Residency Matches with Foreign Medical School Education

[ksub]

I applied to medical school this year, got waitlisted and didnt get in. I wanted to know if it's hard to get residency matches in the US if I was to attend medical school in the carribean or europe? Is it easier to get residencies graduating from a D.O. school or foreign medical school? Please advise.

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[Goofy]

It is indeed tougher to get residency spots as an IMG, and opportunities are much much more limited.

I think a much more prudent strategy for you would be to improve your application and reapply. If you were wait listed, chances are you just need a little extra push to gain the prized acceptance letter. There is any number of things you might do to improve your application, and I suspect you would be able to gain a slot next year.

Finally, an osteopathic slot is infinitely better than going to an international university. Osteopathic education has evolved to the standards of allopathic programs, making the education world class. Having said that, there is still old school prejudice that makes it difficult, but not impossible, to gain residency slots in the more competitive specialties. There is absolutely no comparison between an international and osteopathic education, the former is often questionable at best,while the latter remains an exceptional option for many.

Disclaimer: I have worked extensively in the admission process of a top tier allopathic program in a variety of capacities.

 

[The Pill Counter]

I don't think your opinion holds true for medical education received in UK/Eire, Aus/NZ for english language schools, and if one was multilingual, Western Europe and Japan. I think graduates of these schools have absolutely no feelings of inferiority. I know I won't. Options for graduates of schools from these countries do seem to have better prospects than you allude to. Also, as a member of an admission committee, how many DO applicants did your program accept?

 

[Goofy]

I don't think your opinion holds true for medical education received in UK/Eire, Aus/NZ for english language schools, and if one was multilingual, Western Europe and Japan.

You need to clarify what part of my opinion you feel is faulty. My comments about standards was admittedly vague and blanket. There are indeed fine foreign institutions out there, but they remain the exception rather than the rule. Osteopathic education in the US blows even these fine institutions away. US medical education remains world class and unmatched, there is simply no argument as far as I'm concerned. But your entitled to your opinions I suppose.

I think graduates of these schools have absolutely no feelings of inferiority.

I never insinuated that anyone does or should feel inferior. My gripe with foreign institutions is largely based on deficient standards when graded on the US model. Again, there are exceptions, but they are few and far between. The US IS the standard for medical care, and so is the educational system. This includes osteopathic pathways.

Options for graduates of schools from these countries do seem to have better prospects than you allude to.

This also depends on what meter you use. I'm not saying they don't have ANY options. There are lots of medicine/FP/peds slots for eager and astute FMG's. What I'm saying is that they are much more limited. More so than the limitations on osteopathic graduates. There are entire disciplines of medicine that are virtually closed to any type of FMG whatsoever. Osteopathic graduates regularly enter all disciplines, albeit with less success than their allopathic counterparts.

Also, as a member of an admission committee, how many DO applicants did your program accept?

My program would not be a good meter, as is very old school, placing enormous value in allopathic students. I can tell you that we have taken a handful of outstanding osteopathic candidates, but absolutely no FMG's.

Another point to consider. Osteopathic applicants have residencies in all of the disciplines designed specifically for osteopaths. So even if an osteopathic candidate is applying for something competitive, he/she always has the option to apply to a native osteopathic residency. FMG's also have a similar option, unfortunately most don't want to practice dermatology in zimbabwe.

 

[AndyWeill]

Actually, I'm at a prestigious residency program (and in a competitive field) that has no DO's, but a bunch of FMG's (from all over, including the Caribbean).

I discussed the DO issue briefly with the assistant program director, because my cousin is going to be a DO. Basically, our program is actually open to DO's, but only if they're outstanding, and also come from one of the better DO schools (he didn't say which ones, and I didn't ask).

His advice for DO's (or other nonstandard med students) was that there are thousands of residency programs, and that no matter which medical school you go to, somebody out there will prefer grads from school X over your school, even if it's Harvard. Also, you're only going to go to one residency program. Half the programs might not like you, but the other half won't mind, and that's more than you can interview at. If you go to a bottom tier US school, or a good DO school, or a reputable foreign school, there will be some discrimination, but as long as you're good enough, you still end up with plenty of choices, as long as you don't want something ultracompetitive.

Also, I suspect there may be some feeling that if you're a DO, why don't you stick to your DO residencies, if you think a DO is so great?


Personally, I disagree with all of this. If I were in charge ( ), I'd select my residents based on individual merit, plus whatever varied perspective or skill they would bring to the program, whether it was research, progressive attitudes/ideas, life experience, or joviality .

I may look like a foreigner, but sometimes I feel like I'm the only Real American left in this country....


Ksub, for your situation, if you don?t mind waiting a year and improving your application, that might be good idea, especially if you know right now that you will want something really competitive. I know someone who applied year after year, and after 6 tries, finally got into a US medical school. But he wasn?t in any hurry, and had to apply only to his local school for family reasons. But if you don?t feel the need to become a neurosurgeon, and you don?t want to wait for the med schools? permission to become a physician, then maybe you should investigate the alternatives more closely.

 

[Goofy]

Actually, I'm at a prestigious residency program (and in a competitive field) that has no DO's, but a bunch of FMG's (from all over, including the Caribbean).

I challenge you to divulge a bit more information than this, as your comments are almost impossible to believe.

As an active member of the residency search committee, I can tell you that DO's are definitely preferred over an FMG. It is possible that your program director has such a skewed view of residency applications that my rule isn't applicable. It is also feasible, at least in one's imagination, that I will be able to fly to work tomorrow.

I take your comments very seriously because people might act on them, having severe deleterious affects on one's career. An osteopathic education is 100% superior to virtually any foreign program, and this is how PD's see it.

There are any number of reasons to admit a DO over a FMG, number one on the list being financial. Admitting an FMG over and osteopath means the program loses several 100k. If your program is admitting FMG's en masse, than I assure you it aint as prestigious as you might think, and it aint getting a lot of applications from DO's. (sorry, I never learned how to spell correctlly.)

Goofy

 

[sleep disorder]

quick survey of a few ER residencies. started at the top, harvard/mgh.

resident DO: none
resident FMG: none
residents from the less prestigious US schools: none

faculty DO: none
faculty MD: can?t tell where they came from


then i looked at the other Er residencies in massachusetts that listed residents and faculty.

resident DO: none
resident FMG: 2
resident less prestigious US: some

faculty DO: none
faculty MD: can?t tell where they?re from


i bet if i looked more, i would find programs with DO?s and no FMGs, and vice versa, and programs with both, and programs with neither. i?ve met both DOs and physicians who graduated from foreign schools. good peoples.

always beware of stuff you read on the internet, including this; always beware of extremely strong views

what residency search committee is k on?

zzzzzzzzzzzzzz

 

[Goofy]

quick survey of a few ER residencies. started at the top, harvard/mgh

Is this rubbish what you regularly pass for a scientific study?

i bet if i looked more, i would find programs with DO?s and no FMGs, and vice versa, and programs with both, and programs with neither. i?ve met both DOs and physicians who graduated from foreign schools. good peoples

Nobody is doubting whether these are good people. It seems you have been personally offended by comments that are mere observation. I have nothing personally against FMG's. I'm simply stating what I feel to be blatantly obvious. I'm certain that you probably went to a fine international program. That doesn't mean you will have more opportunity than an osteopath.

always beware of stuff you read on the internet, including this;

I couldn't have said it better myself. You expect people to take you seriously when you wont even register to post? An anonymous first time post just in time to respond to me? I am honored. I have been here for quite some time. I suspect you have too, and perhaps were slighted by my forceful yet truthful tone in the past. Come clean and register if you expect your chicanery to work.

zzzzzzzzzzzzzz

We are all better off with you catching z's than spreading incredulous and hollow information from an anonymous moniker.

 

[Goofy]

These are not statements of fact, but opinion and, at root, values. QUOTE]

Thanks for the public service announcement. Anyone who knows me realizes I am quite forthcoming with my opinions. It might surprise you to learn that some value them so much so that they have gained interviews and even acceptances to medical school on my advice. Further, my experiences now extends to residency search committees as well. I am now initmately involved in the resident application/interview/evaluation/rank process. But don't take my word for it, after all I'm just saying so.

Since you have decided to take issue with the glaringly obvious, that these are MY opinions, I thought I would share some others. It is also my OPINION that Usama Bin Laden represents evil on earth. But don't take my word for it, after all this is mere opinion.

Furthermore, these statements add nothing to the advice asked for in the OP. The fact that the writer felt a need to embed them in his response says more about his bigoted views than about that of which he has written.

I don't give a damn whether you feel my comments 'add' anything. If I have an opinion/thought or otherwise to express, I will continue to do so free of your oppressive censure. Further, your infantile assesment of my 'bigotry' reveals a startling lack of insight in your condemantion. I have actually been one of the more outspoken supporters of excellent FMG physicians. But the fact that I'm of the opinion that the university of baghdad doesn't offer the very best in medical education doesn't make my OPINIONS any less valid.

Of course these are my opinions. It will likely dishearten you to learn that the American medical establishment, as a whole, also seems to embrace and believe these thoughts to be intuitively obvious. I share their opinion that american medical education, be it allopathic or osteopathic, remains the gold standard and meter for others to strive for. The end result is far far less opportunity in my beloved country for FMG candidates. AMG candidates can do virtually anything they want at top tier training programs. What those top tier programs are is also a matter of debate, by I kinda like harvard, hopkins, and yale. I'm certain you believe the university of nairobi is of the same caliber.

That you feel otherwise is acceptable. You are entitled to your opinions, something you have selfishly denied me of. You are also entitled to be wrong.

 

[drusso]

I'm a D.O. and I'll be at Mayo next year for residency. I know several D.O.'s who matched in competitive specialties at several "brand-name" institutions (Harvard, Hopkins, Yale, Cleveland Clinic, UCSF, UCSD, WashU, etc). I really think that the whole residency match process has more to do with individual merit, board scores, letters of rec, audition rotations, and life experience than it does with type of medical degree earned or where you went to school.

To answer the original poster's question: I do think that it is much easier to match as a D.O. than as a FMG. D.O.'s are a known commodity and are well integrated into the whole medical education infrastructure. There is a perception that foreign schools are all fly-by-night operations just out to make a quick buck on vulnerable premeds who didn't have the qualifications for a US medical education. This is, of course, not true. Still, the perception exists...

Here's another issue to consider: Do foreign graduates qualify for military/public health scholarship programs during medical school like US-trained MD and DO's? All the literature I've ever seen from recruiters includes fine print to the effect, "Must be enrolled or graduated from an accredited school of medicine or osteopathic medicine."

--dave

 

[ckent]

I'd like to get into this arguement too. I think that Kleb puts the american medical education system on too high of a pedestal. I go to a mid-ranked state school, and I have not witnessed them doing anything to us that was so extraordinary that foreign schools could not replicate; at no point has anyone sprinkled holy water on us to make us all better docs. Don't get me wrong, if your goal is to be a doc in the US, then your best bet is to enroll in a school in the US. Residency programs do favor AMGs, they get more money from the government to train AMGs vs IMGs, and residency directors like knowing what type of education a graduate has received. I do not think that having an american education automatically makes you a better doc though. I've never been to a foreign medical school, but I don't see any reason why our teachings in the basic science years would be all that different. During my first year, we were taught by PhDs whose "expertise" in their lectures were not derived from their obscure research, but rather looking things up in texts and on the internet, both resources providing the same information to professors in other countries. When you have an IMG who takes the USMLE and scores higher then an AMG, I don't see how you can assume that the AMG has a better grasp of the material then the IMG simply because the AMG graduated from a US med school and the IMG "probably took a Kaplan course". I don't feel as if our physical diagnosis skills are up to par with med students in some other countries, we have an over-reliance on labs and imaging studies to make our diagnosis that has resulted in a progressive atrophy of our physical diagnosis skills over the last few decades. And our screening process for picking medical degree candidates is by no means perfect, our medical education system has graduated at least 2 serial killers in the past. And I still would argue that the lowest ranked AMGs make worse physicians, minus the language barrier, then most of the IMGs who are accepted to train in this country. You have to be very hard working and score significantly higher then AMGs to beat them out for spots because of the barriers that exist. And I know that many of my student colleagues, myself included, even this late in our training, are not anywhere near the medical gurus that Kleb seems to think that we will become as a result of our "prestigious" US medical education.

 

[El Duderino]

Klebsiella, the fact that American hospitals prefer AMGs doesn't prove that AMGs necessarily are better trained (although this may well be the case, it doesn't necessarily follow from what you have posted earlier).

And FYI, there are some pretty good universities outside of the US, and that you haven't heard of them (or refuse to acknowledge them) probably says more about you than it does about those universities.

Sorry for being such a crybaby, I just find it mildly disturbing that you would disparage every single non-US university, when it is quite obvious that your perceptions of the rest of the world are based on prejudice.

 

[womansurg]

kool thread!

Crepitus...I wouldn't care to take you on in debate class.

Now, if we are all honest then we will admit, that the USUAL route of entry into programs is something like this...

"gee.. I'll try to get into allopathic schools...if they won't take me I'll try to get into osteopathic schools...if they won't take me I'll try international schools..."

Many exceptions exist! I know brilliant high-scoring folks who subscribe to osteopathic principles and applied soley to those programs. However, that descriptor is the most common one.

In some cases, folks didn't have their act together, did poorly in undergrad, ended up in a DO or International school, then found their focus and excelled from that point on, ending up in prestigious residencies. Great!

And let's do all admit that the VAST majority of your learning occurs in post-graduate training and beyond. I've forgotten and replaced about 90% of the silly minutiae I choked down in medical school.

Bottom line: get into medical school...any medical school...any philosophy which suits you and with which you are comfortable...then make your own way in the medical community. Excellent board scores and LORs from ANY training program are going to get a second look from any reasonable admissions committee. Yeah, there's going to be some bigots our there, but that holds true in any arena of life.

Good luck, all!

 

[Splinter]

Sleep Disorder,

You must not be looking very hard because there are many DOs in competitive EM Residencies. Stanford, Brown, UCSF, USC, and so on....At these same programs, I don't see any FMGs and certainly no Caribbean Grads.

I think a distinction needs to be made between schools such as Oxford, Tokyo, and other such schools and the rest of the foreign medical schools. There are excellent medical schools outside of the US, but most of the graduates of these institutions remain in their own countries. Most of the FMGs who apply for the match throught ERAS did not go to one of these institutions.

I also have to disagree with ckent in that schools don't make a difference because most of the informations are in textbooks. The clinical experiences and the professors are vastly different. You can't just learn medicine from a book and while the professors derive much of their lectures from a textbook, there is still a difference otherwise we could all teach ourselves medicine. The good professors/attendings are the ones that can filter all that information and draw relevant clinical correlations and focus you in the right places. Certainly the Dominica has a problem drawing good professors. I've worked with many students from the Caribbean and some are good but many are just downright terrible. There is little quality control and the students that do well on rotations have busted their butt and studied on their own. Many can regurgitate factoids here and there from information they've seen in Surgical recall and the likes but they don't really seem to know the pathophysiology of the disease. While the art of the physical exam may be lost here in the US, don't think it's much better with most of the FMGs out there. There are some brilliant FMGs that I've worked with who are residents. You know what? Most of the brilliants one did not go to the Carribeans and have already completed Ortho, Nephro fellowships, and all types of other residencies/fellowships in their own country.

I don't think USMLE scores in and of itself is a good indicator or clinical proficiency and knowledge. Scoring well isn't enough in my mind. The clinical years are important as well and the fact is that you don't really know what the clinical exposure is like for many of these students. Many of the ones I've worked with are equally unhappy about this as well. During my internship, I worked with a Carribean grad who was just about to start his internship and didn't know the basics such as what a sliding scale was, didn't know how to write admit orders, didn't know how to workup an acute abdomen, left out a ton of things in the H&P, and so forth. I know that this has been just my experience but it happened many, many times. The fact is that Carribean students can get away with doing practically nothing if they want to and I'm not saying that all do. You can't really do this with Amercian schools. Many Carribean schools tout rotations in US hospitals as a way of drawing in more students. Why is that? My guess is that they also view rotations at US hospital as more desirable. The rotations available to the Carribean students are often times at community hospitals or any private physician that will let them follow then around for a month.

My message is that it is the quality control of the matriculants and graduating physician that makes the difference. Most of us wouldn't bust our balls like we do during the medical school and especially on rotations and shelf exams if we weren't forced to. Plus, most of us are given about three weeks to prepare for first part of the boards.

This discussion has really digressed but my answer to the original question is that it is by far easier to get a good residency as a DO than a FMG. The top reasons are the funding, our own osteopathic residencies, and graduates of a US education and the quality controls that come with it.

Finally, when comparing the number of FMGs to DOs in a residency program, be aware that there are 10-20 times more applications from FMGs all over the world when compared to apps from DOs. If FMGs were equally successful at matching into ACGME programs, you would see 10-20 FMGs for every DO assuming match rates were equal. This certainly isn't the case. A few links to some Emergency Medicine Residencies since it was brought up (inlcuding DOs in EM residencies in MA) can be found below:

http://www-med.stanford.edu/emed/resinfo/class2003.html

http://www.uchicago.edu/bsd/emmed/2000/fr_resid.html

http://www.ucsfresno.edu/em/residents.htm

http://www.summahealth.org/edu/programs/em/emerg_med.html

http://web-orion.uhmc.sunysb.edu/er/residents/resident.htm

http://www.kmcemed.edu/resprofile.html

http://www.mcw.edu/ertrauma/emresidents.html

http://www.sw.org/depts/emermed/gme/res.htm

http://www.baystatehealth.com/3489/1030/2289/Residents/General_General_r.html

http://www.uicomp.uic.edu/erres/WhereFrom.html

http://emergency.ucdmc.ucdavis.edu/Residency/res_residents4.htm

http://www.usc.edu/schools/medicine/academic_departments/emergency_medicine/

http://emergencymedicine.iusm.iu.edu/Alumni.htm

http://www.brown.edu/Administration/Emergency_Medicine/emr/pages/reslist.htm

 

[jimdo]

Im repeatedly amazed how people can claim to know what is the general trends throughout medicine. Why is this? Because they have heard of a friend of a friend with a particular experinece. Realize this...what you know or think you know is based upon your experience or second hand knowledge. This is a very small amount of information so before you go around speaking of the trends in medicine and, remember that blanket statements based upon limited experience are rarely helpful or correct.

 

[Future GI Guy]

Though I have hardly ever agreed with Klebsiella in the past, and probably won't agree with him in the future, I have to say that he's 100% correct in his opinion.

From a purely economic standpoint, residencies get more money from the US Government (through medicare) for US Trained Physicians than for FMG's.

Money is everything in healthcare.

If you don't think that makes it easier to match from an osteopathic school, then think again.

I assure you, the DO's in my hospital are extremely well respected, much more than the Neurology residents from overseas whose extreme level of imcompetence often jeopardizes patient care.

 

[The Pill Counter]

You're making the same stupid generalisations. What does the neurology resident at your hospital have to do with this?

 

[El Duderino]

Imcompetent? That's unpossible!

 

[Future GI Guy]

Thank you El duderino.

Your fine-tooth-combing for spelling mistakes has really added a new insight to the thread.

Imcompetence stands. It will not be corrected.

 

[Future GI Guy]

To The Pill Counter.

First: a stern warning. You have a spelling error in your previous post, and because of that, you should fear the wrath of one Swedish poster who shall remain nameless. Beware, and be afraid. Be very afraid.

I agree that it is a generalization to say that all Foreign Medical Graduates are substandard to American trained DO's. It's not fair to those who trained at fine institutions in Japan, Australia, NZ, Canada, South Africa, and some European countries.

But these are places where medicine is advanced, and it is taught well. There are standards in place to promote good physicians and standards in place to weed out poor ones.

Keep in mind, however, there are places in the world which don't have the same standards, which produce physicians only to send them to the United States.

These people turn into residents who are often substandard when compared to osteopaths.

All I'm saying is, if given the choice between training at a DO school in the states or at an MD school on an island somewhere, I'd choose the DO school.

There's a wonderful article about this in the latest edition of the New Physician, though it doesn't directly comment on DO's.

 

[The Pill Counter]

GI Guy - point taken, and by the way, there is no spelling error. Generalisation is the English spelling in the British tradition. The substitution of 'z' for 's' is an American invention.

 

[Future GI Guy]

Pill Counter,

Sorry to digress, but because I'm a 4th year medical student, I'm pretty much watching television all day.

Anyway, I saw a story about the Webster Dictionary, and how it often changed British English words to make them more simple to pronounce when read.

Such words included the change of "centre to center."

I guess we Americans really are lazy when it comes to spelling.

 

[El Duderino]

You have a spelling error in your previous post, and because of that, you should fear the wrath of one Swedish poster who shall remain nameless. Beware, and be afraid. Be very afraid.

Yeah, I'm positively fuming...

I thought some people (perhaps even you) would agree with me that misspelling 'incompetence' while complaining about the ineptitude of others could be considered at least slightly amusing. Sorry if I hurt your feelings, I'm just a dumb foreigner after all. No, wait, I'm not - I'm in my home country! Ah, the confusion...

On a serious note, I would agree with you that the American system of letting people practice medicine as long as they pass a couple of HIGHLY theoretical tests that have NO bearing on how you would act in a tight spot could well pose some problems. Especially so considering that residency (not to mention working as a specialist) is so much more lucrative in the US than in most other countries (oil emirates and the likes excluded).

As someone has pointed out, the people most likely to emigrate may not be the best students of their class (as they would have no problems securing decent positions in their home countries). This probably increases the problems of adverse selection as well.

The question is, of course, what to do about it. One solution would be to tighten the demands on international medical schools - as we all know, not all WHO-accredited schools are equal. Such a measure would restrict the USMLE testing procedure to only those who have attended medical schools that meet certain (additional) demands. It would probably mean less money to the USMLE bureaucrats, but I'm sure someone could come up with drawbacks as well...

 

[The Pill Counter]

Good point El dude, of all the industrialised nations, the US is the easiest for a foreign-trained doctor to obtain a medical license. I wouldn't have any problems in making the requirements more stringent, as long as the opportunity was still there. After all, isn't that what the US is about, opportunity?

 

[Future GI Guy]

I think there are additional problems, as well.

For instance, I know of a 3rd year resident in internal medicine who was a critical care specialist in a W. European country.

This person is going to do a Critical Care Fellowship next year.

There's no good reason this person should be forced to repeat their 5 years of training when it's obvious to me that their originial training was more than adequate.

So, for certain trained physicians, the rules are perhaps too strict.

The problem in the US is that the government funds this whole endeavor from the wrong end. Instead of funding, say, 18000 residency spots (while only maintaining 10,000 medical student spots), they should increase the capacity of current medical schools or build new ones to help meet the demand. There are plenty of young people in this country (about 30,000 applicants per year) who would love to go to medical school and who could do well, but because of some excess partying at college or a bad exam here or there, they're excluded from training programs.

 

[Goofy]

Originally posted by The Pill Counter
After all, isn't that what the US is about, opportunity?

You got it all wrong bub. The US aint about opportunity for you and we make no guarantees whatsoever that foreign born md's have ample 'opportunity' to train here. We also don't guarantee guarantee saddam hussein the possibility of asylum. This is a very selfish country, and rightfully so. It is motivated by one thing and one thing only, it's own self interest.

The only reason why foreign born MD's get in at all, is because it's in the US medical establishment's best interest to do so. The flip side being these foreigners receive the best medical training to be had. We certainly don't guarantee 'opportunity' for those outside this country. One thing I 'guarantee' is that if residency slots were ever to become scarce, foreigners would be the first locked out of the system. Consider it an honor and privelege that you have this so called 'opportunity' to train in the medical heartland. If you don't agree, than please apply for the residency slot that has just opened at Baghdad university. Perhaps that 'opportunity' is more to your liking.

I wont debate this last point because it is so intuitive. Those that disagree would argue Sudan is at the cutting edge of medical technology. That other countries also provide fine education doesn't mean it's the norm, and certainly doesn't put them on the level of the US.

 

[Goofy]

All I'm saying is, if given the choice between training at a DO school in the states or at an MD school on an island somewhere, I'd choose the DO school.

I think all of the naysayers on this board would agree with you too. Anyone who would opt for island medicine over a US DO program is in terrible need of medical care themselves. Debating this issue is an act in futility. I hope those who have these two choices will indeed heed my advice, rather than convoluted and misguided ideas by disgruntled foreign MD's who fail to recognize glaring standard limitations.

 

[El Duderino]

Kleb, maybe you have to understand that "the rest of the world", although a very comfortable expression when you want something to frown upon, is not as homogenous as you seem to be thinking.

First of all, the way you dismiss "foreign born MDs" as somehow necessarily having received inferior training is quite uninformed. At least Future GI Guy (sp?) acknowledges that there are very prestigious medical educations outside of the US.

Now, I wouldn't argue against someone saying that Harvard (or whatever) offers the single best medical education in the world, but I would argue against the idea that US medical education as a whole is vastly superior to that of other countries of comparable wealth (Canada, Australia/NZ, W.Europe etc). Perhaps this isn't what you are saying, but it certainly sounds that way.

OTOH, I think it's perfectly reasonable that AMGs are given the upper hand when it comes to residency slots in the US, and I commend your system of giving people a reasonable chance no matter where they are from - even though the system may well need tweaking.

My $0.02, nothing more.

 

[Goofy]

Kleb, maybe you have to understand that "the rest of the world", although a very comfortable expression when you want something to frown upon, is not as homogenous as you seem to be thinking.

Thanks for the public service announcement. We now return you to our regularly scheduled show...

First of all, the way you dismiss "foreign born MDs" as somehow necessarily having received inferior training is quite uninformed.

Instead of offering up clap-trap rhetoric, go back and read my comments until you understand their full meaning. I never said they were 'necessarily' inferior. Your reading comprehension seems to be the only thing that is 'necessarily' inferior.

At least Future GI Guy (sp?) acknowledges that there are very prestigious medical educations outside of the US.

I'm glad that 'GI Guy' was able to make you feel all cozy and warm. Frankly watson, I don't give a damn. Again you have completely missed a very clear, cogent, and coherent point. You have also adulterated my views. It's much easier to debate points that I never made I suppose.

Now, I wouldn't argue against someone saying that Harvard (or whatever) offers the single best medical education

How noble of you. Glad you have given this notion your blessing. Again, I could care less.

but I would argue against the idea that US medical education as a whole is vastly superior to that of other countries of comparable wealth (Canada, Australia/NZ, W.Europe etc).

Your entitled to argue. You are also entitled to be wrong. I have elucidated the point ad nauseum, but will repeat it for your edification. Other fine institutions exist outside the US. They are the scarce exception, rather than the rule. Even the most base medical education in the US will usually be superior to even these fine institutions.

Perhaps this isn't what you are saying, but it certainly sounds that way.

At least one of my points made it through. It is indeed what I'm saying. Everyone knows it to be true. The tens of thousands of Foreign MD applicants a year know it to be true. The US medical establishment knows it to be true. Thats why even a London trained surgeon must start residency ALL OVER again if he/she wants to practice in the land that gave birth to elite medicine. This point is intuitive, and your arguments smell of an inferiority complex more than anything else.

I commend your system of giving people a reasonable chance no matter where they are from - even though the system may well need tweaking.

It's nice that you appreciate a gift horse when you see it. On the other hand, I assure you this opportunity isn't being offered out of the goodness of our heart. The US medical system NEEDS foreign MD's to help fill a disciplinary shortfall. That is the only reason they are permitted to train here, plain and simple. Those foreign MD's who do get in should rightfully be thankful for such a remarkable opportunity.

even though the system may well need tweaking.

All systems need tweaking. But that doesn't mean it aint the absolute best in medical education.

My $0.02, nothing more

Keep the loose change.

 

[Global Disrobal]

Greetings all,

Its interesting to read the posts. I too would not dare take Crepitus on as he makes valid points, impartial statements, and does not resort to high school brand grandiloquency to make himself sound above others.

I think that K is correct in stating that DO's are at an adv. over IMG's in obtaining residencies, but I also believe that his statements should cease there as the rest is BS.

Bottomline: regardless of the institution of graduate training, it is the person, his qualities as a human and a physician that make the doctor not the name on his diploma!

K, one last word of advice: When you begin to over state your rank and position you only begin to diminish the value of your words... Think about it!

Regards!

 

[BellKicker]

I think people are talking about 2 different things here.

Getting into a US residency: Yes, US schools are better. Every country favors its own grads. That's just natural.

Quality of education: Many countries are on about the same level. I think most people agree on that, don't they?

Klebsiella, you're one crazy IMG. I wonder if you are like this in real life or if it's all an act.

 

[El Duderino]

go back and read my comments until you understand their full meaning. I never said they were 'necessarily' inferior

Well, you have said that American education is superior - wouldn't that imply that education received elsewhere is inferior?

I kinda like harvard, hopkins, and yale. I'm certain you believe the university of nairobi is of the same caliber.

This statement amply shows that you have a very poor understanding of what the world actually looks like outside of the US.

Thats why even a London trained surgeon must start residency ALL OVER again

The reasons are of course political rather than medical.

if he/she wants to practice in the land that gave birth to elite medicine.

This will doubtlessly elicit yet another torrent of impoliteness, but FYI most scholars contend that Baghdad or Cordoba gave birth to medicine. What would you consider to be 'elite medicine' that is not practiced in other countries?

The tens of thousands of Foreign MD applicants a year know it to be true.

Where do they come from again? India and Pakistan account for a third of all IMGs. The European country that supplies the most IMGs is the UK, which contributes an astounding 2,4%. As far as I can see, this number even includes Americans trained in the UK returning home for their residency.

To sum things up:

You seem to be saying that American medical education is above and beyond the rest of the world. I'm saying that while it may well be the case that the single best institution is in the US, medical training in countries that have comparable standards of living is pretty much alike. Now, they may not be alike in the eyes of American program directors sorting through a bunch of applications, but that is not a very objective indicator, is it?

 

[Imhotep]

Finally, a clear, concise, and cogent post. Good work, Crepitus!

 

[BellKicker]

El Duderino, where did you get those numbers? Do they keep statistics for each region, like Scandinavia, etc? Are they match applicants or residents?

Good post, by the way.

 

[orthodude]

I am an osteopathic student. To the original poster, do what you think is best for you, be that a DO school or a foreign school. It doesn't really matter where you graduate from . As long as you are prepared well, you will do fine in getting a residency. Good luck.

 

[El Duderino]

BellKicker:

http://www.ama-assn.org/ama/pub/category/1550.html

Sadly, it only lists the 'top' ten IMG countries (and it only shows IMGs who are either in or past their residency).

If anyone else has more stats on this, please let me know.

 

[hayixie]

Crepitus Fremitus and El Duderino are thoughtful.

 

[placenta]

My opinion...
Obviously US med schools are ideal. I wouldn't wait around forever though unless time doesn't factor into the equation for you. How many years do you want to waste trying to get into a US med school? Bigots run rampant in med school admissions committees. I know first hand after excelling in undergrad at a highly competative school (3.9 GPA) with average MCATs (27), strong supporting credentials and a MPH to boot. They still rejected me 2 years in a row. Why? I haven't the slightest clue. People who I considered much less competative than myself got in. Did it have anything to do with race? I wouldn't dare speculate.

In any event, I went to a foreign med school (St. George's in the Carribean) cause I refused to wait any longer and because I wanted to become a MD, not a DO. Just a personal preference. I ended up transfering to a US school after my 1st year and am currently doing my residency at a top ten program. St. George's prepared me well for my US school. In fact, I think the basic sciences were superior at St. George's and I felt more prepared than my US med student counterparts.

Many of my buddies who remained at SGU ended up getting very good residencies in most fields. A few got prestige schools, but most got into very strong programs nonetheless. Derm and Ortho are tough to get as a FMG. You need to kick butt if you want that, but otherwise you can get a good residency from St. George's.

If you have a strong desire to become a MD and don't want your fate in the hands of a US school (and prefer not to wait anymore), I would suggest St. George's. I can't comment on going to DO school cause I never considered it for myself.

 

[orthodude]

In my opinion, DO school opens up a lot of opportunities. As a DO student you can apply to DO residencies as well as traditional allopathic residencies. When I decided to go to DO school, I took this into consideration. Osteopathic residency programs are open only to DO students. If you are a strong candidate you can possibly match into the most competitive programs such as derm, ortho, optho etc. That's a huge advantage, at least in my opinion. But, some people hate explaining what a DO is during med school. After med school, no one really care. Anyway, as I said before, it's a personal choice. DO, MD, IMG same thing, no difference among them in hospital, where it matters.

 

[neilc]

give me a break, kleb...

there are many outstanding universities that teach medicine as well as or better than the US. they often use different systems, have different methods of instruction/examination, etc. but still remain outstanding.

i agree that the US is the best at providing an american medical education, but that is not the goal of all medical schools. the goal is to teach medicine. i am outside the US, i am being provided an education that is just as good as any in the US. the usmle scores from my school are outstanding, and we are not ever given usmle style tests or any preparation. there certainly are some questionable schools out there, in the caribean and elsewhere, but the statement that US medical education is the best is simply ridiculous.

also, i think if you look carefully you will find internationally trained doctors in every specialty of medicine in the US. not to say that there is not a bias in some specialties against img and do, or to imply that it would be easy or usual to get a residency in, say, dermatology. but, it has been done, and will likely be done again.

i am glad you are so proud of the medical education available in the states. as an american, i also agree that we do an exceptional job training doctors in the us. but, there are plenty of schools out there that also do this very well.

i hope you see that this is not an attack on the US style, or an attempt to even compare my education with the US. the reason for this post is to merely request that you open your eyes to the reality that there is more than one way to do something well.

 

[Thewonderer]

Originally posted by Future GI Guy
I agree that it is a generalization to say that all Foreign Medical Graduates are substandard to American trained DO's. It's not fair to those who trained at fine institutions in Japan, Australia, NZ, Canada, South Africa, and some European countries.

Sorry to be picky about this point
Canadian med schools are accredited and monitored by the same governing body, namely Liason Committee on Medical Education, as the American med schools. Hence, both American and Canadian schools appear in the same book, "Medical School Admissions Requirements," published by AAMC. To say that Canadians receive different education from Americans is to not recognize this point.

A couple anecdotes. I hanged out with a couple med students from Taiwan and Germany last year while on rotations. Apparently, their first couple years of clinical experiences consist mostly of "shadowing." In other words, they take little patient responsibilities and can ask residents questions but do not get their hands "dirty" and do not get to lead the course of pt treatment. Then, in Taiwan, their last year of med school is called "internship," but the duties consist mostly of what 3rd year med students do in the US. Hence, even though in Taiwan, they have 3 years of clinical rotations, they are simply not as rigorous as the 2 years of clinical rotations mandated by American schools. I did not get to clarify this point with the student from Germany.

A third-year medicine resident also joined my medicine team to eat lunch one day and mentioned his 2-month away experience @ Oxford (i.e. The Radcliffe Infirmary). He was horrified at how difficult it is to get the med students over there to "pre-round" on the pts (i.e. you collect vital signs and follow up on overnight hospital course before residents or attendings get to the patients) and how little reponsibilities they had in terms of pt care. However, that could be team-dependent.

I wonder if anyone can please confirm or refute the stories above.

In the US, they do prescribe to the philosophy of throwing students onto the wards and ask them to be an integral part of the team right away. In some aspect this speeds up the learning curve but that also makes the situations very stressful for students.

 

[rtk]

It's interesting that the original poster's question was 'what are a person's chances of matching into a US residency program as an IMG?' This wouldn't be a question of odds if the tables were turned... Imagine as a US med school graduate applying for residency in any other country. It wouldn't happen (okay, perhaps western Europe... but certainly not from middle-eastern and arabic countries, where the vast majority of IMG's in US residency training originate).

The only reason that non-US citizens and foreign trained physicians can even get residency training in the US is that they are allowed to by law. And the irony is, US tax payers pay their salary. Interesting also that an FMG doesn't pay income taxes on their 35-40K resident salary while they are here in training.

I realize that I digress from the original topic, but I find it remarkable that there is even a question that a US citizen and US medical graduate (DO or MD) would have to compete w/ IMG's for a residency position in their own country...

From a historical perspective, international med grads were recruited to the US when it was predicted there would be a shortage of US trained physicians back in the 1960's w/ the advent of Medicare. As residency programs proliferated, more residents were needed to run hospitals, and hospitals increased their cash flow w/ the more resident's they had. Now we're in the position of more residency positions than US graduates.

Although there are many well-trained international medical graduates, it's a true "Fleecing of America" that US tax payers continue to subsidize training of internaltional graduates when there's already a glut of physicians in the US and US health care = nearly 20% of the GDP.

 

[drusso]

Originally posted by rtk


Although there are many well-trained international medical graduates, it's a true "Fleecing of America" that US tax payers continue to subsidize training of internaltional graduates when there's already a glut of physicians in the US and US health care = nearly 20% of the GDP.

I think that you've nailed the issue on the head. What's more, special interest groups are emerging to protect the rights of FMGs to come to the US to practice medicine. Caribbean schools have even formed political action committees (PACs) to lobby congress to prevent restrictions on training physicians from non-LCME and non-AOA accredited institutions (You ever wonder where that off-shore exhorberent tuition goes to??). It appears that an argument is being put forth that the US-government, via direct and indirect federal funds from medicare and medicaid, has a social obligation to train foreign physicians and US-FMGs who could not gain admission to a US-accredited medical school. Strange days are these...

 

[The Pill Counter]

Sounds about right.
I emailed the program director at University of Toronto for Neurology and asked him that if I trained in the U.S after finishing med school in Australia, how hard would it be to get a PGY-5 spot to qualify for RCPC exams (Canadian neurology residencies are a year longer, so American neurologists would need to do an extra year of residency to qualify to sit Canadian examinations) - his response?

"Impossible, no funding"

And I grew up there...
It's pretty obvious that the opportunity and generosity of training opportunities in the U.S is unparalleled. I agree, even as a prospective IMG in the future, I should be second in the pecking order after US grads have matched, but even more preferable would be if Canada eased its restrictions.

I find it hard to believe an IMG doesn't pay income tax, any proof to back that up?

 

[Goofy]

Originally posted by The Pill Counter
Sounds about right.
I emailed the program director at University of Toronto for Neurology and asked him that if I trained in the U.S after finishing med school in Australia, how hard would it be to get a PGY-5 spot to qualify for RCPC exams (Canadian neurology residencies are a year longer, so American neurologists would need to do an extra year of residency to qualify to sit Canadian examinations) - his response?

"Impossible, no funding"

And I grew up there...
It's pretty obvious that the opportunity and generosity of training opportunities in the U.S is unparalleled. I agree, even as a prospective IMG in the future, I should be second in the pecking order after US grads have matched, but even more preferable would be if Canada eased its restrictions.

Pill counter, Your sentiment is refreshing. Some of the invective weilded as irrefutable nonsense in this thread is utterly amazing. I suspect that your attitude will carry you far. There is room for respectful well meaning and intelligent IMG's in the American system, the pillar of medical education. Those that would refute this intuitive truth are more than welcome to enroll in Zimbabwe's medicine residency program.

There is little in the way of opportunity for those outside the country who feel the US owes them a living.

I find it hard to believe an IMG doesn't pay income tax, any proof to back that up?

I think you are missing the point the above poster alludes to. Certianly IMG's pay income tax when they train in the US. This is a rather nominal fee however when viewed on a more grandiose scale. What the above poster is alluding to are the large federal grants that fund residency training. This money comes not only from IMG's training here in the US. It comes from all taxpayers.

 

[BellKicker]

Originally posted by rtk

The only reason that non-US citizens and foreign trained physicians can even get residency training in the US is that they are allowed to by law. And the irony is, US tax payers pay their salary. Interesting also that an FMG doesn't pay income taxes on their 35-40K resident salary while they are here in training.

I realize that I digress from the original topic, but I find it remarkable that there is even a question that a US citizen and US medical graduate (DO or MD) would have to compete w/ IMG's for a residency position in their own country...

Hey all.

rtk, I think you're missing the point slightly. Do you even realize how much money it costs to educate a doctor? I have had many people tell me that I'm a traitor for leaving Denmark. I'm married to an American so I always play the personal reasons card but generally leaving the country after getting one of the most expensive medical educations in the world (while getting paid!) is not popular at all.

As for IMGs competing with AMGs I kinda see your point. In my country there is also free competition with in-coming IMGs but we're generally too PC to really bitch about it. But let's say we're talking an engineer from India; shouldn't he be able to compete with his American counterparts? I think the keyword here is skill. If an IMG is obviously more suited for a job then why on earth shouldn't he get the job?

Take care.

 

[rtk]

Bellkicker;

Perhaps Danes are more PC than I, but I think you're missing my point. I'm certainly not saying that foreign trained physicians are somehow inferior. I agree that in a free market, may the most qualified applicant get the job. I also don't see myself (or other US residents and fellows that I work with) as biased against international grads. In fact, some of my close friendships are with my collegues from India, Pakistan, Jordan, Poland, etc...

That said, however, US medical education is NOT a free market. It's actually tax payer funded through entitlements programs (particularly Medicare). The irony is, the US gov't continues to import foriegn trained physicians when there's a glut of physicians in the US and the US currently spends more money on health care than any other nation in the world.

So, your comparison of an Engineer from India competing for a job in the US is significantly different from an IMG competing for a residency position (all of which are US taxpayer funded). Each physician that enters the US workforce contributes to the cost (albeit slight) of providing health care in the US. And, the only way an intn'l grad can enter the US physician workforce is through taxpayer funded training.

Post graduate training in the US is a gov't policy issue that needs to be addressed. I would venture to guess that the number of physicians in Denmark is significantly lower per capita than in the US. I would also venure to guess that the health care expenditure per capita is significantly lower in Denmark than the US.

As I stated earlier, my post was a segway from the original question. However, it's an important issue, and I would go so far as to say that the US has been very generous in training international medical grads (likely more generous than any other country). Generous to the point of potentially bankrupting the US economy through funding of entitlements programs (Title 13 and 19) which acount for >20% of US taxpayer dollars and growing every year.

 

[BellKicker]

All right. You got a bit technical on me there in the end but here's my reply.

First off, I actually thought the reason you guys imported docs was because there was a need for them. Isn't that what the whole H1 visa thing is about? ANyway, in that case you have a point.

My country is also a great importer of IMGs. In fact, we have open positions constantly. The catch is you have to pass a hard-@ss language test to apply for residencies.

As for per capita spending and docs...... In fact, I would have guessed we paid more than you guys for health care but again I have no real proof. It's just one of the things we hear over and over how the scandinavian countries pay the most for almost everything in the world. I mean, our average imcome is quite a bit higher than the US so I just figured that meant more docs.

I dunno, we probably agree more than it would seem.

Take care.

 

[Celiac Plexus]

Just the fact that this thread exists is testament to the bias that PDs have against DOs and FMGs...

To the OP: Improve your app, and reapply EARLY in the process. Work some kind of angle at the school at which you were waitlisted. I'll bet the second time around you'll get in.

I would not immediately run to a DO school, or a foreign med school. There IS a bias against these graduates, even if there are some wonderful success stories about FMGs matching at Mass Gen... Those individuals represent the exception. If you go to a foreign school, you will be starting your career at a disadvantaged position. You will probably have to score higher, and perform better than an equivalent U.S. MD student to be as competitive. D.O.s probably have it off a little better since they are American, and have a pretty visible presence on the U.S. medical landscape.

At my school, which is middle upper-tier, I think that I have met only one D.O. anesthesiology resident. I think that D.O.s generally compete for the lesser programs, but can still match in "competitve" fields. FMGs basically have to take what they can get, or look for "FMG friendly" community hospitals.

Personally, I would prefer not to work with a lot of FMGs, or D.O.s. I guess that I am biased against them as well. I've never really examined my prejudice, but it probably has something to do with the fact that I have little to no contact with them. All I hear about foreign schools are the horror storries about the Mexican diploma mills etc... And pretty much everyone I know thinks that DO students are the ones that couldn't get in to MD schools... But then, things may change in the future as I enter residency and beyond and get more contact with FMGs and DOs...

 

[jdaasbo]

I would like to add one thing regarding searching for DOs on the WWW. Many programs will either just list names, without a degree, or simply list everyone's degree as MD--making the assumption that that is the medical degree that they hold (ie. folks with DO, MBBS or other combinations of lettering will be listed simply as MD). When I started at my residency, half the time I was listed as DO, the other half, MD. This took some time to correct, and my requests for this change were usually met with "oops I am sorry i will fix that right away," or something to that effect. In one instance, it was actually asked that I prove that I held the DO degree rather than the MD--strange indeed.