Programs that dont accept FMG

[kevinMD]

---

Members don't see this ad.

I havent seen a list of any to date, and yes there has to be programs, although no one will ever admit.

I am a 237/96 honors student with a masters, three years tox work at Harvard, several tox publications including primary author, and 1 year bioterrorism work for the goverment. I plan on applying to top programs only so as to gear towards research and bioterrorism tox, and would like to hear if anybody has any inside info. on programs that have a black list to foreign schools.

I have hear from reliable source that the Kings County program is one of these, anybody hear of anything else.

 

[Annette]

I havent seen a list of any to date, and yes there has to be programs, although no one will ever admit.

I am a 237/96 honors student with a masters, three years tox work at Harvard, several tox publications including primary author, and 1 year bioterrorism work for the goverment. I plan on applying to top programs only so as to gear towards research and bioterrorism tox, and would like to hear if anybody has any inside info. on programs that have a black list to foreign schools.

I have hear from reliable source that the Kings County program is one of these, anybody hear of anything else.

I wouldn't put your research wants first, if I were you, you might get contaminated by an FMG.

Have you ever noticed how the most impressive people are the ones that are the most modest about their accomplishments?

 

[southerndoc]

I plan on applying to top programs only so as to gear towards research and bioterrorism tox, and would like to hear if anybody has any inside info. on programs that have a black list to foreign schools.

I think some of the top programs still accept a foreign grad or two. Who can argue with the reputation of Cincinnati, Denver, Emory, etc.? They still accept foreign medical graduates who are qualified.

Have you ever noticed how the most impressive people are the ones that are the most modest about their accomplishments?

I agree, and I think this lad may find it difficult to secure a residency spot with what many will perceive as a Holier than Thou attitude. Many well qualified candidates are not ranked for this very reason.

 

[kevinMD]

I apologize, no disrespect, just caught informed about Kings, and I am alittle upset that people still consider this a negative.
thanks for all who reply

 

[trkd]

I think I remember something on the cook county website about requiring a year of US internship/training year before being considered. Not sure what it is all about but I guess that would preclude consideration for FMGs straight out of med school.

 

[southerndoc]

I apologize, no disrespect, just caught informed about Kings, and I am alittle upset that people still consider this a negative.
thanks for all who reply

No offense to Kings County, but I can't say that I've heard many people mention it as a top program.

I think you'll find that those who do not accept FMG's usually have an insecurity about their residency and do not accept FMG's for fear they will be labeled as a mediocre or subpar residency.

 

[MushieCookie]

No offense to Kings County, but I can't say that I've heard many people mention it as a top program.

I think you'll find that those who do not accept FMG's usually have an insecurity about their residency and do not accept FMG's for fear they will be labeled as a mediocre or subpar residency.

well said...

 

[bluebonnet07]

Kevin, who else but you can find it out? Just a hint: please go to FREIDA, find the programs of your choice and call them. They are usually pretty honest about how many IMG of FMG are there on the list. And please do not start your conversation in the way you just did it here 😛 . Another hint: go to the program’s site and find the list of residents. If there are no any FMG – this is a bad sigh for you. With my scores that are higher than yours, I do not consider to apply to these programs. I respect their choices and I am not going to waist my money or my time.

 

[EctopicFetus]

I think I remember something on the cook county website about requiring a year of US internship/training year before being considered. Not sure what it is all about but I guess that would preclude consideration for FMGs straight out of med school.

trkd,

I think you are confusing something. Cook county is a "2-4" program. As such you have to do your internship (PGY-1) before you can start the residency. I rotated there as an m4 and they DID have DO's, FMGS and nontrads.

Bottom line is that by being an FMG dont think that you dont have a chance there. So when you apply to any 2-4 program you are required to do a yr of US internship/training prior to starting their program.

Hope this clears this up!

Ectopic

 

[trkd]

trkd,

I think you are confusing something. Cook county is a "2-4" program. As such you have to do your internship (PGY-1) before you can start the residency. I rotated there as an m4 and they DID have DO's, FMGS and nontrads.

Bottom line is that by being an FMG dont think that you dont have a chance there. So when you apply to any 2-4 program you are required to do a yr of US internship/training prior to starting their program.

Hope this clears this up!

Ectopic

I just looked it up. In fact, it is not a year of US residency, the entire program. That is, unless I am misunderstanding (happens often 😳 ).

"International medical graduate (IMG) applications will only be considered pending completion of an ACGME approved residency program."

Don't get me wrong, I don't really care much as I am not too interested in that particular program. I just thought it was interesting.

 

[MD Dreams]

Just a couple of things:

I think it's important to differentiate between foreign grads and carib grads (myself being in the latter category). I think some programs that take foreign grads may not take carib grads 😡

Even the programs that have never taken foreign grads before may take one in the future. After all, someone had to be the first

If you find out which programs absolutely will not even consider a foreign or carib grad (even with high credentials) please share so that those of us applying won't be wasting our money

All the best

 

[MushieCookie]

Just a couple of things:

I think it's important to differentiate between foreign grads and carib grads (myself being in the latter category). I think some programs that take foreign grads may not take carib grads 😡

Even the programs that have never taken foreign grads before may take one in the future. After all, someone had to be the first

If you find out which programs absolutely will not even consider a foreign or carib grad (even with high credentials) please share so that those of us applying won't be wasting our money

All the best

That would be a great help...knowing which programs will not consider taking foreign/caribbean grads. I too am the latter...but will match in EM somewhere...knock on wood...

 

[EctopicFetus]

I just looked it up. In fact, it is not a year of US residency, the entire program. That is, unless I am misunderstanding (happens often 😳 ).

"International medical graduate (IMG) applications will only be considered pending completion of an ACGME approved residency program."

Don't get me wrong, I don't really care much as I am not too interested in that particular program. I just thought it was interesting.

I dont know but perhaps this "ACGME approved residency program" just means PGY-1. I know they had a carib grad. I dont know about FMGs from other places. When I interviewed at Henry Ford they had someone from Ireland and Orlando had someone from Germany.

Perhaps I am not fully getting the Cook County thing but I do know they had carib students on board.

 

[southerndoc]

Sometimes foreign grads, especially the European schools, have far better clinical accumen than we Americans. Americans rely more on diagnostic imaging and laboratory tests, whereas many of the Europeans are taught clinical assessment.

 

[trkd]

Sometimes foreign grads, especially the European schools, have far better clinical accumen than we Americans. Americans rely more on diagnostic imaging and laboratory tests, whereas many of the Europeans are taught clinical assessment.

In Aus, they also say that American docs go for far more imaging than Aussie docs. However, having rotated in both Aussie and US ED's, I am not sure how true this is. That said, I am just a student, and many docs in Aus have done US fellowships so they probably know better than me.

 

[trkd]

I dont know but perhaps this "ACGME approved residency program" just means PGY-1. I know they had a carib grad. I dont know about FMGs from other places. When I interviewed at Henry Ford they had someone from Ireland and Orlando had someone from Germany.

Perhaps I am not fully getting the Cook County thing but I do know they had carib students on board.

Yeah, I don't know EF. I guess if someone is interested in the program, they will just have to give them a call before applying.

 

[EctopicFetus]

Sometimes foreign grads, especially the European schools, have far better clinical accumen than we Americans. Americans rely more on diagnostic imaging and laboratory tests, whereas many of the Europeans are taught clinical assessment.

Isnt this usually just a CYA maneuver. It is crap like this that runs up the cost of the healthcare system in the US...

 

[EctopicFetus]

Oh and since we rely on this more we pay less attention to developing our physical exam skills.

 

[bulgethetwine]

Oh and since we rely on this more we pay less attention to developing our physical exam skills.

🙂


Of course, Ectopic is just responding indignantly (and, I might add, appropriately!) to the insinuation that less emphasis on PE skills during training equates with less reliable PE. I think this is only true for a very short period of time. I believe the following: On day ONE of internship, the foreign trained docs have generally spent a higher proportion of time honing PE skills, and less time brushing up their management skills. This means that -- and I qualify this statement with the acknowledgement that should be taken as a sweeping generalization -- the foreign trained docs, on average, are probably a little more comfortable, and yes, maybe even just a *little* better at their exam. The cost is they don't have as much background in managing the patient... what comes next in terms of imaging? Is CT appropriate? Ultrasound? Is this a surgical issue and/or are there possibly medical options to managing this case? Can I dispo the patient to the floor or to the ICU?

This occurs because U.S. seniors spend far more time involved in actually managing patients during their senior year. Sub-internships are gruelling, I'm not entirely sure they should be legal from a labor law point of view, and surely they are not entirely educational (i.e. a fair amount of scut-work flows their way). What are the other world-wide grads doing? A lot more observing. A lot more reading. A lot more practice of physical exam skills.

And finally, you'll notice that I said above that my belief that non-U.S. PE skills are better on day ONE of internship: I think all who have done med school in one system and then migrated to the other for post-grad training would agree that after a year or so, it's a level playing field (this goes both ways, too).

 

[Annette]

🙂
And finally, you'll notice that I said above that my belief that non-U.S. PE skills are better on day ONE of internship: I think all who have done med school in one system and then migrated to the other for post-grad training would agree that after a year or so, it's a level playing field (this goes both ways, too).

I agree that FMGs and USgrads end up about the same with PE skills, when trained in the US. However, I would bet the PE skills of a UK attending level physician would out do a US attending easily. Why? Less imaging, less imaging, less imaging. I rotated under a cardiologist who could tell what the murmur would be by the radial pulse, the jvd, and carotid. As a US resident, I just get an echo to confirm what I think I heard.

 

[BKN]

I agree that FMGs and USgrads end up about the same with PE skills, when trained in the US. However, I would bet the PE skills of a UK attending level physician would out do a US attending easily. Why? Less imaging, less imaging, less imaging. I rotated under a cardiologist who could tell what the murmur would be by the radial pulse, the jvd, and carotid. As a US resident, I just get an echo to confirm what I think I heard.

You know, after training at two institutions in the 70s where clinical acumen were very strongly emphasized, my prejudice is for figuring it out from the history and exam. I was always amazed at what the Baylor cardiologists could tell me about a murmur in the heyday of cardiac surgery for rheumatic and congenital disease. At Hopkins we were rather disdainful of those folks across town at shock-a-rama doing everything by protocol, particularly in the pre-CT era since that meant a 4 vessel angio on every head injury. I left the Hop feeling I could do almost everything without the studies and get it right 90+% of the time. I still am disappointed when my colleagues order a study without a clear idea what they expect to find.

But there are problems with that view:

1. We used to have to have the neurology resident come around and do a full exam prior to the scan. Most of the time they could tell you the location and the disease. Occasionally they were magnficently wrong.

2. Studies in the 90s looked at the reliability of physical exam, plain films and surgical pathology. Reliability for a statistician is a measure of agreement above chance between two equally qualified observers when there is no gold standard. If a measure is not very reliable, the information contained in the measure is essentially ambiguous. The measure for heart exams by cardiologists and chest exams by pulmonolgists agreed above chance about 60-70% . Radioogists reading xrays agreed somewhat better and pathologistson slides better still (up to low 90s). But. . . is this acceptable for the importance of the decsions being made with this material?

3. Abdominal pain without signs of a surgical abdomen is notorious for missed diagnosis. I did the models for an idea that Bob Gerhardt had. He collected all the historical and physical facts, lab data, abd plain films and CT for a series of patients. We then generated 4 models to attempt to predict the need for urgent intervention: 1. H&P alone, 2. add lab, 3. add plain films, and 4. add CT. Models 1-3 had increasing complex decision trees with relatively poor predictive value. In model 4 everything dropped out except the CT scan and accuracy improved. Around here it's called "the truth machine".

Remember, the missed important diagnosis rate at autopsy remained at about 30% throughout the 20th century. Even the most experienced, smartest clinicians will get it wrong frequently. All in all, H&P, judgment and all that are screening measures; technology is the answer.😎

BTW the thread highjacking is coming along well, thanks.

 

[totalbodypain]

BTW the thread highjacking is coming along well, thanks.

The old thread was waning in interesting content...Commence highjacking....

 

[bulgethetwine]

I agree that FMGs and USgrads end up about the same with PE skills, when trained in the US. However, I would bet the PE skills of a UK attending level physician would out do a US attending easily. Why? Less imaging, less imaging, less imaging. I rotated under a cardiologist who could tell what the murmur would be by the radial pulse, the jvd, and carotid. As a US resident, I just get an echo to confirm what I think I heard.

Well, I think you may be right. But I don't know if the UK physician would outdo "easily" the exam skills of the U.S. ... I expect the end game is closer than you think. Having spent significant time in both systems, that is my opinion, anyway. It's also a function of how many patients you see, not just imaging. At the consultant level, the physician on both sides of the pond has seen an adequate amount to be able to discern subtleties on an exam that many residents might not.

 

[basementbeastie]

I agree that FMGs and USgrads end up about the same with PE skills, when trained in the US. However, I would bet the PE skills of a UK attending level physician would out do a US attending easily. Why? Less imaging, less imaging, less imaging. I rotated under a cardiologist who could tell what the murmur would be by the radial pulse, the jvd, and carotid. As a US resident, I just get an echo to confirm what I think I heard.

how did you know if the clinical assesment was correct?

 

[southerndoc]

BTW the thread highjacking is coming along well, thanks.

C'mon BKN, I highjack threads covertly. You just had to call me on it, didn't you? 🙂

 

[BKN]

C'mon BKN, I highjack threads covertly. You just had to call me on it, didn't you? 🙂

You call that covert. 😕

 

[EctopicFetus]

🙂


Of course, Ectopic is just responding indignantly (and, I might add, appropriately!) to the insinuation that less emphasis on PE skills during training equates with less reliable PE. I think this is only true for a very short period of time. I believe the following: On day ONE of internship, the foreign trained docs have generally spent a higher proportion of time honing PE skills, and less time brushing up their management skills. This means that -- and I qualify this statement with the acknowledgement that should be taken as a sweeping generalization -- the foreign trained docs, on average, are probably a little more comfortable, and yes, maybe even just a *little* better at their exam. The cost is they don't have as much background in managing the patient... what comes next in terms of imaging? Is CT appropriate? Ultrasound? Is this a surgical issue and/or are there possibly medical options to managing this case? Can I dispo the patient to the floor or to the ICU?

This occurs because U.S. seniors spend far more time involved in actually managing patients during their senior year. Sub-internships are gruelling, I'm not entirely sure they should be legal from a labor law point of view, and surely they are not entirely educational (i.e. a fair amount of scut-work flows their way). What are the other world-wide grads doing? A lot more observing. A lot more reading. A lot more practice of physical exam skills.

And finally, you'll notice that I said above that my belief that non-U.S. PE skills are better on day ONE of internship: I think all who have done med school in one system and then migrated to the other for post-grad training would agree that after a year or so, it's a level playing field (this goes both ways, too).

I sure hope so! I purposely tried to spend extra time examining patients so my PE skills werent bad. As such I think and hope I am at least average as compared to my EM PGY-1 peers.

 

[Annette]

Back to the highjacking:

how did you know if the clinical assesment was correct?

Later ultrasound.

BKN is right about the technology issue, but a good neuro exam can be damned impressive.

Does anyone know how the term highjacking developed?

 

[southerndoc]

You call that covert. 😕

Nobody noticed until you called me on it.

 

[basementbeastie]

Back to the highjacking:



Later ultrasound.

BKN is right about the technology issue, but a good neuro exam can be damned impressive.

Does anyone know how the term highjacking developed?

thanks annette....were the cardiologists *impressively* correct most of the time?