinical jobs and then do a bunch of administrative and academic stuff on top of that for free. Nonetheless, you have a limit on how many candidates you interview. There is some element of randomness. There are some arbitrary criteria sometimes. Programs often look for ways to filter the pile of mostly good looking candidates to fit the number of residency interviews they have. So, not sure where you “checked” last time, but you have incorrect information.

Also, my experience with Caribbean students that I know personally is that their clinical evals and letters come from mostly unknown physicians and sometimes based on subpr experiences. So you can’t just look at the content of the letter or evaluation, you have to look at the author and the context. On average, US students will have higher quality experiences and more meaningful letter writers.

 

[deleted1077853]

There are about 10 or so DO schools that have TONs of students with 510/3.7+ but anyways getting into any DO school (even the brand new ones) is an order of magnitude more difficult than getting into SGU/Ross.

I'm talking about character, not about how hard or easy it is to get in. That's been the focus of a lot of responses here. If we're making judgements based on preconceived notions about how a student got to the point that they did, then it can be easily inferred that DO schools took in a subset of a population that were denied by US MD programs. I haven't heard of a single person that willingly went DO (at least in my circle of connections). Again, using the logic and theory that's been pretty obvious though this thread, the fact a vast majority of DO students were people that got denied by MD programs should be a cause for concern. But it doesn't seem to the case.

 

[ACSurgeon]

Not ignoring that at all. I understand there are risks with Caribbean schools. But those risks are created by the very people that rule the space and then go onto weaponize it against them. Caribbean students that come from properly accredited schools (i.e. the main three of SGU/Ross/AUC) should have access to decent clinical rotation sites. Instead, those clinical sites have purposely excluded them and lower-name hospitals pick up those students to fill their spaces. So naturally that will be seen as a big risk.

Don’t think we are beating on you or Caribbean students. The goal is the explain what the limits are and why your proposal is not realistic. You understand the risk, now you have to accept the risk. Doesn’t mean you like it, but don’t think you can wish it away. If your suggestions were taken into place, hundreds to thousands of US students would fail to match rather than hundreds to thousands of Caribbean students. How’s that fair to those who played by the rules of the system?

 

[ACSurgeon]

I'm talking about character, not about how hard or easy it is to get in. That's been the focus of a lot of responses here. If we're making judgements based on preconceived notions about how a student got to the point that they did, then it can be easily inferred that DO schools took in a subset of a population that were denied by US MD programs. I haven't heard of a single person that willingly went DO (at least in my circle of connections). Again, using the logic and theory that's been pretty obvious though this thread, the fact a vast majority of DO students were people that got denied by MD programs should be a cause for concern. But it doesn't seem to the case.

It is the case. DO students have an uphill battle to get above average residency spots. As a good MD student I matched general surgery with essentially zero concern that I wouldn’t match. Most DO students applying to general surgery stress like crazy. And that’s not even a competitive specialty.

 

[Captain_Falcon]

I'm talking about character, not about how hard or easy it is to get in. That's been the focus of a lot of responses here. If we're making judgements based on preconceived notions about how a student got to the point that they did, then it can be easily inferred that DO schools took in a subset of a population that were denied by US MD programs. I haven't heard of a single person that willingly went DO (at least in my circle of connections). Again, using the logic and theory that's been pretty obvious though this thread, the fact a vast majority of DO students were people that got denied by MD programs should be a cause for concern. But it doesn't seem to the case.

DO students are not viewed as perfect equals to MD students when it comes to residency apps either.

 

[deleted1077853]

My post was focused on the quality of clinical rotations and the number of residency seats that dictate we prioritize people who stayed part of the US educational system before we take people who are trying to enter through a different route. I said nothing about character.

Given the limited number of seats at US medical schools, there has to be a way to sort the applicants and take the “best”. We can argue about what metrics should be prioritized and why, but that doesn’t change the fact that thousands of people every year will not get accepted to US medical schools. Then they have a choice: try again next year, take a huge risk and go to an offshore school, or change careers. For those who chose to take the Caribbean risk, it should be a well thought out risk and accept that risk.

Don’t think we are beating on you or Caribbean students. The goal is the explain what the limits are and why your proposal is not realistic. You understand the risk, now you have to accept the risk. Doesn’t mean you like it, but don’t think you can wish it away. If your suggestions were taken into place, hundreds to thousands of US students would fail to match rather than hundreds to thousands of Caribbean students. How’s that fair to those who played by the rules of the system?

I have to bring it back to character unfortunately because that seems to be the main reason as to why people have an aversion to Caribbean students. Judgement of their character then has downstream effects of PDs being more inclined to take people who "played by the rules". That shouldn't have to be the case. When Caribbean students reach the point of applying to residencies, it's safe to say that they're in good academic standing, have passed their exams, have been proficient enough to complete clinical rotations and electives. What more do PDs want?
-Personality? That's through an interview that is sometimes not even offered strictly because of their standing as a Caribbean student.
-LORs? If the feedback is positive and meaningful then there's no reason why the doctor's legitimacy or standing should come into play. They're not the ones applying to residency. They're a licensed and board certified doctor and that should be enough.

I'm in no way trying to dampen the opportunities available to US MD students. All I'm advocating for is an equal playing field for everyone. If the fear is saturating the residency market and overwhelming PDs with applicants, then that shouldn't be any of our concern as students/residents. We are doing what our career path requires us to do. There should be a concerted effort to make this field available to more people. AAMC has forecasted a physician shortage by 2034. Narrowing the playing field and dealing with the fallout of burnout students and physicians isn't the way it's going to be fixed.

 

[deleted1077853]

It is the case. DO students have an uphill battle to get above average residency spots. As a good MD student I matched general surgery with essentially zero concern that I wouldn’t match. Most DO students applying to general surgery stress like crazy. And that’s not even a competitive specialty.

DO students are not viewed as perfect equals to MD students when it comes to residency apps either.

Same line of my thinking goes for DO students do. I understand that they themselves are not equal either. But it shouldn't have to be like that for anyone especially DO and Caribbean MD students.

 

[howdoiknow]

I'm talking about character, not about how hard or easy it is to get in. That's been the focus of a lot of responses here. If we're making judgements based on preconceived notions about how a student got to the point that they did, then it can be easily inferred that DO schools took in a subset of a population that were denied by US MD programs. I haven't heard of a single person that willingly went DO (at least in my circle of connections). Again, using the logic and theory that's been pretty obvious though this thread, the fact a vast majority of DO students were people that got denied by MD programs should be a cause for concern. But it doesn't seem to the case.

You're right. As a non-trad with SMP/post-bacc experience, I haven't come across anyone who willingly chooses DO over MD. I did know people with 4.0/low MCAT (who could have gotten into an MD with a gap year) but just decided to go DO (one had a decent scholarship and wanted a non-comp field and went to a "top DO program"). The others I know did regret it (overbearing parents, ego, etc). (For example) Like the comments below, gen-surg is non-competitive and any average MD can "walk into it" while DOs stress over it (my DO friend decided to not even bother and just went for IM instead)

Now that's been put aside. We're all humans and we generalize. Let's say Harvard average S1 is 240. Once it goes P/F PDs will be like "ooh harvard applicant - must be a 240+ kid" even though we know that 5-10% of harvard may be scoring <210.

While there are many DOs who choose that route due to the same reasons students choose Caribbean (ego, overbearing parents, don't want to take gap years) the vast majority are just as qualified as MDs. It's not like US MDs will somehow provide better care because of the initials after their name. If anything, I'd wager that 3/4 of current DOs are "smarter" than MDs from 20 years ago and those guys still provided quality healthcare. It's just that the juice is getting harder to squeeze since there are so many applicants for so few seats.

If you're going to go Caribbean at least shoot for SGU/AUC/Ross. I've seen FAR TOO MANY people go to lesser-known schools. Some make it out but others get saddled with debt and go into unrelated jobs.

 

[Captain_Falcon]

Same line of my thinking goes for DO students do. I understand that they themselves are not equal either. But it shouldn't have to be like that for anyone especially DO and Caribbean MD students.

Why not? The medical school training and the average student is going to differ between those 3 places. Do you have a better way to stratify equally qualified applicants (at least on paper)? If so, maybe that would warrant a better discussion than simply saying "Caribbean students are being discriminated against and that's not fair"

 

[Matthew9Thirtyfive]

Last time I checked, they get paid and are expected to interview every qualified student regardless of the school they came from.

Actually they aren’t. They get thousands more apps than they have interview spots. They aren’t even interviewing every qualified US student.

 

[VA Hopeful Dr]

I have to bring it back to character unfortunately because that seems to be the main reason as to why people have an aversion to Caribbean students. Judgement of their character then has downstream effects of PDs being more inclined to take people who "played by the rules". That shouldn't have to be the case. When Caribbean students reach the point of applying to residencies, it's safe to say that they're in good academic standing, have passed their exams, have been proficient enough to complete clinical rotations and electives. What more do PDs want?
-Personality? That's through an interview that is sometimes not even offered strictly because of their standing as a Caribbean student.
-LORs? If the feedback is positive and meaningful then there's no reason why the doctor's legitimacy or standing should come into play. They're not the ones applying to residency. They're a licensed and board certified doctor and that should be enough.

I'm in no way trying to dampen the opportunities available to US MD students. All I'm advocating for is an equal playing field for everyone. If the fear is saturating the residency market and overwhelming PDs with applicants, then that shouldn't be any of our concern as students/residents. We are doing what our career path requires us to do. There should be a concerted effort to make this field available to more people. AAMC has forecasted a physician shortage by 2034. Narrowing the playing field and dealing with the fallout of burnout students and physicians isn't the way it's going to be fixed.

I'll preface this by saying that I haven't been involved in residency applications in a number of years but I don't remember character playing into it.

Simply put, for whatever reason Caribbean students were not able to obtain admission to US MD schools. Something about their application was lacking compared to the US MD student peers. Now the fairness of admissions and what metrics they use can be debated, but this is what it is.

Next as has been mentioned is the variability of 3rd/4th year clinical training. US MD schools are both held to LCME standards and the rotation sites are usually more well known to residency program faculty so they have a better idea of the bare minimum quality of students they're getting. Caribbean students have much more variety in their clinic training. This isn't to say its inherently bad, its just much more of an unknown.

For those reasons, US MD students have (and will likely continue to have) an advantage of DO and Caribbean graduates.

To address your other point:

The source of the LOR matters. Attending A at Big Medical Center has been doing LORs for years. The students he/she writes them for have always performed well. Attending B at Community Hospital wrote his/her first LOR this year. It was a great letter, but this attending has no history and so the programs have no idea what a letter means from him/her. So no, just being a physician isn't enough to say their LOR should carry equal weight with any other physician.

 

[deleted1077853]

Why not? The medical school training and the average student is going to differ between those 3 places. Do you have a better way to stratify equally qualified applicants (at least on paper)? If so, maybe that would warrant a better discussion than simply saying "Caribbean students are being discriminated against and that's not fair"

There is a better way in my eyes. But at the same time, the aversion toward Caribbean students will always exist no matter what reform is made.

Instead of drawing the line at Step 1 scores (soon to be Step 2 I guess), each residency program should have their own certified "admissions test" that is created using standards set out by that specialty's board organization from the American Board of Medical Specialties. That should be the determining factor instead of generalized information given in Step 1 and 2. Applicants would be tested on material relevant to their specialty of interest and then PDs can stratify those people who have shown a demonstrated interest in that specialty. It would also allow them to use the score to make general assessments about their level of knowledge within that field. It's a rough idea especially considering it would be a logistical nightmare to coordinate those exams with Step 2 and MS4 curriculum. But it's just an idea.

Aside from that, I still stand by the fact that no matter what reform takes place Caribbean students' character is somehow questioned due to "quality" measures outside their control. Work to qualify and properly accredit the 3 big name schools (at least) and that would create a smoother pipeline for those proficient and motivated students.

 

[Ganon]

Also, everyone needs to remember that Step 1 is going Pass/Fail for the next cycle, and step 2 averages are already sky-high.

There used to be times when Caribbean was an okay choice, but with no tangible way to prove your worth coming in with a rubber-stamped "P" on boards, I can't see the match getting any better any time soon.

I feel for those applicants, because some of the cooler docs I've worked with went to those schools, but even they tell me that times have changed.

The only reason I discuss this topic is because I post a lot in some other website's boards Re: nurses going to medical school, and a *SHOCKING* number of nurses think they'll just jet off to the islands for a bit and come back an MD, and I spend a considerable amount of time trying to save them the hundreds of thousands of dollars and heartbreak that would come for the vast majority.

I'm not an expert, but I've explored the topic out of necessity. It's grim

 

[Matthew9Thirtyfive]

There is a better way in my eyes. But at the same time, the aversion toward Caribbean students will always exist no matter what reform is made.

Instead of drawing the line at Step 1 scores (soon to be Step 2 I guess), each residency program should have their own certified "admissions test" that is created using standards set out by that specialty's board organization from the American Board of Medical Specialties. That should be the determining factor instead of generalized information given in Step 1 and 2. Applicants would be tested on material relevant to their specialty of interest and then PDs can stratify those people who have shown a demonstrated interest in that specialty. It would also allow them to use the score to make general assessments about their level of knowledge within that field. It's a rough idea especially considering it would be a logistical nightmare to coordinate those exams with Step 2 and MS4 curriculum. But it's just an idea.

Aside from that, I still stand by the fact that no matter what reform takes place Caribbean students' character is somehow questioned due to "quality" measures outside their control. Work to qualify and properly accredit the 3 big name schools (at least) and that would create a smoother pipeline for those proficient and motivated students.

This is a terrible idea. We already take step exams and shelf exams for every core specialty. Now you want to add more exams for people to take just to help Carib students?

 

[Ganon]

Work to qualify and properly accredit the 3 big name schools (at least) and that would create a smoother pipeline for those proficient and motivated students.

That exists, it's called doing an SMP and getting into a USMD or DO school.

 

[deleted1077853]

This is a terrible idea. We already take step exams and shelf exams for every core specialty. Now you want to add more exams for people to take just to help Carib students?

This is to help everyone. Not just Caribbean students. Plenty of medical professionals out there have said Step 1 tests on useless factoids that aren't relevant to clinical practice at all. Not that Step 1 is going P/F the focus will be shifted to Step 2, which is more relevant but still general clinical knowledge that isn't tailored to a student's specialty of interest. Rather than going off truly standardized exams, why don't PDs look at the shelf exam score or an exam similar to what I proposed? Just an idea.

 

[deleted1077853]

That exists, it's called doing an SMP and getting into a USMD or DO school.

Doing an SMP doesn't guarantee admission into a MD or DO school, I actually think that it creates more questions as to why the student had to pursue a Masters in the first place. I've had plenty of peers that got those questions and some of those got denied because the admissions department went for people that had the right qualifications right out of the gate. At the bare minimum it guarantees an interview, but not admission.

 

[Ganon]

Doing an SMP doesn't guarantee admission into a MD or DO school, I actually think that it creates more questions as to why the student had to pursue a Masters in the first place. I've had plenty of peers that got those questions and some of those got denied because the admissions department went for people that had the right qualifications right out of the gate. At the bare minimum it guarantees an interview, but not admission.

Nothing guarantees and admission, and nothing ever will, nor should it.

It creates a hell of a lot fewer questions than why someone went to a Caribbean school. Tons of my classmates did SMPs and proved that they could hack the material before getting admitted. If you look at stats for SMPs vs. carib for who actually make it to residency, I think you'll see which one is a wiser investment.

 

[Damson]

I didn't read most of the thread, but my 2 cents is that it makes sense for a country to prioritize employing their own graduates in order to protect their schools and patients.

 

[howdoiknow]

Doing an SMP doesn't guarantee admission into a MD or DO school, I actually think that it creates more questions as to why the student had to pursue a Masters in the first place. I've had plenty of peers that got those questions and some of those got denied because the admissions department went for people that had the right qualifications right out of the gate. At the bare minimum it guarantees an interview, but not admission.

There are 5+ DO-SMPs that essentially *guarantee* an acceptance (LECOM 497 and 3.3 in the SMP), VCOM with 3.2-3.7 with 494-501 depending on GPA. etc
No MD-SMPs guarantee anything but there are a few good ones that will give you a good shot

LOTS of students myself included that had to do an SMP had a legit reason. Either being first-gen and failing to understand how to study from day 1 (can set you up for failure, sickness, personal reasons etc) can all result in a low undergrad GPA. This at least ensures we know what we're getting into.

 

[VA Hopeful Dr]

This is to help everyone. Not just Caribbean students. Plenty of medical professionals out there have said Step 1 tests on useless factoids that aren't relevant to clinical practice at all. Not that Step 1 is going P/F the focus will be shifted to Step 2, which is more relevant but still general clinical knowledge that isn't tailored to a student's specialty of interest. Rather than going off truly standardized exams, why don't PDs look at the shelf exam score or an exam similar to what I proposed? Just an idea.

Except US MDs don't need help so its not necessarily helping everyone. They still have to pass Step 2 to graduate and become physicians already so no reason to add something else on top of that.

 

[howdoiknow]

Except US MDs don't need help so its not necessarily helping everyone. They still have to pass Step 2 to graduate and become physicians already so no reason to add something else on top of that.

This made me laugh haha. OP has no idea what they're talking about and is probably upset about their own shortcomings. By the end of M3 at my school, nearly everyone is essentially functioning at the level of an intern. We don't need "help"

 

[Goro]

I understand where you’re coming from. However, those qualities which you listed are not relevant when assessing a student in the context of a residency or other clinical position. The interviewer’s job is to assess the student based their achievements in medical training, not by their own assumptions of how they got to the school they did. Which brings me back to my point that those Caribbean students who make it past the initial score filter are then unfairly judged based on these preconceived notions of being gullible or having overbearing parents (two examples). The assessment should be fair and objective.

The program Director's survey clearly shows the bias against Carib grads in nearly every specialty, so what you're mentioning is more what you want to be real that actual reality. I'll post the data later.

 

[deleted1077853]

Except US MDs don't need help so its not necessarily helping everyone. They still have to pass Step 2 to graduate and become physicians already so no reason to add something else on top of that.

This made me laugh haha. OP has no idea what they're talking about and is probably upset about their own shortcomings. By the end of M3 at my school, nearly everyone is essentially functioning at the level of an intern.

This just proves my point about select people out there feeling entitled to certain positions and recognitions. Sure they passed Step 2 and all other requirements, but so did a Caribbean student. And a DO student. They're going to be a physician at the end of the day. Adding something else on top of that is to ensure the best of the best are being recruited for their proficiency in the field of interest. Up until now, a prospective Anesthesiology resident was assessed based on Step 1 where they had to know the difference between Schizophrenia and Schizophreniform disorders and the genetic mutation behind a rare lymphoma. Why not give them a chance to show their proficiency in Anesthesiology by administering an assessment centered around Anesthesiology basic science and clinical knowledge? (EDIT: and evaluating their performance in Anesthesiology related shelf exams and rotations MORE SO than their standardized USMLE scores?)

Most physicians I talk to have pride in the fact that they are lifelong leaners and have survived all these exams, so one more shouldn't hurt. Having one more layer of insurance would ensure the best of the best get recruited. And that's what you all want at the end of the day, right?

For the record, I'm not upset about my own shortcomings. I have pride in all that I've accomplished and I certainly don't need anyone here to validate or invalidate that for me. Not sure if you've noticed but the several posts leading up to this one I never once expressed my feelings toward my own accomplishments. I provided my opinion and suggestion, like most of you already do. I think if anyone is slightly offended that a random medical student attempted to equate Caribs with US MDs, it's you. And good for you that most of your M3s are functioning like interns. Nothing to brag about, it's what's expected of them as medical professionals in training.

 

[Matthew9Thirtyfive]

This just proves my point about select people out there feeling entitled to certain positions and recognitions. Sure they passed Step 2 and all other requirements, but so did a Caribbean student. And a DO student. They're going to be a physician at the end of the day. Adding something else on top of that is to ensure the best of the best are being recruited for their proficiency in the field of interest. Up until now, a prospective Anesthesiology resident was assessed based on Step 1 where they had to know the difference between Schizophrenia and Schizophreniform disorders and the genetic mutation behind a rare lymphoma. Why not give them a chance to show their proficiency in Anesthesiology by administering an assessment centered around Anesthesiology basic science and clinical knowledge? (EDIT: and evaluating their performance in Anesthesiology related shelf exams and rotations MORE SO than their standardized USMLE scores?)

Most physicians I talk to have pride in the fact that they are lifelong leaners and have survived all these exams, so one more shouldn't hurt. Having one more layer of insurance would ensure the best of the best get recruited. And that's what you all want at the end of the day, right?

For the record, I'm not upset about my own shortcomings. I have pride in all that I've accomplished and I certainly don't need anyone here to validate or invalidate that for me. Not sure if you've noticed but the several posts leading up to this one I never once expressed my feelings toward my own accomplishments. I provided my opinion and suggestion, like most of you already do. I think if anyone is slightly offended that a random medical student attempted to equate Caribs with US MDs, it's you. And good for you that most of your M3s are functioning like interns. Nothing to brag about, it's what's expected of them as medical professionals in training.

Putting aside my obvious thoughts on God being the one who puts us where we are. We are entitled. We are attending medical school in the country we are seeking training in. We worked hard to get into a medical school in this country, where less than 40% of applicants are accepted. We didn’t take shortcuts and go to some diploma mill offshore. In no other first world country do they act like it’s wrong to prioritize their own citizens and graduates. If you want to have that priority here, go to med school here. Not everyone can/should be a doctor.

 

[ACSurgeon]

I have to bring it back to character unfortunately because that seems to be the main reason as to why people have an aversion to Caribbean students. Judgement of their character then has downstream effects of PDs being more inclined to take people who "played by the rules". That shouldn't have to be the case. When Caribbean students reach the point of applying to residencies, it's safe to say that they're in good academic standing, have passed their exams, have been proficient enough to complete clinical rotations and electives. What more do PDs want?
-Personality? That's through an interview that is sometimes not even offered strictly because of their standing as a Caribbean student.
-LORs? If the feedback is positive and meaningful then there's no reason why the doctor's legitimacy or standing should come into play. They're not the ones applying to residency. They're a licensed and board certified doctor and that should be enough.

I'm in no way trying to dampen the opportunities available to US MD students. All I'm advocating for is an equal playing field for everyone. If the fear is saturating the residency market and overwhelming PDs with applicants, then that shouldn't be any of our concern as students/residents. We are doing what our career path requires us to do. There should be a concerted effort to make this field available to more people. AAMC has forecasted a physician shortage by 2034. Narrowing the playing field and dealing with the fallout of burnout students and physicians isn't the way it's going to be fixed.

But PDs need some metric to rank people. Your earlier posts complain about the high exam score standard for med school admission. So you understand there should be factors that are not numerical to choosing who to interview and how to rank people that you interview. PDs need a way to stratify candidates. Making everything seem equal only makes it harder to stratify and rank. So when you have a limited number of interview spots and several fold more qualified(by your definition) applicants, you have to rank them by something. For some programs it’s amount of research. For others it’s which school you went to even within US MD schools some are viewed more favorably.

An average surgery programs has 5 spots but they got over 1000 applicants (mostly non-US MDs). At most they interview 80 of the 1000. What criteria do you propose they stratify? Keep in mind step 1 is about to be pass/fail so that objective metric is going away. It’s not like PDs are picking US MDs with terrible letters or multiple failures over a stellar Caribbean.

This is to help everyone. Not just Caribbean students. Plenty of medical professionals out there have said Step 1 tests on useless factoids that aren't relevant to clinical practice at all. Not that Step 1 is going P/F the focus will be shifted to Step 2, which is more relevant but still general clinical knowledge that isn't tailored to a student's specialty of interest. Rather than going off truly standardized exams, why don't PDs look at the shelf exam score or an exam similar to what I proposed? Just an idea.

because most problem residents aren’t problematic because of lack of intelligence or ability to score on a test. Most clashes are interpersonal. If 80 people get interviewed for five seats, the biggest determining factor for how to rank those 80 is based on personality fit as they’re all plenty qualified on paper.

Also, you’re suggesting a way to make it better for people at the big 3 Caribbean schools. That’s very hypocritical. The top 3 Caribbean schools are still much closer to any average Caribbean school than they are an average US med school. But, I assume you attend one of the big 3 so you’re making suggestions that help your case while still letting thousands of students at the lesser schools get screwed over.

 

[howdoiknow]

Putting aside my obvious thoughts on God being the one who puts us where we are. We are entitled. We are attending medical school in the country we are seeking training in. We worked hard to get into a medical school in this country, where less than 40% of applicants are accepted. We didn’t take shortcuts and go to some diploma mill offshore. In no other first world country do they act like it’s wrong to prioritize their own citizens and graduates. If you want to have that priority here, go to med school here. Not everyone can/should be a doctor.

OP wants to continue to feed the money-machine behemoth that is off-shore diploma mills. Heck, you could say the same about some of the for-profit new DO schools funded by the hedge fund manager

OP also forgets that medicine is about the patient. Now whether most physicians believe that is entirely up to them. I am also not sure what OP means by "most qualified". Completing any US MD program ensures that the students are more than qualified for any specialty (especially since most have respectable S1/S2 scores). Instead of the Caribbean assembly-line style of learning where you're just buried in books and nothing else to try and pass the boards.

A professor of mine told me SGU (back in the day) offered him good money to just put his name on their list of faculty (and fly him out 2x a year to "lecture"). They're no better than "buy here pay here" car dealerships

To OP - if you want to make any changes or "Equalize" the playing field then petition whatever diploma mill you attended to have smaller classrooms and to invest more in clinical education + GME

 

[deleted1077853]

Putting aside my obvious thoughts on God being the one who puts us where we are. We are entitled. We are attending medical school in the country we are seeking training in. We worked hard to get into a medical school in this country, where less than 40% of applicants are accepted. We didn’t take shortcuts and go to some diploma mill offshore. In no other first world country do they act like it’s wrong to prioritize their own citizens and graduates. If you want to have that priority here, go to med school here. Not everyone can/should be a doctor.

The use of the phrase diploma mills implies that 100% of the people that enter are leaving with an MD in hand. If someone fails in M1, then they're out. If they fail a USMLE (fun fact: it's made by the United States), they have to take it again. If they fail at a shelf exam, they have to take it again. And so, at the end of the day, the people that made it through completed the requirements they had to. I think if you're so adamant on not counting offshore schools in the mix then you should lobby that anyone that goes outside of the US for medical school should NOT be allowed to take the USMLE or even practice in the US at all. Why is it that Carib residents are still matching in the US then? Put an end to that nonsense and completely bar them from practicing in the US. After all, we of course have to prioritize people who didn't cheat the system and stayed in the states. I'm sure plenty of people will sign that petition gladly. And I'm sure that'll be enacted overnight. Is there a reason that a policy like that hasn't been enforced yet?