I think you misunderstand what the difference is between a US graduate and an IMG. The US graduate is better qualified in almost every aspect. They went to a school that was certified, passed their board exams on a proscribed schedule, completed their (accreditted) clerkships on a proscribed schedule, etc etc. An IMG does none of these things. Having US experience and going through a US med school are two very different things. An IMG does none of these things. They went to a school with no LCME oversight, they performed US rotations with much less expectations than a US graduate and they can spend as much as time as they want studying for the board exams. That's what makes IMG graduates less desirable. On top of that, foreigners have to be sponsored and getting through visa paperwork is not an efficient use of time.
In this context, an American is easy to define. It's a citizen or permanent resident who has gone through US medical school training. An IMG, whether a foreigner or a US citizen, does not fulfill at least one of those criteria. It's no wonder that IMGs are less coveted by US residencies. IMGs should consider themselves lucky that they can even qualify for a residency. In most of the developed world, your foreign medical degree is essentially worthless. The barriers to practice are much higher in Europe for a foreigner than here in the US.
Your argument is reasonable, but I'll address some of the points raised.
I agree that the barriers here in Europe are much higher. This is unfortunate and is something I disagree with. I see this even with American graduates qualifying from our school here in Europe - they're ranked beneath even the lowest-ranked national student. I'd like to see the brightest, best qualified individuals get jobs - unfortunately this isn't the case.
You are definitely misperceiving the time available to us to study for board exam. While the stories of Postgraduate IMGs taking years off to complete their boards certainly pertain, this is not the case for those of us at Undergraduate level. We have approximately the same amount of time available as the average US student. It's even more difficult with Step 2 CS and CK as, in our school, we receive no designated time off or study breaks between our penultimate and final year, and so need to fit this in during our rotations. I'm sure this is the case in a lot of US school so, as I mentioned, I think the time available is comparable. It's not comparable, however, when an IMG takes 2-3 years off to complete their board exams. Thankfully, this is considered by Program Directors.
The standard of education here is non-inferior, though not superior, to US schools. This is demonstrated by our Board scores and the fact that we can perform to a similar standard as US students when we carry out Electives in the US. I, for one, received extremely positive feedback on my Electives in the US, and both my Step 1 and Step 2 scores are around 20 points higher than the US average.
One point I will make, and I think you were alluding to it, is the fact that the responsibilities of final year US students and final year European students are extremely different. I was taken aback by the fact that US students effectively function as sub-Interns and are valued members of the team for their final year - thereby creating a seamless transition from Final Year to PGY1. Here, we effectively function as Observers throughout Medical School. For this reason, I feel that some clinical experience is essential for IMGs before attempting to embark on a US Residency.
The fact that we're able to compete with US students for Residency spots isn't a right - it's a privilege. I feel that no IMG should take this for granted, and this is the reason we hold the US in such high esteem. The standard of Postgraduate training in the US is the best in the world by a long way. I'm very thankful for the opportunity to be able to compete for those posts.
Again, you articulated your points very well and your argument, as a whole, was reasonable.
EDIT: I just spotted your point regarding the completion of the Steps on a proscribed schedule. Again, it's a good point - there's no date by which we have to take the exam. Although it would be foolish to let it slide into the penultimate or final year, this is often done and probably not considered by Residency programs. I know this is also the case in a lot of US schools, but the curriculum is very, very different to our own curriculum (if that helps!).
