Please Help - Sign the Standish Petition

[exPCM]

http://new.petitiononline.com/Standish/petition.html

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[docrv]

 

[bigapple34]

Sorry... positions should go to whomever is the most qualified and capable and should not depend upon citizenship status.

 

[Leukocyte]

The whole immigration system needs a reform. It is only a matter of time before we follow the lead of the United Kingdom.

 

[BabyPsychDoc]

The whole immigration system needs a reform. It is only a matter of time before we follow the lead of the United Kingdom.

Whether we like it or not, but AMGs are already hired in preference to FMGs, so what is the point of this petition? To protect interests of AMGs who could not get a position due to competition from FMGs??? Wow, what sort of AMG would that be?

 

[Leukocyte]

BabyPsychDoc, you are in/from the UK right? Why did the UK reformed its policy towards new incoming foreign Docs? Just Curious.

 

[Faebinder]

You know, each country has its own set of highly trained physicians. When it comes to applications for the US, clearly a 10 year practicing neurosurgeon is more qualified than a new AMG graduate. So lets not claim that qualifications are the only thing that should be considered for residency.

Further, AMGs and US IMGs take loans from our banking systems and need to pay them back. By shifting a position of training to a pre-trained non-US citizen we harm our graduate medical education lenders that react by increasing interest rates, reducing payment options, and making it difficult to get loans as a medical student.

In the past this didnt matter. Now it has become significant as the number of US medical schools increased and the class sizes increased but the residency positions is increasing steadly but not fast enough. You might claim that the number of residency spots is increasing in the same amount as the number of active US seniors.... true... but... You will notice the number of US graduates applying have increased. US graduates include those who did not match the year before for some reason such failing CS/CK or not matching and taking a year off to strengthen an app. You see the influence of the limited residency positions on the USMLE, as the passing score keeps going up in an effort to limit down the number of applicants (weeding out more and more qualified candidates). So pay attention to the number of active "US graduates" as well as the number of active "US seniors".

If this issue dies this year, I predicted it will be brought up in the next 4 years very vigorously as more unmatched AMGs/US IMGs voice their concerns, unless of course congress decides to raise the number of positions like they were petitioned last year. (Not going to happen with a war sucking all the funding).

 

[BabyPsychDoc]

BabyPsychDoc, you are in/from the UK right? Why did the UK reformed its policy towards new incoming foreign Docs? Just Curious.

It's a complex issue. First, you have to look at the history of the NHS. historically, there has been a relative shortage of UK graduates, and the shortage was covered by graduates from the subcontinent (where the British govt established medical schools taught according to the British curriculum in English). Then, Blair's government pumped more money into the NHS, and along with the European Working TIme Directive this allowed (necessitated!) a few years of substantially more active recruitment of overseas doctors. In the meantime, several new medical schools were opened, producing more home-grown doctors. By that time, unfortunately, there was a massive backlog of overseas doctors that passed the licensing exams but have not been able to get a job. Now the competition was getting increasingly tough, the British graduate whined about the competition, the overseas doctors whined about racism, and the government responded by making it illegal to hire an overseas doctor without British citizenship or permanent resident status unless there is no domestic candidate qualified to do the job.

Now, two years down the line, the pendulum is about to swing into the opposite direction. With no pool of locums available to do the odd shifts, cover the vacation and long-term leaves of all sorts, the BMA is crying that they need more docs. Unfortunately, most of the overseas docs are now on pastures new and green: US, NZ, Australia.

So, to answer you question - poor workforce planning.

 

[BabyPsychDoc]

You know, each country has its own set of highly trained physicians. When it comes to applications for the US, clearly a 10 year practicing neurosurgeon is more qualified than a new AMG graduate. So lets not claim that qualifications are the only thing that should be considered for residency.

Further, AMGs and US IMGs take loans from our banking systems and need to pay them back. By shifting a position of training to a pre-trained non-US citizen we harm our graduate medical education lenders that react by increasing interest rates, reducing payment options, and making it difficult to get loans as a medical student.

In the past this didnt matter. Now it has become significant as the number of US medical schools increased and the class sizes increased but the residency positions is increasing steadly but not fast enough. You might claim that the number of residency spots is increasing in the same amount as the number of active US seniors.... true... but... You will notice the number of US graduates applying have increased. US graduates include those who did not match the year before for some reason such failing CS/CK or not matching and taking a year off to strengthen an app. You see the influence of the limited residency positions on the USMLE, as the passing score keeps going up in an effort to limit down the number of applicants (weeding out more and more qualified candidates). So pay attention to the number of active "US graduates" as well as the number of active "US seniors".

If this issue dies this year, I predicted it will be brought up in the next 4 years very vigorously as more unmatched AMGs/US IMGs voice their concerns, unless of course congress decides to raise the number of positions like they were petitioned last year. (Not going to happen with a war sucking all the funding).

1. When was the last time you saw a foreign-trained neurosurgeon with 10 years of experience in his own country being accepted into a neurosurgical residency in the US? The age, the time of graduation, the perceived "untrainability" of such an applicant would all play against him. So, the experience would not necessarily be their best asset. I am sure, there may be a few people like that in the US residency programs, but I am certain they are far and few between. Exceptions, not rules.

2. Most FMGs end up in ****holes that AMGs do not even consider as viable options. let's see.... "IMG-filled sweatshops" was an expression recently used on this forum. I doubt this is the type of competition the petition is concerned about. There are some FM programs in Midwest that are 99% filled by FMGs. Why? because no AMG would apply there.

3. From #2 it follows that the authors of the original petition are concerned about outstanding FMGs applying and being accepted into decent and even competitive programs in competitive specialties. The impact that these FMGs have on the US labour market is minimal, so then let me ask you what is the fuss about?

4. I think in most specialties, the number of residency slots still exceeds the number of US-trained applicants.


Am I missing something?

 

[DadofDr2B]

It's a complex issue. First, you have to look at the history of the NHS. historically, there has been a relative shortage of UK graduates, and the shortage was covered by graduates from the subcontinent (where the British govt established medical schools taught according to the British curriculum in English). Then, Blair's government pumped more money into the NHS, and along with the European Working TIme Directive this allowed (necessitated!) a few years of substantially more active recruitment of overseas doctors. In the meantime, several new medical schools were opened, producing more home-grown doctors. By that time, unfortunately, there was a massive backlog of overseas doctors that passed the licensing exams but have not been able to get a job. Now the competition was getting increasingly tough, the British graduate whined about the competition, the overseas doctors whined about racism, and the government responded by making it illegal to hire an overseas doctor without British citizenship or permanent resident status unless there is no domestic candidate qualified to do the job.

Now, two years down the line, the pendulum is about to swing into the opposite direction. With no pool of locums available to do the odd shifts, cover the vacation and long-term leaves of all sorts, the BMA is crying that they need more docs. Unfortunately, most of the overseas docs are now on pastures new and green: US, NZ, Australia.

So, to answer you question - poor workforce planning.

And how did the pay change for the working MD's in England? Do the young people consider being an MD a good career choice if you are from the UK? Maybe socialized medicine had something to do with wanting cheaper doctors from off shore.

 

[Faebinder]

1. When was the last time you saw a foreign-trained neurosurgeon with 10 years of experience in his own country being accepted into a neurosurgical residency in the US? The age, the time of graduation, the perceived "untrainability" of such an applicant would all play against him. So, the experience would not necessarily be their best asset. I am sure, there may be a few people like that in the US residency programs, but I am certain they are far and few between. Exceptions, not rules.

You are very wrong. My home program institution has at least 7 (2 in NS, 2 in urology, 3 in GS) like that, and those are the ones I know PERSONALLY. You underestimate the lure of the US pay/life style. It's hard to ignore 10 years of specialty practice vs. the lower than average USMLE AMG. Everyone feels the exam result speaks of your knowledge and predicts your score on those inservice exams and future boards and in all honesty that is all that matters for many many programs. Interviews are to weed out personality compatibility issues.

2. Most FMGs end up in ****holes that AMGs do not even consider as viable options. let's see.... "IMG-filled sweatshops" was an expression recently used on this forum. I doubt this is the type of competition the petition is concerned about. There are some FM programs in Midwest that are 99% filled by FMGs. Why? because no AMG would apply there.

See I have great issues with this. AMGs go for the best. That leaves the bottom programs unchecked. They go for FMGs cause they got them by the visa threat. I know one program that called a pediatric resident and made ECFMG threaten the resident to withdraw the visa if she decides to not continue the program till july (she had finally gotten into a catagorical program that didnt depend on her finishing the year and she wanted a break).

Bottom line, you call those places ****holes but that will not improve when you hire FMGs with no true power to make the change in the program. Those sweatshops maintain their spots with minimal training services because they recruited candidates pretrained before and thus able to pass specialty exams. Family Medicine looking for past family medicine experiece? Surgery looking for past surgery experience?

Note no one is against taking FMGs, but not over taking US citizens. That's where I disagree. The petitioner seems to want to stop the H1B visa. That's a visa that converts to a green card and later citizenship. It was initially started to recruit foreign skills not present in the US. In the medical field, that's garbage. Plenty of candidates all over the place and many dont match and would rather do other specialties than sit aside. Further, the petition doesn't speak of the J-1 visa, which means you can still recruit FMGs.

The truth is, I am more anti J-1 visa than the H1B. Why spend government money and residency spots to train someone who is supposed to go back? Waste of resources. Someone wanting J1 training to go back to their country probably shouldnt be part of the residency process. Train em and send em back, do they really need to go to the match, etc? That's off topic.

3. From #2 it follows that the authors of the original petition are concerned about outstanding FMGs applying and being accepted into decent and even competitive programs in competitive specialties. The impact that these FMGs have on the US labour market is minimal, so then let me ask you what is the fuss about?

Minimal impact. Agreed. Those graduates will be substituted by the unamtched US seniors / graduates / DOs / IMGs + Green Cards. I dont think that was their concern.

4. I think in most specialties, the number of residency slots still exceeds the number of US-trained applicants.


Am I missing something?

Yup, you are missing the increasing number of DOs, IMGs and US graduates. Remember how you said bad poor work planning cause of foreign trained physicians having licenses? The US can easily head that way but not at the physician market level, at the resident level.

 

[BabyPsychDoc]

You are very wrong. My home program institution has at least 7 (2 in NS, 2 in urology, 3 in GS) like that, and those are the ones I know PERSONALLY. You underestimate the lure of the US pay/life style. It's hard to ignore 10 years of specialty practice vs. the lower than average USMLE AMG. Everyone feels the exam result speaks of your knowledge and predicts your score on those inservice exams and future boards and in all honesty that is all that matters for many many programs. Interviews are to weed out personality compatibility issues.

WOW! I did not realize things are the way they are. Apologies.

However, this begs the question: should healthy competition be encouraged and brightest and the best be rewarded? Or, should less bright but home grown candidates be coddled through the system, lowering the standards of both medical education and medical care? What is wrong with healthy competition, after all?

The truth is, I am more anti J-1 visa than the H1B. Why spend government money and residency spots to train someone who is supposed to go back? Waste of resources. Someone wanting J1 training to go back to their country probably shouldnt be part of the residency process. Train em and send em back, do they really need to go to the match, etc? That's off topic.

Oh, but how is the US government supposed to fill all those jobs in the "medically underserved areas"? If it was not for J-1 waivers, who would work there? So, no, I do not think that J-1 visa holders are simply trained and sent back, wasting the US taxpayers money. In fact, there is a lot of savings made, getting a "ready-made" physician (often times already with PG experience, let alone medical diploma) to work in the areas where US citizens/Permanent Residents would not set a foot in.

Yup, you are missing the increasing number of DOs, IMGs and US graduates. Remember how you said bad poor work planning cause of foreign trained physicians having licenses? The US can easily head that way but not at the physician market level, at the resident level.

I think, healthy competition must rule. I want a best doctor to look after my health, not simply the one who was fortunate enough to be born in the country in question, be it the US, UK or whatever.

P.S. I have competing interests here: I am a FMG with a higher-than-average board score, immigrating through a family member. Probably should sign the petition, after all.

 

[BabyPsychDoc]

And how did the pay change for the working MD's in England? Do the young people consider being an MD a good career choice if you are from the UK? Maybe socialized medicine had something to do with wanting cheaper doctors from off shore.

The pay actually went up, believe it or not. The UK intern makes on average 30 - 35K (pounds!) per year, working less hours (56 is legal maximum, though 60-65 is where you usually end up). Any extra hours are paid at locum rates in addition to the salary, usually 20 - 30 pounds/hr. Plus, you have 5 weeks holidays, one year (6 months paid one way or the other, 6 months unpaid) maternity leave, two weeks paid paternity leave. So, yes, being an MD is pretty cushy, even in training over here. And it is as competitive a specialty as ever.

 

[debuub]

I recently got a new study partner for step 3.
She is american born, got married to a foreign man and emigrated to his country.
She studied medicine and says she never gave a thought to returning to the US.
Unfortunately her husband died and she returned to be near her family.

She is not licensed here and therefore could not work in her profession. She took any job she could get to earn a living, pay bills, afford the prep courses, application fees for the USMLE steps, ERAS application fees and interview expenses. BTW she passed all exams first time.

She received a few invitations and she says that most of the PDs commented on the length of time she had been non-practicing (4 years at time of interview).

One PD asked her why he should offer her a position when he has hundreds of applicants that are currently practicing with no gaps in their resume?

That's the big problem for US-IMGs.
They can't work in their field after returning to the US, whereas non-resident FMGs continue to work uninterrupted.
US-IMG are caught in a catch 22 and penalized for not working as physicians when in actuality they can't legally do so, while non-resident FMGs are credited for continuing to work in their homeland.

Personally, I think many PDs prefer submissive, grateful FMGs who they can work like horses and treat like slaves from a bygone era without any fear that the totally cowed resident will complain.
That's probably the key to the large number of FMGs that match.

As for step 3, every single PD asked her why she hadn't taken it.
She explained that she's a citizen and doesn't need a visa.
She said the PD at EVMS replied "I'm surprised you made it through the filter, we don't interview any non-AMG who hasn't passed step 3".

ergo, step 3

The road is even bumpier than usual if you are a US-IMG.

 

[Hurricane]

The pay actually went up, believe it or not. The UK intern makes on average 30 - 35K (pounds!) per year, working less hours (56 is legal maximum, though 60-65 is where you usually end up). Any extra hours are paid at locum rates in addition to the salary, usually 20 - 30 pounds/hr. Plus, you have 5 weeks holidays, one year (6 months paid one way or the other, 6 months unpaid) maternity leave, two weeks paid paternity leave. So, yes, being an MD is pretty cushy, even in training over here. And it is as competitive a specialty as ever.

Wow. That (and David Tennant) makes me want to move to the UK right now. The US is so backwards when it comes to benefits and time off.

 

[buckley]

This thread saddens me. I thought what made the US such a "great" place to practice medicine in (as well as to live in) was the spirit of the opportunity, where you are judged by your merit. Oh well, that's the American dream for you...
I just thought I'd point out that people without a visa are disadvantaged in the match race. And on a more personal note, I don't think it's such a good strategy to go through life pulling others down so you can go up. You can compete with yourself, you know.

 

[BabyPsychDoc]

Wow. That (and David Tennant) makes me want to move to the UK right now. The US is so backwards when it comes to benefits and time off.

yeah, but you have much longer residency. and your pay as an attending is capped at ca 100K/year (maximum in the NHS, unless you go into military). GPs that are partners in their practices can make much more than that, but the majority still earn ca 100K/year. You can make more if you private practice after your minimum of 40 hrs/week of NHS hours, but this is mostly lucrative enough for surgical specialties only (or private psychotherapy - but the demand is certainly not as high for it as it is in the US. Don't get me wrong, people need and want psychotherapy, but nobody wants to pay for it out of their pocket.)

 

[BabyPsychDoc]

This thread saddens me. I thought what made the US such a "great" place to practice medicine in (as well as to live in) was the spirit of the opportunity, where you are judged by your merit. Oh well, that's the American dream for you...
I just thought I'd point out that people without a visa are disadvantaged in the match race. And on a more personal note, I don't think it's such a good strategy to go through life pulling others down so you can go up. You can compete with yourself, you know.

 

[debuub]

This thread saddens me. I thought what made the US such a "great" place to practice medicine in (as well as to live in) was the spirit of the opportunity, where you are judged by your merit. Oh well, that's the American dream for you...
I just thought I'd point out that people without a visa are disadvantaged in the match race. And on a more personal note, I don't think it's such a good strategy to go through life pulling others down so you can go up. You can compete with yourself, you know.

Applicants without a visa are not disadvantaged.
They know they can always get a visa and programs know that fi they want a particular applicant from abroad they have the magic H1 B to offer.

Where is the disadvantage?

 

[docrv]

I think you are misinformed debuub. There are a LOT of programs which do not sponsor visas which translates to lesser opportunities for applicants who need visas.

 

[BabyPsychDoc]

I think you are misinformed debuub. There are a LOT of programs which do not sponsor visas which translates to lesser opportunities for applicants who need visas.

Just to clarify - I fully understand and accept that homegrown candidates are given preferences. I never understood when overseas doctors whined in the UK about the fact that the British grads are hired in preference to the overseas doctors. The fact is, anyone is looking out for their own, and it is fine. What I do have a problem with is the protectionist spirit of this petition, which seeks to undermine better qualified FMGs to offer advantage to less qualified US citizens and permanent residents. So, is a FMG with a Green Card somehow better than a FMG who needs HB1 visa?

 

[debuub]

I think you are misinformed debuub. There are a LOT of programs which do not sponsor visas which translates to lesser opportunities for applicants who need visas.

Fine by me.
Programs should consider US-citizens and permanent residents for those position.
They and their families worked and paid taxes that contributed to the Medicaid funds that pay / will pay the salaries of residents.
They are already here and should be considered first.

Plus, after those "doctors" in Scotland planted bombs why take the chance?

Do you think it's a coincidence that England asked thousands of doctors residing in the country to leave and banned non-british, non-european union members doctors from residencies in England in the future?

No coincidence. That decision happened after the bombings by those doctors.
England learned its lesson, but the US?

 

[debuub]

I think you are misinformed debuub. There are a LOT of programs which do not sponsor visas which translates to lesser opportunities for applicants who need visas.

What's your point?

If programs don't sponsor visas, then they don't.
Maybe if we can find some way to limit how much funding that visa sponsoring programs receive, we can totally eliminate this program.

Maybe if the number of visas is linked to the amount of funding: i.e. the more visas a program sponsors, the lower is their finding, I'm sure they would get the message.

 

[docrv]

What's your point?

If programs don't sponsor visas, then they don't.

That's exactly my point. If a program does not sponsor visas, then applicants who need these won't be able to apply to them. Thus, there are more opportunities for greencard holder FMGs since they can apply to these programs.

It's like having a "home court advantage".

 

[debuub]

That's exactly my point. If a program does not sponsor visas, then applicants who need these won't be able to apply to them. Thus, there are more opportunities for greencard holder FMGs since they can apply to these programs.

That's wonderful, from My POV.
Hopefully, as Medicaid funding shrinks, they'll be fewer foolhardy programs squandering american tax dollars on foreign doctors.

Americans can't go to India / Bangladesh / China / Umpa Lumpa and expect to be hired before Indians / Bangladeshi /Chinese / or Umpa Lumans.
They COULD expect it, but that would make them delusional and we all know it's not going to happen.

Therefore this country should take a lesson from other countries and take care of its own people first and provide jobs for them before worrying about the others, because god knows none of you think about this country unless your palm is turned upward like an Erb-Duchenne palsy patient or some greedy mendicant!

Keep the home court advantage for us. Hooray.

 

[docrv]

Whether we like it or not, but AMGs are already hired in preference to FMGs, so what is the point of this petition? To protect interests of AMGs who could not get a position due to competition from FMGs??? Wow, what sort of AMG would that be?

I just thought I'd point out that people without a visa are disadvantaged in the match race. And on a more personal note, I don't think it's such a good strategy to go through life pulling others down so you can go up. You can compete with yourself, you know.

Hey debuub, you seem to have some points there! Can you also give your comment on these posts? What changes do you propose? A different "left-over programs" match for the FMGs after the initial match exclusively for AMGs and citizen/GC/LPR FMGs?

Can you please enlighten us?

Thanks!

 

[BabyPsychDoc]

Plus, after those "doctors" in Scotland planted bombs why take the chance?

Do you think it's a coincidence that England asked thousands of doctors residing in the country to leave and banned non-british, non-european union members doctors from residencies in England in the future?

No coincidence. That decision happened after the bombings by those doctors.
England learned its lesson, but the US?

Dude, if you do not know what you are talking about, stop blabbering.

Permit-free training was abolished in March 2006.

Glasgow airport bombing happened in summer 2007.

Get your facts straight.

 

[debuub]

Dude, if you do not know what you are talking about, stop blabbering.

Permit-free training was abolished in March 2006.

Glasgow airport bombing happened in summer 2007.

Get your facts straight.

You may try to misinform forum members but they can do an internet search and verify the facts themselves.

Abolition of Permit-free training was proposed in 2006, then deferred due to lawsuits by BAPIO (British Association of Physicians of Indian Origin).

The law was reversed after which the NHS (National Health Service) appealed the ruling, the ban was upheld and finally took effect in July 2007 around the same time as the bombing.

In the meantime foreign doctors in England started scrambling to prepare for USMLE steps.
That is the reason there was a massive increase in applicants with training from England this year.

YOU should get your facts straight.
If you don't know the facts read following and note the dates.

http://www.bma.org.uk/pressrel.nsf/wlu/STRE-6NYK27?OpenDocument

http://www.tribuneindia.com/2007/20070210/main2.htm

http://timesofindia.indiatimes.com/articleshow/msid-1586856,prtpage-1.cms

 

[NotAProgDirector]

The petition states: "Only after all US citizens and permanent residents who apply are found not suitable, should programs be free to hire non-resident applicants."

First, as others have stated, if this only applies to the H1b visa it may have no effect. Programs use H1b's as a "benefit" -- if by law no one can do so, then programs will simply switch to J visas.

If this applies to both H1b and J visas, then two effects happen:

1. The relatively small number of non-US citizens who get competitive residencies will go down. Some IMG's might obtain these competitive spots after completing a year in a non-competitive spot -- in that case they would be transferring their visa and hence this change would not affect that outcome (i.e. an IMG who matches into a prelim surgery year and gets a visa would be free to compete for a categorical GS / neurosurgery spot the next year, as visa transfers are not under the same scrutiny as new visa applications)

2. US IMG's would have a distinct advantage over non-US IMG's.

What would be difficult to define is how we would measure that all remaining US candidates are "not suitable". Exactly how would this work?

One option is the Canadian system -- a two stage match. The match would run as it usually does, except only US citizens / perm residents would be allowed to be ranked in the first stage. After that match is complete, unfilled positions (and unmatched US applicants) would remain. Then, about 2 weeks later, there would be a second match that both US and non-US citizens could particpate in, to fill the remaining spots. Any unfilled spots after the second match would be open in the scramble. The NRMP floated a two stage match proposal several years ago, which didn't create much positive interest (although that proposal didn't exclude non-US citizens from the first match).

This would be ugly for non-US citizens. They would have to interview at programs, not knowing if there would be any open spots after the first match.

Another poster suggested withdrawing funds for slots filled with non-US citizens. This would close many programs down completely -- whether this is a "good" outcome or not depends on your point of view.

 

[Hurricane]

yeah, but you have much longer residency. and your pay as an attending is capped at ca 100K/year (maximum in the NHS, unless you go into military). GPs that are partners in their practices can make much more than that, but the majority still earn ca 100K/year. You can make more if you private practice after your minimum of 40 hrs/week of NHS hours, but this is mostly lucrative enough for surgical specialties only (or private psychotherapy - but the demand is certainly not as high for it as it is in the US. Don't get me wrong, people need and want psychotherapy, but nobody wants to pay for it out of their pocket.)

I assume you mean 100K pounds, which is like 200K dollars. Not bad. How much med school debt does a typical doc have?

I still think the US could learn a thing or two from our european (and canadian) cousins re vacations, maternity/paternity leave, etc. The way we work here is nuts.

 

[buckley]

Applicants without a visa are not disadvantaged.
They know they can always get a visa and programs know that fi they want a particular applicant from abroad they have the magic H1 B to offer.

Where is the disadvantage?

I believe this has been answered quite well by the other posters. Just to add my own thoughts on areas that are otherwise untouched--

If you are a nonUS grad, you need ECFMG certification and you can only take Step 2 CS in the US. For the nonGC holder from a rather developing country, this means applying for a visa. Yes, the ECFMG will write you a letter. But many have been turned down even with this. I have a friend who has 99, 99 on Step 1 and CK and could not get a visa for CS.

You need to appear in person to attend the interviews, and again this needs a visa--another friend of mine was given a single entry visa to take CS. He went back and reapplied for another visa to atend his interviews. Surprise! The consul just refused. So no interviews, no match.

Personally, I got a call from a PC saying my credentials were in order but that they can't interview me "until my visa status changes". It was a hard pill to swallow and politely tell them that there was no way my visa status would change within the duration of the match, but I accepted that as part of the game. That, yes, I am a visa-requiring IMG and that's bottom of the barrell for me.

Perhaps there is a more pressing question that needs attention. Why is it that some visa-requiring people match when visa-non-requiring people don't? Could it be the specialty choice? the location choice? Or that those who PDs ramked higher are simply better qualified for the post?

Look, I already matched. I won't gain anything by arguing against your petition. I was just thinking that maybe, you would increase your chances of getting matched by doing something more substantial like research work. "Heading a petition against visa-requiring IMGs" is not that remarkable in the CV and if anything, I think it might even send a red flag to the PD reading it.

That being said, good luck to the match next year. I can understand the frustration, but I hope you can also understand why I am refusing to support you.

 

[BabyPsychDoc]

You may try to misinform forum members but they can do an internet search and verify the facts themselves.

Abolition of Permit-free training was proposed in 2006, then deferred due to lawsuits by BAPIO (British Association of Physicians of Indian Origin).

The law was reversed after which the NHS (National Health Service) appealed the ruling, the ban was upheld and finally took effect in July 2007 around the same time as the bombing.

In the meantime foreign doctors in England started scrambling to prepare for USMLE steps.
That is the reason there was a massive increase in applicants with training from England this year.

YOU should get your facts straight.
If you don't know the facts read following and note the dates.

http://www.bma.org.uk/pressrel.nsf/wlu/STRE-6NYK27?OpenDocument

http://www.tribuneindia.com/2007/20070210/main2.htm

http://timesofindia.indiatimes.com/articleshow/msid-1586856,prtpage-1.cms

My dear friend,
I have no doubt that this forum members may found relevant information for themselves, but may I respectfully suggest that they skim through these articles while doing so:

http://www.bmj.com/cgi/content/full/333/7581/1240-b?rss=1

http://news.bbc.co.uk/1/hi/health/4928954.stm (April 2006 overseas doctor complaining about having the rug pulled out from under them)

http://news.bbc.co.uk/1/hi/health/4929902.stm (April 2006 - ditto)

http://news.bbc.co.uk/1/hi/health/7087846.stm (doctors complaining about the new proposals that those who have HSMP visa should not be allowed to take up training posts)

or, just do a search on BBC website for "overseas doctors".

Ultimately, I of course believe that somebody getting the information second-hand from Indian popular newspapers knows more about what is happening in the UK than the person living through the events.

 

[debuub]

"Heading a petition against visa-requiring IMGs" is not that remarkable in the CV and if anything, I think it might even send a red flag to the PD reading it.

For accuracy sake, you should note that I was not the person who started this thread and I was definitely not the writer of the petition, however I support it fully.

I believe american citizens and permanent residents should have first priority for american jobs financed by american taxpayer dollars, after all these tax funds are the direct result of their labor.

These citizens and permanent residents have no option other than medical residency here in the US.
It's not as if they can go to india, pakistan or county X to practice and why should they have to? This is their home, whereas applicants from abroad have the option of working / continuing to work at home.

I did take note of the sublet threat of fear and reprisal by programs, PDs and of possibly never getting a residency that opponents persistently raise to silence and intimidate anyone who voices support for the petition in order to prevent them from openly supporting the petition or signing it.

as for my CV, it's just fine.
I don't subscribe to plagiarism, therefore no need to take credit for something I did not author.

 

[BabyPsychDoc]

I assume you mean 100K pounds, which is like 200K dollars. Not bad. How much med school debt does a typical doc have?

I still think the US could learn a thing or two from our european (and canadian) cousins re vacations, maternity/paternity leave, etc. The way we work here is nuts.

I do not know about the debt. And the leave is pretty good, yes. But...

1). Any income over ca 40K is taxed at 40% rate.
2). Cost of living is higher in the UK. Gas is over £1 per LITRE! Two miserly cobs of corn are ca £1.50. House price inflation is even higher than it is in the US. Private school fees are ca £10K per year. Daycare is ca £700 per month. Same as in the US, just IN POUNDS!
3). So, at the end of the day, the standard of living of a UK consultant is probably lower than the standard of living of the US attending. But, I have no way of knowing since a) I am neither and b) I am not counting the debt.

I think, pastures are always greener elsewhere. Both countries have problems; both have distinct advantages.

 

[debuub]

Ultimately, I of course believe that somebody getting the information second-hand from Indian popular newspapers knows more about what is happening in the UK than the person living through the events.

Gee whiz, what a change from "DUDE" to "MY DEAR".

You seem to have a gift for selectively ignoring facts.

Did you notice there were 3, REPEAT 3, links, including a press release by the BMA (British Medical Assoc.)

Did you really expect me to post 40 links?
I picked the 3, REPEAT 3, I felt made the point.

You conveniently ignored the first.
Dx: Selective Blindness

For THE person living through the event, you still reported the facts incorrectly the first time.
I'll be generous, you reported half the facts to suit your position.

 

[nervous student]

I agree with the idea of a two step match for many reasons.

First off all the US citizens/permanent residents would have an advantage over non-US IMGs which is the case in most other countries. If you grew up and were raised in this system you just know it better. Period. I know someone mentioned healthy competition and whats wrong with it.

Lots....in other countries you can take YEARS to study for the USMLE steps where US citizens usually go to US schools or the Caribbean and they have only weeks or months to study for the same test. So is a 99/99/99 from someone who already had a residency in a home country with 3 years to study that much better than a medical student in the US with an 82/82/82????

Also, what the hell happened to TEACHING in residency. If all these great institutions are SOO good at teaching then take someone who NEEDs to be taught. If you were already a doctor in another country than you don't need to be taught !!! Many "IMG mills" will take these candidates to take the pressure off teaching.

We have to protect US citizens who take loans out of the US system and have paid into medicare and medicaid their whole lives. I can not have a 250,000 loan to my country and have NO job after I finish medical school when someone with NO debt from their country gets a job over me.

I have worked with many foreign doctors and I have nothing against them but I also know many US citizens that did not match and now have to start paying back loans with no income and NO job. I know most AMGs never have to think about this but dont forget about those that tried like hell for many years to get into a medical school in the US but couldn't so they trained in another country but still took out the same loans you did and now have no job.

 

[debuub]

..........CLIP......... So is a 99/99/99 from someone who already had a residency in a home country with 3 years to study that much better than a medical student in the US with an 82/82/82????

................CLIP.............Also, what the hell happened to TEACHING in residency. If all these great institutions are SOO good at teaching then take someone who NEEDs to be taught.

............CLIP...................We have to protect US citizens who take loans out of the US system and have paid into medicare and medicaid their whole lives. I can not have a 250,000 loan to my country and have NO job after I finish medical school when someone with NO debt from their country gets a job over me.

I have worked with many foreign doctors and I have nothing against them but I also know many US citizens that did not match and now have to start paying back loans with no income and NO job. I know most AMGs never have to think about this but dont forget about those that tried like hell for many years to get into a medical school in the US but couldn't so they trained in another country but still took out the same loans you did and now have no job.

Hallelujah, a light is dawning!!!!!!!!!!

Nervous Student, it is up to you, your fellow students wherever they may be and every student who will follow you to make this problem known.

You are the beginning.
Start by discussing the problem with your parents and their friend, your friends and neighbors.

Start a protest group / interest group / debate circle at your school.
Try to get chapters at all the other schools of those that potentially can be affected.

Get your school admin involved.
They will be shaking in their boots at the thought of their graduates not matching.
That's not good for the reputation of the school or their ability to attract future paying students.

Word of mouth is the best advertisement.
You have far more power than we that have already graduated and working so-so jobs.

Spread the word. Let the public know what you are up against and see if someone won't do something about it.

Money talks, if you can't repay your loans, someone has to.
Enough noise and there will be change.

Get one of the non-resident FMG's with H1 B to pay your loan or medicaid

 

[BabyPsychDoc]

Gee whiz, what a change from "DUDE" to "MY DEAR".

You seem to have a gift for selectively ignoring facts.

Did you notice there were 3, REPEAT 3, links, including a press release by the BMA (British Medical Assoc.)

Did you really expect me to post 40 links?
I picked the 3, REPEAT 3, I felt made the point.

You conveniently ignored the first.
Dx: Selective Blindness

For THE person living through the event, you still reported the facts incorrectly the first time.
I'll be generous, you reported half the facts to suit your position.

<sigh> Have it your way, if you wish. The Home Office announced that they abolish PFT visas in March 2006. The BMA and BAPIO protested against it, and lost (http://www.bmj.com/cgi/content/full/334/7589/333?rss=1), but it ALREADY was an active law from April 2006. Only people who already were in training posts on the said visas were allowed to complete their posts FROM MARCH 2006 onwards; others had to obtain work permits (equivalent of H1B). Several of my friends that were originally from India had to leave in August 2006, as their visas expired and/or their contracts came to the end.

Then the NHS tried to make HSMP candidates ineligible for training posts; BAPIO appealed against that, too, but at a later date.

Your link from the BMA website simply states what I already stated in my previous posts; I read it and I am sorry that I did not reference it as well.

The only reason I am wasting another 10 min of life on this post is because you made a factually incorrect and inflammatory in spirit remark about the perceived link between terrorist attacks in Glasgow and the Home Office rules effectively abolishing UK equivalent of J1 visa. While your conspiracy theory may be amusing, there is no ground to it. I think I made my point and any sensible reader on this forum can confirm the facts for himself.

This is my last posting on this thread.

 

[docrv]

Money talks, if you can't repay your loans, someone has to.
Enough noise and there will be change.

Get one of the non-resident FMG's with H1 B to pay your loan or medicaid

Isn't this a discrimination to non-resident FMGs?

I guess this is my last post too. Goodluck with your petition.

 

[Blade28]

Guys, just a friendly reminder to keep the discussion in here civil and professional. If you have a specific complaint against another SDN user, please PM that person instead.

 

[yippyskippy]

I am an American graduate and I do not support this petition for several reasons.

First of all, we already have a huge advantage over FMGs (the match statistics have been referred to several times already), and the majority of FMGs are not taking spots away from AMGs. Yes, there are AMGs who go unmatched, but the people that I know that were in this category were either 1) applying in difficult specialties, 2) applied to too few programs, or 3) had some serious red flags on their records. Most AMGs match. And definitely most who apply to family/IM (which is what so many FMGs are applying in) match well.

Second, we have a shortage of primary care providers in many areas the US, despite increasing medical school class sizes (this was just in an article in the NEJM) - this is because more people than ever are subspecializing and, for those that go into primary care, these underserved areas generally are not areas that AMGs want to work in. We stick to the cities and towns that we like, and the hospitals we like. FMGs are usually much more willing to go to these underserved areas because they don't have the match advantages we have. Faebinder pointed out that these areas have poorly run programs -- but are FMGs really the cause of that? If there were no FMGs, would AMGs suddenly rush to fill the need in these areas? I think that nervous student astutely pointed out that we need to protect the taxpayers that pay for medicare and medicaid... and a huge number of these taxpaying people are from areas with a shortage of primary care doctors... if you compare the percentage of the population that is living in designated 'health professional shortage areas' (see health and human services website if you want the run down on this) with the percentage of medical students who don't match and are left with debt, I am not sure that we can adopt an "us over them" mentality when it comes to choosing our debt over their health. These are our patients. A lot of them are hardworking people, and I would venture to say that someone with a medical degree and 250,000 dollars in debt can still find a better paying job and cushier lifestyle than many of these folks can. It may not be your first choice of jobs, but with an MD degree you can certainly find some gainful employment.

In terms of the 2 phase match system, I don't really see the need for this either. Again, I think our graduates are pretty advantaged by the current system. I think that the small percentage of AMGs who didn't match would perhaps take the spots that an FMG might have otherwise had in this system... and I think of these AMGs, the ones who originally applied to really tough specialties or a specific geographic area would transfer out as soon as possible. And the other AMGs, the ones with big red flags on their records... I mean, really, we all have at least a few people we can think of from our med school that really and truly, should not be practicing doctors. I think my patients would be much better off with an FMG who was smart and competitive enough to get into a US residency.

I am also very nervous about insulating ourselves from what are possibly the best and the brightest intellectual minds out there and thinking that this is somehow protecting our country... if someone from another country is truly brilliant, then I absolutely think it is in our best interest to have them working here. One of these people could be the person to cure HIV, cancer, whatever... if they stay in their country, they may not have access to the same resources, and it may never happen... or, they may achieve whatever success they are bound to achieve elsewhere, maybe in a country that does not believe in sharing that knowledge, technology, etc with us... and we are left out in the cold.

We already have the advantage on the whole and, though there will inevitably be some of us who are not immediately successful, this is not the fault of the FMGs that managed to make it in to the spots that a lot of us didn't apply for in the first place.

Last point - I am not sure where everyone got the idea that every American medical student should have a guaranteed job after they graduate. No other profession does this.

 

[deleted50478]

One option is the Canadian system -- a two stage match. The match would run as it usually does, except only US citizens / perm residents would be allowed to be ranked in the first stage. After that match is complete, unfilled positions (and unmatched US applicants) would remain. Then, about 2 weeks later, there would be a second match that both US and non-US citizens could particpate in, to fill the remaining spots. Any unfilled spots after the second match would be open in the scramble. The NRMP floated a two stage match proposal several years ago, which didn't create much positive interest (although that proposal didn't exclude non-US citizens from the first match).

This would be ugly for non-US citizens. They would have to interview at programs, not knowing if there would be any open spots after the first match.

I pretty much agree with you with minor changes.

I think the best system would include two rounds of the match. US citizens should get preference for jobs and would primarily match in the first round. Every country gives preference to its own. It's not discrimination because they don't have any "right" to our jobs anyway. Many foreigners are welcome to work here and should be treated well when they do, but they should get in line behind us.

The second round in the match would replace the scramble and give foreign docs a chance too. Rather than having just 2 weeks between the rounds, round one could be like March 1st and round 2 could be at the end of May. That would give unmatched Americans and FMGs time to apply to open positions and interview before the second round of the match.

There could then be a scramble after round 2 if needed though virtually all jobs would be filled by then.

 

[3dtp]

WOW! I did not realize things are the way they are. Apologies.

However, this begs the question: should healthy competition be encouraged and brightest and the best be rewarded? Or, should less bright but home grown candidates be coddled through the system, lowering the standards of both medical education and medical care? What is wrong with healthy competition, after all?

Nothing is wrong with healthy competition. I doubt home grown candidates are coddled through the system. And the standards are not lowered.

What has been pointed out is that the competition must be fair and unbiased, which is clearly impossible. I would be totally free market and open on this issue except for one thing. The show stopper is that a US medical school graduate cannot even have the opportunity to earn a living or obtain a license to earn a living without at least one and now in some states, three years of residency. Since residency is supposed to be "training/education" which in reality it rarely is any more, particularly in bottom feeder programs, I find myself in agreement with those who would reserve these training positions for those who need the training: the medical school graduate who has not had an opportunity to practice for many years.

The real problem is the US protectionist medical licensing hedgemony that mandates 1-3 years of training for FMGs, even though they may be pre-eminently qualified in their own country or internationally recognized experts in their field. Eliminate this barrier and you would promptly eliminate this problem. But in so doing, you deprive the "training institutions" of their plentiful and compliant source of free laborers who will tolerate anything for the right to permanently emmigrate.

Oh, but how is the US government supposed to fill all those jobs in the "medically underserved areas"? If it was not for J-1 waivers, who would work there? So, no, I do not think that J-1 visa holders are simply trained and sent back, wasting the US taxpayers money. In fact, there is a lot of savings made, getting a "ready-made" physician (often times already with PG experience, let alone medical diploma) to work in the areas where US citizens/Permanent Residents would not set a foot in.

Therein lies a major falacy. One of my former students on a J-1 visa accepted a "training" position in a "medically underserved" area. He was basically screwed by the agency he went to work for, and when he figured it out and called them on it, they told him that since he signed a "training wage contract," then signed an affidavit certifying he was being paid much more, that was fraud and if he said anything, he'd be deported. He worked for $600/month for a year before he called me. INS did not deport him, and did arrest his boss, himself a green card holder, who was deported for this little charade.

What does it take to make a medically underserved area? Someone who says it is. Consider this real scenario. A city of 100,000+/- has a need for a medical specialist. The law says they must give priority to a US national. So, they advertise for this medical specialist in the local newspaper. Naturally there are none of these specialists reading the local paper and none apply. They are then free to hire the foreign national on the J-1 Waiver program at 1/2 of the prevailing wage of a suitable US candidate. For the hospital this is a no-brainer. 1/2 pay, more work because of the fear of loss of visa, or full price and following the rules with a citizen. What happens next and frequently is at the end of the J-1 waiver period, the visa is converted to a green card and the waiver candidate is now free to move to Beverly Hills or Long Island and make the big bucks.

Secondary impact, is that we drain the brightest and best from where they are most needed in the developing world. But, this too is changing as these brightest and best are making boutique hospitals in Bangkok and Delhi, charging US nationals cash at 1/3 the cost of US hospitals on "medical vacations."

So, competition is starting to rule and in the process, perhaps raising the standard of living elsewhere as well. Which is a good thing.

'Tis a real quandary. I don't think we should remain insular, but on the other hand, our present system is ripe for abuses and exploitation on all sides.

And I do not support a second match, nor a first match for that matter. If we truely want a fair and open competition, then get rid of the NRMP. Programs should be free to compete for the best and the brightest and absent an artificial, ugly and anticompetitive horsetrading system, they will or they will fail. The NRMP allows programs to pay artificially low wages, maintain working conditions that the rest of the world considers abhorrent and abuse residents with impunity. The NRMP states that it expects residents to complete a program they begin, and if the program does not tell its applicants the truth or changes the terms of its residency after the match, there is nothing a resident can do about it except pray that the beatings will stop soon. So, get rid of the match, which is only for the benefit of the programs, let the candidates and the institutions compete on a fair and open basis and everyone should have a better "match" and working conditions will improve.

Every other sector of our economy works this way and it seems to be working pretty well for most.

 

[yippyskippy]

Those are really good points, especially about the brain drain (taking the best and brightest from their countries). This is difficult to get around, as is the abuse of FMGs within our system. I don't have a good answer for this... I still don't think that shutting our system off is the right choice.

I guess my major worry is that we are so quick to blame the FMGs for the basic fact of life, that you can't always get exactly what you want. I don't think FMGs are the reason that people are not getting the residencies they want. And, despite the fact that you need a residency training to practice medicine after getting your MD, I still don't think that getting into a residency program should be guaranteed. There are people who manage to finish medical school who may not be people that you would want to work with, or have seeing patients. Not many, but there are definitely some.

It would be awful to go through medical school and not get a residency at the end of it. A lot of these people re-apply and get a residency. For the rest, they may be looking at jobs outside of the clinical realm. Again, I think that an AMG who can't get any residency (including the less desired programs) at all, probably has something on their application that really stood out in a bad way. There are always horror stories, and anecdotal cases to the contrary, and maybe I am just naiive, but I don't think this is that random a process.

As for getting rid of the match... it's a flawed system, but it sounds like the old way was worse!

 

[3dtp]

As for getting rid of the match... it's a flawed system, but it sounds like the old way was worse!

How is the old way worse? In the old system, you applied for the job/program, along with all others interested in the program. The programs selected applicants they thought would most likely be a good fit with their programs, invited them to come out for a visit and a deal was struck or not. If it was, there was a week or so window to make up your mind, sign the contract/negotiate amendments and life is good for all concerned.

Programs, especially programs of lesser repute hated this system. It put the applicants squarely in the driver's seat. One program director once told me he hated the old system because he would make an offer to an applicant and then have to wait while that applicant waited on an offer from Mass General. He much more liked the "new" system where he had full control of everything.

It also gave him carte blanche to do nothing to improve his program, knowing that he would match people because of geography and by making his list long enough and gave him the ability to say anything and everything to induce applicants to rank him highly, while retaining the ability to renege on his side of the deal.

Are all programs like this? No, but we make rules to cover those that live on the margins and those rules are no good unless than can be enforced and they cannot be enforced if we live in fear of our livelihoods for speaking out.

The argument is made that programs/applicants are better served by having this "universal match" system to avoid the confusion/pressure and problems of deciding a residency given the 20k or so applicants slots each year. I submit that this is not true. By corellary if it were true, then we should likewise have a "match" system for high school seniors and colleges/universities. And for college seniors and medical schools. We don't because competition serves us well. Competitive universities are able to attract and matriculate anyone they want while East Podunck State College in Skunk Rapids is left with the dregs. But East Pdunck, with insightful and forward thinking leadership can improve their reputation as has happened any number of times, including one very notable institution in my home state. With a match system, guaranteed to fill the entering classes, this institution would have no incentive to improve and the matriculants would be the poorer for it.

I think the same is true with residency. And the match promotes mediocrity.

One other thought. The USMLE in the not so distant past had a comment on board scores on their web site. It stated, as best I can recall, that the USMLE was an exam to determine that a passing candidate had the minimum acceptable qualifications for practicing medicine. It went on to state that the exam was not designed for further discrimination among applicants on the basis of numerical scores and that using high/low passing board scores for this purpose was invalid. Nevertheless, they continued to report numerical scores/ranks and programs, lacking insight and looking at the ease of using a national number, began using it as a filter.

Nervous student had excellent insight into this issue: All Board Scores are not created equally. I took one of my steps after returning from a mission trip in a country 12 time zones away, spending 13 hours on a train, 14 hours in planes and airports and then spending an additional 11 hours driving to the test center. I fell asleep during the exam, completely lost track of time remaining and paniced. I passed and got a respectable score, but I'd bet that if I had had a week of 8 hours sleep in my own bed, drove across town to take the exam and was refreshed and well rested, that I might have had much better score, or then again, maybe not. When I was asked about this while interviewing at a noted east coast University I replied that I had passed the exam, and gave them a copy of the USMLE statement. I did not match at that institution, for which I am grateful.

 

[Faebinder]

Well said 3dtp.

If the permanent license requirement for FMGs was lowered to 1 year, many would do 1 year and go practice primary care. Why waste 3 years of residency when you have been working in primary care for 10 years in another country? They dont mind the salary cut of not being board certified IM or FM because in their countries they didnt make as much.

Bottom line, the license requirement is more of a protect the turf and get cheap labor and yes NRMP is highly biased towards the programs way more than the applicants.

As for the USMLE, just go to the forum and see all the program directors asking the NBME not to make the 2012 combined exam Pass/Fail that way they can assess the applicant since they have no other universal way of assessing the applicant. They firmly believe the USMLE determines your competency since it predicts passing the certification boards. To me that basically says that certification boards are just another "standardized timed" test.

I am not anti residency programs or the great sith lords that rule them. I just feel that there are many many programs out there that don't deserve residents because they have no interest in training. They want cheap labor and the H1B + J1 are their ways of getting them. H1B is okay but it should not be prioritized over a person from this country for the reasons we have been stating over and over again. The J1 is garbage and would have been acceptable if the J1 never competed in the residency process. You aren't supposed to stay after a J1!

And dont tell me we would lose on exceptional talent. There is a third type of a visa to practice in an institution if you are of some exceptional talent. That's the secret O1 visa. It's hard to get you know why? It's rare to find an extraordinary talent outside the US that does not exist in the US. The US is the third largest population in the world you know.

 

[NotAProgDirector]

As for the USMLE, just go to the forum and see all the program directors asking the NBME not to make the 2012 combined exam Pass/Fail that way they can assess the applicant since they have no other universal way of assessing the applicant. They firmly believe the USMLE determines your competency since it predicts passing the certification boards. To me that basically says that certification boards are just another "standardized timed" test.

Getting a bit OT here, but my experience is that in general residents (both AMG and IMG) with higher board scores do better in residency. True, some residents with outstanding board scores can have trouble with interpersonal issues etc, but most of the residents who have struggled in my program are those with low USMLE scores. Although the exams were designed to assess competence for licensure, in my experience they are valid for predicting success in residency. If the minimum pass on a USMLE step is 75, there is clearly a difference between someone getting a 75 and someone else getting a 90.

However, I do agree that too much emphasis is placed on Step 1. I hope they will combine Step 1 and 2, keep the scores, and make sure that students are able to take it and get scores before application season.

I am not anti residency programs or the great sith lords that rule them.

That's a relief!

How is the old way worse? In the old system, you applied for the job/program, along with all others interested in the program. The programs selected applicants they thought would most likely be a good fit with their programs, invited them to come out for a visit and a deal was struck or not. If it was, there was a week or so window to make up your mind, sign the contract/negotiate amendments and life is good for all concerned.

The match has been around for a long enough period that it's hard to compare what happened 20+ years ago. However, some of the subspecialties in IM have recently been brought into the match, most notably GI.

The situation in GI without a match was awful. Residents applied to programs. Programs would contact residents to set up interviews. Because positions were handed out first-come first-served, it was vital to interview immediately. Residents were often forced to purchase plane tickets and travel within a few days, or risk the positions all being offered before they even interviewed. Offers were often given at the interview, with no allowance for a decision -- "This offer expires when you walk out the door" was a common response. Salaries were no better, and there was no negotiating for anything. It was absolutely awful for every single resident in my program who applied, and most of them got spots.

Programs, especially programs of lesser repute hated this system. It put the applicants squarely in the driver's seat. One program director once told me he hated the old system because he would make an offer to an applicant and then have to wait while that applicant waited on an offer from Mass General. He much more liked the "new" system where he had full control of everything.

News stories from before the match suggested that it was equally horrible for students. PD's would call with an offer -- if there was no answer, they would simply call the next person and you'd lose your spot. This was before cell phones / answering machines / email etc. Most PD's recruited from people they knew, making it difficult/impossible for good students from lesser known programs to get competitive spots. Even the most competitive students could suffer in this system -- if I think a student is "too good" for my program, I might not offer them a spot worrying that they'd take it, then bolt when a better offer emerges.

It also gave him carte blanche to do nothing to improve his program, knowing that he would match people because of geography and by making his list long enough and gave him the ability to say anything and everything to induce applicants to rank him highly, while retaining the ability to renege on his side of the deal.

This kind of behavior is independent of a match. You can leave your program any time you want to. If there is no match, there's no guarantee you'll find another slot open.

The argument is made that programs/applicants are better served by having this "universal match" system to avoid the confusion/pressure and problems of deciding a residency given the 20k or so applicants slots each year. I submit that this is not true. By corellary if it were true, then we should likewise have a "match" system for high school seniors and colleges/universities. And for college seniors and medical schools. We don't because competition serves us well.

These situations are a bit different in many ways:

1. A match theoretically works best when the number of applicants and the number of slots are equal. For the college seniors --> med schools, there are many more applicant than slots. If someone changes their mind at the last minute, there is always someone willing to take their slot.
2. Colleges and Medical Schools are very flexible about how many students they have. If I run a school with 100 students per year, it really doesn't matter if I have 90 or 110. Residencies are constrained to have an exact number of residents. If I have a residency with 20 slots, I can't offer 25 people slots and assume that 5 will drop out.
3. One of the big problems is that if a resident drops out of a program, the schedule for everyone else is affected. I fully agree (before you mention it) that this is our fault / the fault of the system. It might be better if there was some way to "cover" the work of a missing resident with some other person, but that might further degrade the educational system by making residents "disposable". This adds to your concern that "things might be different than you were promised" concern.

Competitive universities are able to attract and matriculate anyone they want while East Podunck State College in Skunk Rapids is left with the dregs. But East Pdunck, with insightful and forward thinking leadership can improve their reputation as has happened any number of times, including one very notable institution in my home state. With a match system, guaranteed to fill the entering classes, this institution would have no incentive to improve and the matriculants would be the poorer for it.

I think the same is true with residency. And the match promotes mediocrity.

Except for the last line, I agree. The same is true for residencies. Programs with good names which have problems do not fill in the match. You can see a few in this year's match. The match is not guaranteed to fill entering classes. Other programs improve and their match prospects improve also.

All Board Scores are not created equally. I took one of my steps after returning from a mission trip in a country 12 time zones away, spending 13 hours on a train, 14 hours in planes and airports and then spending an additional 11 hours driving to the test center. I fell asleep during the exam, completely lost track of time remaining and paniced. I passed and got a respectable score, but I'd bet that if I had had a week of 8 hours sleep in my own bed, drove across town to take the exam and was refreshed and well rested, that I might have had much better score, or then again, maybe not.

I hate to say this, but this was extremely poor planning on your part. If someone else plans better and gets a better score, that seems fair to me.

Rather than having just 2 weeks between the rounds, round one could be like March 1st and round 2 could be at the end of May. That would give unmatched Americans and FMGs time to apply to open positions and interview before the second round of the match.

It would be virtually impossible to get visas for IMG's or build the schedule (assuming I didn't fill completely in the first match) without knowing my complement of residents by early April. I guess I could build the first few months out and then build the rest once I fill in the second match but this would be a real pain for everyone, esp the residents who would want to know when their vacations were.

 

[3dtp]

This kind of behavior is independent of a match. You can leave your program any time you want to. If there is no match, there's no guarantee you'll find another slot open.

And in all likelihood you will not. And certainly not without a PD's permission.

Originally Posted by 3dtp
All Board Scores are not created equally. I took one of my steps after returning from a mission trip in a country 12 time zones away, spending 13 hours on a train, 14 hours in planes and airports and then spending an additional 11 hours driving to the test center.

I hate to say this, but this was extremely poor planning on your part. If someone else plans better and gets a better score, that seems fair to me.

Perhaps, but it was even worse maintenance on an international airline's part which caused the first cancelled flight in the first place which led to the cascade. The choice was take it where it was scheduled and when or cancel and repay the fees. Or make the best of a bad situation. Which was done, successfully.