Should we allow IMGs, get into residencies

[Joe Richards]

Joe,
I am not talking about Dermatology any more. some say that all the positions(IM,FM,Surg,....)should be first filled with all the USMG, then if there are unfilled spots, that should be given to IMGs.

So what.

There is much to consider when choosing a resident.

Liability, experience, visa status, etc.

I'm not saying an IMG may not be a better candidate as a doctor. They may be much better.

I'm just saying you need to understand that the process is not just about who is the better doctor.

PDs are not going to be able to know that based on a few letters and a high board score.

In fact there have been studies that show that board scores or standard tests don't correlate with performance.

Recently I read that major universities are trying to get rid of the ACT as a prerequisite for admission.

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[wolfvgang22]

I was casting pearls before swine. Sorry.

 

[RTGuy]

wolfvgang22,

Not to be rude but this might be the dumbest arguement I have ever heard. You talk about hurdles...the reason you are in 95 degree weather with no AC and have poor teaching is because you made a choice. The majority of caribbean IMG students could not get into an american medical school and are forced to go to school down there. They could work and improve their MCAT scores or add research to their CV in attempt to get into an american school but take the path of least resistance. In terms of studying for step 1, your school may give you a fixed amount of time but I know many students in the caribbean who have a "fixed" amount of time and they simply take extra semesters off to study for step 1. what a crock.

In terms of foreign FMG's, I understand what you are saying. However, if I wanted to be an attending in France, I would not expect hospitals to consider me before i became fluent in French. If you want to work in another country the impetus is on you to learn their language.

Having read this discussion has made me laugh and pissed me off. No offense to the caribbean or foreign FMG's posting but you have some nerve. You want to get into top tier specialties or be considered equivalent to AMG's for residency spots, but face facts, its not reality. Accept it, and do your best to get what spots are available to you. As for the future, consider yourselves lucky that you have any spots at all available since the future seems to hold an increase in the number of AMG graduates with a stagnant number of residency spots.

 

[Brunette1981]

I have a question from ProgDirector , in medicine we are moving toward the evidence based practice and we try to replace the individual judgments by more advanced, document based approaches. I am not talking just about the IMGs, but don’t you think that maybe we need a totally objective qualifying, evaluating system that give us some score that you know exactly where you are standing as an IMG or even AMGs from different schools. I don’t know exactly how it can be, but a qualification system that gives you score and you know your stage and even your prognosis in your future career. An evaluating system that it final product can be assessed only by its achievements during the process.

This post seems to imply that "best" future doctor (by some uncertain algorithm) should be admitted to most competitive residency program, then a "lesser" applicant to a less competitive residency and so on.

But obtaining entrance to a competitive residency doesn't mean that you had the highest scores in your medical school class nor does entering a community FM program mean you did badly at your school. People have different interests and different life goals - some people actually want to work in underserved communities (or at least talk about it when applying to medical school in the first place) or in primary care.

If anything, I think this association of dermatology/ortho/neurosurg/etc means I am THE BEST is unfortunate - because some of these people might be better fits personality-wise and societal needs-wise with OB or IM or FM or anything else that is less popular.

Besides, as any more senior doc will tell you, the competitiveness and desirability of residencies fluctuates as do salaries and lifestyle.

So if you want to go into Derm for the money and the prestige, you may find those aren't there 20 years from now. Or maybe they will be, who knows?

But I think it's ridiculous to assert that dermatology residencies should be for the BEST applicants (thereby applying everyone else is lesser in some way).

 

[dragonfly99]

Brunette,
that is an excellent point.
Anyone who knows the history of medicine in the US knows that derm was a not very competitive field years ago. Internal medicine used to be more competitive than it is now. General surgery used to be very very competitive, then became less competitive b/c of the hellish hours, then got a bit more competitive again when the 80hr work hours rules came into play.

Also, there are intangible things that program directors use to judge applicants. If they see someone they think has a lot of passion for patient care and a lot of interest in dermatology (publications are one indication of this, but not the only one), they might pick that person over someone with a 10 point higher USMLE. There were people in my med school with 250 USMLE's who didn't get in to radiology because there were a lot of other applicants who also had high scores and who impressed the PD that they wanted radiology more than just for the $ and lifestyle. Picking residents or fellows is inherently subjective and you can't make it totally objective...that will never happen.

 

[Law2Doc]

Brunette,
that is an excellent point.

If it were really an excellent point, it would be written in a font big enough for people to read. Please folks, use the default font. Some of us are looking at this on small screens, and when you got to these tiny fonts, it might as well be invisible.

My take is this. We have fewer US graduates than residency slots. So the IMGs serve an important function in filling those open slots. So in that sense not only do we allow IMGs to get into US residencies, we welcome their participation in the match. However, as the number of US students increases and starts to approximate the number of residency slots, I think it appropriate for the number of IMGs taken each year to be reduced by the proportionate amount. These are, after all, slots paid for by US tax dollars, and a lot of the US educated students are getting through med school on federal loans or subsidized state school educations. So we have invested a lot in US students, and after all the noise the AAMC has been making that US med schools should fill US healthcare needs, it really wouldn't be fair to have US students graduating and not finding work. So yeah, if it ever comes to a point that there are as many US grads as residency slots, then too bad, we can't afford to import. It isn't like other education -- this is rationed. Now in terms of OP's real motive (from his/her other thread), notwithstanding that OP is trying to educate us on racism and other reasons why we should accept competition from IMGs, in fields like derm where there is an abundance of overqualified US students, I cannot conceive of a reason why we should be importing folks to fill those slots. Doesn't matter who's best -- the goal is to generate physicians to fulfill US demands and if we have homegrown folks to do that, we have no need to import. So yes, I support use of IMG help when we have a shortfall, as we do in primary care currently. But no, I don't see it as appropriate to bump US students out of slots. No other country would do that, so I see no reason the US should be expected to.

 

[LADoc00]

as a US IMG, I have no problem with a spot preferentially going to US citizens/Perm residents who have paid taxes/parents pay taxes/ and will continue to pay taxes in this country and work here.

I even understand why a PD will choose a US grad over an US IMG/FMG with all things being equal, because they are the least "risky" candidates. But I think its wrong for a program to pick a FMG from another country over a US citizen/Perm resident if all things are equal (scores, qualifications etc...)

But I do believe that FMGs serve an important part of the healthcare system and until US doctors are willing to work primary care jobs in rural america, it will continue to be this way.

^^
I agree

 

[dan001]

I really enjoyed this post. while reading through this i agreed to a lot of points made by members. especially the fact that when you are in a foreign country no matter how good you are you just cannot get the same thing as the citizens of the country get ..........but then while i was reading so much about the tax payer money, i simply had to admit that i live in a small town in USA. I have been living here for a long time. I know about 200 people from my country. they are all either doctors or engineers or on really good jobs. Do they pay Taxes?.......oh yes.. every body in US pay taxes. so they might pay taxes too. in this town i don't see a single resident from my country or even another country so who is paying taxes for the residents here. there are nursing homes. people from my country do not leave their parents in nursing homes.so i assume that the tax payers from my country are actually paying for US SENIORS........... coz there is not a single person in my local nursing home who is from my country or from any other country.........they are locals.......and who gets the social security,foreigners...........oh forget it..

just to make a point that lots of IMG have great jobs and they pay HIGH taxes. that should be sufficient to pay 8 dollars/hr for very few residents. and its just one town.. I am sure there are alot of other examples. so when it comes to taxes we pay the same.

 

[bmcgilligan]

I really enjoyed this post. while reading through this i agreed to a lot of points made by members. especially the fact that when you are in a foreign country no matter how good you are you just cannot get the same thing as the citizens of the country get ..........but then while i was reading so much about the tax payer money, i simply had to admit that i live in a small town in USA. I have been living here for a long time. I know about 200 people from my country. they are all either doctors or engineers or on really good jobs. Do they pay Taxes?.......oh yes.. every body in US pay taxes. so they might pay taxes too. in this town i don't see a single resident from my country or even another country so who is paying taxes for the residents here. there are nursing homes. people from my country do not leave their parents in nursing homes.so i assume that the tax payers from my country are actually paying for US SENIORS........... coz there is not a single person in my local nursing home who is from my country or from any other country.........they are locals.......and who gets the social security,foreigners...........oh forget it..

just to make a point that lots of IMG have great jobs and they pay HIGH taxes. that should be sufficient to pay 8 dollars/hr for very few residents. and its just one town.. I am sure there are alot of other examples. so when it comes to taxes we pay the same.

I am confused now.

 

[drfunktacular]

.

 

[Law2Doc]

just to make a point that lots of IMG have great jobs and they pay HIGH taxes. that should be sufficient to pay 8 dollars/hr for very few residents. and its just one town.. I am sure there are alot of other examples. so when it comes to taxes we pay the same.

Um, we are in most cases talking about IMGs who want to emigrate to the US and up to this point (pre-residency) have not paid US taxes. But that's not really the point. We aren't talking about specific benefits for individual taxpayers. We are saying that the US citizens as a group pay taxes to create these positions, and the sentiment is that other US citizens should reap the benefit. It's a political notion. It's not about a quid pro quo thing -- not "I paid 8 dollars an hour for ten years so I should get a US residency". It's more that 100 million US individuals paid taxes and expect the programs they funded to be doled out to US citizens first. The notion that we are educating the world when we have shortages at home is not a salable notion to taxpayers, nor is bumping US citizens out of spots the nation is paying for.

But I think the whole taxpayer issue is a secondary argument, not the primary one. The primary one being this is the US healthcare system, and like all industries, to the extent we have adequate resources we should not import from abroad, but to the extent resources are lacking, we need to. So for the residencies that aren't being filled, we import. For the ones, like derm, that we have no problem filling at home, we shouldn't. The AAMC has been adamant that US schooling should increase to meet US healthcare needs, so we no longer have to import and will have complete control over the quality and quantity of our physicians education, and I don't really see that as a bad idea. It is, in fact, in line with almost every other industrialized nation on the planet. Until we reach that point, we will import for the unfilled slots.

 

[cleansocks]

In most other industries importing exceptional talent is the norm and in my opinion a very American concept. I would argue tax payers care less about employing American citizens and more about employing the best of the best, thus improving upon the American system. America IS unique compared to other countries in this respect; they provide the opportunity for anybody who is at the top of their profession to succeed. I don't think America needs to copy other nations in banning doctors from practicing just because they're foreign. Importing the best of the best from other countries is a very logical, capitalistic notion.

The whole concept that Americans who fail to match into derm/rads/etc will be "unemployed" is ridiculous as well. To lose out to an IMG in these specialties they really have to be below average as it is. Then they have 30 backup specialties to choose from. Medicine is a tough specialty that requires very talented people. Granted these specialties do not need "more" talented people than any other, but if you want to live the dream (ie nice lifestyle, lots of money, and intellectually challenging job), you gotta make the cut.

 

[cleansocks]

Also I think we need to make a distinction between IMG's and FMG's. This should not even be an argument for some USIMG's who, after paying taxes in the US, are forced to choose between paying >100k for undergrad (degree of limited usefulness) and >200k for med school versus much less in a foreign school. The current market conditions demonstrate that it is valid to avoid unnecessary leverage. If they prove themselves overseas, why shouldn't these tax paying US citizens be allowed to practice in the US? Obviously the "value" of their education is still an uncertainty that needs to be considered, but they should have a shot especially if their education can be verified.

 

[cleansocks]

I dunno much about how carribean schools work with respect to the boards, but I do know that other foreign schools outside the US do NOT teach to the boards and generally require a much broader knowledge base about board-unrelated concepts than AMG's in order to pass their exams. They are very busy and have to make time to not only learn board related material but also to learn take tests similar to board exams, a concept already intimately familiar to AMG's. So outside Carribean schools (about which I cannot speak), there is no board-related advantage over US citizens.

 

[DERMLOVER]

I was casting pearls before swine. Sorry.

😡

 

[DERMLOVER]

This post seems to imply that "best" future doctor (by some uncertain algorithm) should be admitted to most competitive residency program, then a "lesser" applicant to a less competitive residency and so on.

But obtaining entrance to a competitive residency doesn't mean that you had the highest scores in your medical school class nor does entering a community FM program mean you did badly at your school. People have different interests and different life goals - some people actually want to work in underserved communities (or at least talk about it when applying to medical school in the first place) or in primary care.

If anything, I think this association of dermatology/ortho/neurosurg/etc means I am THE BEST is unfortunate - because some of these people might be better fits personality-wise and societal needs-wise with OB or IM or FM or anything else that is less popular.

Besides, as any more senior doc will tell you, the competitiveness and desirability of residencies fluctuates as do salaries and lifestyle.

So if you want to go into Derm for the money and the prestige, you may find those aren't there 20 years from now. Or maybe they will be, who knows?

But I think it's ridiculous to assert that dermatology residencies should be for the BEST applicants (thereby applying everyone else is lesser in some way).

I never said that in my ideal evaluating system, best doctor should get into Derm, Neurosx, Ortho....I said I wish there were a system that regardless of your background, just give you a score, or index of our true knowledge including our communication skills,too. an index that tells anyone where is he/she standing in the world of medicine. An objective index and not a subjective one, and then everyone choose their fovaorite ones, based on those scores(NOT USMLE!!!). At least in that case you would know that it is just you that decided to go to IM, FM , Ob and not because you didn't have anyother options. I know that it is just idealistic and not pragmatic. and I do agree that Nobody knows what would be best in future in terms of money making, just like 30 years ago that nobody was intrested in Derm or Anesth

 

[yaah]

I never said that in my ideal evaluating system, best doctor should get into Derm, Neurosx, Ortho....I said I wish there were a system that regardless of your background, just give you a score, or index of our true knowledge including our communication skills,too. an index that tells anyone where is he/she standing in the world of medicine. An objective index and not a subjective one, and then everyone choose their fovaorite ones, based on those scores(NOT USMLE!!!). At least in that case you would know that it is just you that decided to go to IM, FM , Ob and not because you didn't have anyother options. I know that it is just idealistic and not pragmatic. and I do agree that Nobody knows what would be best in future in terms of money making, just like 30 years ago that nobody was intrested in Derm or Anesth

I would wager that every single program director as well as every single medical school admissions director wishes there was an ideal talent evaluating system. It is all a relative crapshoot. There are certain things that suggest and predict excellent performance, but none are very specific. Forget the distinction between IMG and US grad for this, it's impossible to tell which US grads will be excellent physicians or residents. There are simply more unknowns for IMGs. Hence the two realities:

1) Medical education is somewhat standardized in this country in terms of topics and focus, yet it is next to impossible to accurately predict performance and ability from our existing American standardized exams and evaluation systems.

2) There are even more unknowns in the process for IMGs.

 

[Nebraska1]

I am an IMG but a US citizen with plans to stay in the US. This is what gets me: I hate when a program sponsors someone for a visa to come from a different country to be trained in a US hospital, under great teaching attendings, taking a spot away from either a US grad or an IMG with US citizenship, only to go back to their country of origin without any obligation to the country that gave them this opportunity. They should sign something that obligates them to serve this country somehow. Why should we educate them, train them, take away from others that worked hard in this country, awaiting their due spot? My 2 cents.

I completely agree with Psychman! As a US citizen IMG, I often see spots given away to FMG's with years to prepare for the boards to get 99's. Many US citizens sacrifice alot to go abroad for med school with studentloans of 200k have such a difficult time getting a spot. Life is not fair, we all know that, but shouldn't program directors at least consider their fellow Americans who are trying to get trainning to serve more of their fellow Americans? I know at least 2 FMGs who came here just to get the world class American trainning to go back to their country and be well paid "consultants"

shouldn't program directors be reminded that my family and I have been paying a lot of taxes to fund these spots that they are giving away to people who have no intention of giving back???

As for Dermlover, I believe this person needs to find something productive to do and stop trying to piss off the good people who come here to give or get real advice!

If anyone thinks i'm completely off, please let me know!😡

 

[DERMLOVER]

The primary one being this is the US healthcare system, and like all industries, to the extent we have adequate resources we should not import from abroad, but to the extent resources are lacking, we need to. So for the residencies that aren't being filled, we import. For the ones, like derm, that we have no problem filling at home, we shouldn't. The AAMC has been adamant that US schooling should increase to meet US healthcare needs, so we no longer have to import and will have complete control over the quality and quantity of our physicians education, and I don't really see that as a bad idea. It is, in fact, in line with almost every other industrialized nation on the planet. Until we reach that point, we will import for the unfilled slots.

you admitted that as an industry, the rules should apply here in medicine, and I think that although it is not exactly the same, but yeah, the rules should be similar. But remember that you are talking just an only for the industry and not the consumers, you are not thinking about the American tax payeres rights. you are thinking about your future career and it is your right but please don't use them(tax payers) as scapegoat for your professional benefits. just tell me as a consumer you prefer to have a choice to buy a car or just because you are living here you must have a US maid car. why do you like the idea of global trading, because you are the ultimate beneficiary of a German car, or Italian cloths but when it comes to the field of medicine which is your territory, you want to control the borders, ban the imports and...you can not just say that Italian brands should only be sold when all the Americans are sold.
I defenitely,agree that you shouldn't import poor quality IMGs and you should impose your standards, but when you qualified sth(you can change your standards, whenever you think it is not efficient) you should not make discrimination. But please don't talk about the rights of American tax payeres, you are not worry about them, Are you?

 

[DERMLOVER]

I completely agree with Psychman! As a US citizen IMG, I often see spots given away to FMG's with years to prepare for the boards to get 99's. Many US citizens sacrifice alot to go abroad for med school with studentloans of 200k have such a difficult time getting a spot. Life is not fair, we all know that, but shouldn't program directors at least consider their fellow Americans who are trying to get trainning to serve more of their fellow Americans? I know at least 2 FMGs who came here just to get the world class American trainning to go back to their country and be well paid "consultants"

shouldn't program directors be reminded that my family and I have been paying a lot of taxes to fund these spots that they are giving away to people who have no intention of giving back???

As for Dermlover, I believe this person needs to find something productive to do and stop trying to piss off the good people who come here to give or get real advice!

If anyone thinks i'm completely off, please let me know!😡

😡who have said that we have plenty of time to read for boards!!!!!my cousins who are med students in a decent Uni in US are basically tought for the boards from their very first months in school and they studied for 6-7 months for their step1 and got 99, I had only 5 months to pass step1 step2 and CS, do you really think that it is a lot, while I was working and reading completely new books that i never read before(unlike med stu, who mainly read and rely on books like FA, crush, blue prints, kaplan during their school years)

 

[RTGuy]

Nebraska1,

What do you think that american FMG's should be better than foreign FMG's. In my books it's the other way around. You have foreign trained american citizens who couldn't get into school in their own country and then pay their way to a medical degree in the caribbean. Why should we feel bad that you accrued greater debt, you chose to go to a foreign school with exorbitant tuition because you couldn't get into a state medical school with more reasonable tuition.

As an AMG, ive always felt like all residency spots should be filled with AMG's first. They went to school in the United States not Grenada, St. Kits or elsewhere. After all spots are filled by AMG's then we can fill the leftovers with FMG's, whether they be american or foreign.

 

[Nebraska1]

Nebraska1,

What do you think that american FMG's should be better than foreign FMG's. In my books it's the other way around. You have foreign trained american citizens who couldn't get into school in their own country and then pay their way to a medical degree in the caribbean. Why should we feel bad that you accrued greater debt, you chose to go to a foreign school with exorbitant tuition because you couldn't get into a state medical school with more reasonable tuition.

As an AMG, ive always felt like all residency spots should be filled with AMG's first. They went to school in the United States not Grenada, St. Kits or elsewhere. After all spots are filled by AMG's then we can fill the leftovers with FMG's, whether they be american or foreign.

To RTGuy and whoever misunderstood me:

I do NOT think that American FMGs are BETTER than foreign FMGs. The only thing we got going for us is that we are more familiar with our patient populations! American FMGs obviously lack something, that's why they could not get in a US med school, that's why they "chose" to go to some island for med school. (that is probably another debate!) if anyone in the right mind could have a chance to go to a reasonable tuition state school, he/she would!

As an American FMG, I completely agree with YOU (RTGUY) and believe that it is right and fair to FIRST pick US grads and fill ALL the spots before giving it to anyone else. yes, that's bad for other American FMGs like me, but that's only fair, right?

The point that I was making was if American FMGs who have "paid taxes" in the US and are going to be working in the US forever (which is where most American FMGs are from, so they would continue to stay here in the US) then it would be fair to let them get the training first, before the FMGs whom have NOT invested anything in the US economy/tax pool, so that they can start taking those primary care jobs that no AMGs would ever take!

Would you agree with that?

 

[Nebraska1]

Also I think we need to make a distinction between IMG's and FMG's. This should not even be an argument for some USIMG's who, after paying taxes in the US, are forced to choose between paying >100k for undergrad (degree of limited usefulness) and >200k for med school versus much less in a foreign school. The current market conditions demonstrate that it is valid to avoid unnecessary leverage. If they prove themselves overseas, why shouldn't these tax paying US citizens be allowed to practice in the US? Obviously the "value" of their education is still an uncertainty that needs to be considered, but they should have a shot especially if their education can be verified.

Well put cleansocks!

 

[Law2Doc]

But remember that you are talking just an only for the industry and not the consumers, you are not thinking about the American tax payeres rights. you are thinking about your future career and it is your right but please don't use them(tax payers) as scapegoat for your professional benefits. just tell me as a consumer you prefer to have a choice to buy a car or just because you are living here you must have a US maid car. why do you like the idea of global trading, because you are the ultimate beneficiary of a German car, or Italian cloths but when it comes to the field of medicine which is your territory, you want to control the borders, ban the imports and...you can not just say that Italian brands should only be sold when all the Americans are sold. ... But please don't talk about the rights of American tax payeres, you are not worry about them, Are you?

Um, you obviously don't know many US taxpayers do you. I think your confusion here stems from the fact that the sale of services versus goods are very very different, and cannot be compared.. So while it might be trendy to buy a german car or an italian suit, the average consumer doesn't want to buy them from a salesman who speaks broken english, and uses the metric system in describing specs, and writes his notes in poor grammar like your last sentence above.

The average taxpayer wants his money to be used for US citizens needs. It is always a political hot button when a president wants to provide aid to XYZ country, and the retort is universally that we have poor people here to deal with. The political notion of America first, buy american etc is well ingrained in our culture. Joe taxpayer doesn't really care who has a higher Step 1 score, because that is meaningless to him. To him, the "best" doctor is the one who will sit down and talk to him, in a language he understands, and is able to connect with him interpersonally. This is a personal service industry. The consumer doesn't come in demanding "the best". He comes in, meets a doctor, and decides if he is "good" or not on purely subjective grounds. So yeah, in that respect, selecting someone who shares nationality and a common first language with the patients is giving the taxpayers what they demand. So yeah, my point is on the side of the American taxpayer, and it's pretty clear from this and your prior thread who it is who "is thinking about [their] future career" in making these arguments. Heck, you were the person who wanted to bring racism into the mix in an earlier thread.

Dude, we get it. You want derm and you are justifiably rightly concerned that you probably are going to get hosed because of the way IMGs get treated in this process. We get that. And I still think you should apply and give it your best shot. But seizing on AMA statements out of context, some warped view that you are the equivalent of a german luxury car to taxpayers, or that not taking IMGs into derm is somehow an example of racism doesn't serve you well or win your point. The system is a good one, and yet it might come out against you. But it's fair because if someone from the US was trying to go in the opposite direction the hurdles would be even higher. Deal with it.

 

[dragonfly99]

Lawdoc is correct about the language difficulties and severe communication difficulties between most foreign FMG's and patients in North America. I have had multiple, multiple patients complain to me about this. This problem is just very important because there are so many patients who are elderly, have diminished hearing, or just a low educational level and just aren't able to understand some of the FMG's who have heavy accents. It can be a MAJOR problem for these patients. That's not racism. I am certain I would experience the same problems if I tried to immigrate and practice medicine in a Spanish-speaking country, even though I speak Spanish. There's just so many small nuances, etc. that are important in patient-doctor communication. It is obvious from dermlover's posts that although he/she writes English well, there are still some obvious problems with grammar, etc. and getting his desired point across. This could be an issue in interactions with US patients, I would think. Don't say that is racism, because it is not.

Dermlover, you never answered my question above. If there is so much racism and prejudice against foreigners (that you say is the reason FMG's have a hard time getting in to derm) then why did the multiple nonwhite foreign folks in my medical school (but who attended undergraduate and medical school here in the US and were very fluent in English) all match very well and into competitive US residencies? The reason is that they attended US colleges, did very very well, attended a well known US medical school and did very, very well, and were already present here in the US and had dealth with their visa issues. They were "low risk" for a residency program to take. The residency programs knew how to evaluate folks who had managed to get in to my particular med school and do well, and didn't care that these folks were foreign-born. It's not being foreign-born that causes you the problem in residency application, it's the fact that you attended some medical school that docs here in the US have no way to objectively evaluate, and residencies know they would have to deal w/visa issues for you, would worry about the language barrier between you and patients, and really don't know how well (vs. how poorly) a student like you would adjust to working in a particular US hospital.

 

[Isa2010]

First of all......It's their COUNTRY
Second..........It's their Country
Third.............it's their COUNTRY!!!!!!!🙄

Dermlover and everybody else: I'm an IMG an I have this clear: They have rules, Like it or not!!!!.....And also I think the US citizens must be preferred.....why?......just because as I said before: It's their country.......and I got it since I was considering moving here....And I had had clear that Derm, Radio, Rad-onco....Ortho.....are almost "impossible" for IMG....

Why do they allow us to filled the "unwanted" positions???.....reciprocal interests!!......By the way....I don't think about those spots like the "leftovers" as somebody said.....I call them BIG OPPORTUNITIES!!!!....And I always will be thankful to this country for that.........👍

 

[sandraf]

Answering your question:
Wake up! They already do!
Now, suppose somebody says "yes" when you ask "can you please give me a ride?", then would you say "but I want to seat next to the window!" when all his kids want to do it and there are more kids than windows in the car???!!!! You can always give up the ride, the kids can't and shouldn't and won't! It's their father's cars!
So... be grateful for the "yes". Forget the view if the ride is all you want, or take the next bus.

 

[sandraf]

ISA2010: I agree completely with you. And I love this country BECAUSE THEY HAVE RULES. And they are followed and whoever does not is punished (most of the times). That's one of the reasons why this is a great country. If some rules favor the people who were born here, I think that's more than natural and fair. Their parents and grandparents and greatgrandparents, etc, earned it for them. Some Americans do not say it like that so they don't sound bad, but I can say it because I am not American.
🙂

 

[Isa2010]

AGREE 100% With you.....I love this country too!
Good luck!!

ISA2010: I agree completely with you. And I love this country BECAUSE THEY HAVE RULES. And they are followed and whoever does not is punished (most of the times). That's one of the reasons why this is a great country. If some rules favor the people who were born here, I think that's more than natural and fair. Their parents and grandparents and greatgrandparents, etc, earned it for them. Some Americans do not say it like that so they don't sound bad, but I can say it because I am not American.
🙂

 

[sandraf]

To you, too, ISA.

 

[Law2Doc]

Answering your question:
Wake up! They already do!
Now, suppose somebody says "yes" when you ask "can you please give me a ride?", then would you say "but I want to seat next to the window!" when all his kids want to do it and there are more kids than windows in the car???!!!! You can always give up the ride, the kids can't and shouldn't and won't! It's their father's cars!
So... be grateful for the "yes". Forget the view if the ride is all you want, or take the next bus.

Really good analogy. This is exactly what the OP is doing.👍

 

[DERMLOVER]

Dermlover, you never answered my question above. If there is so much racism and prejudice against foreigners (that you say is the reason FMG's have a hard time getting in to derm) then why did the multiple nonwhite foreign folks in my medical school (but who attended undergraduate and medical school here in the US and were very fluent in English) all match very well and into competitive US residencies? The reason is that they attended US colleges, did very very well, attended a well known US medical school and did very, very well, and were already present here in the US and had dealth with their visa issues. They were "low risk" for a residency program to take. The residency programs knew how to evaluate folks who had managed to get in to my particular med school and do well, and didn't care that these folks were foreign-born. It's not being foreign-born that causes you the problem in residency application, it's the fact that you attended some medical school that docs here in the US have no way to objectively evaluate, and residencies know they would have to deal w/visa issues for you, would worry about the language barrier between you and patients, and really don't know how well (vs. how poorly) a student like you would adjust to working in a particular US hospital.

I send a post earlier, that only 1.5% of Ortho residents are African American which is obviously disproportionate. this is the only article about the possible discrimination in a highly competetive residency as far as a I know. Do you think that in general AA applicants are less than caucsians? or are they only make 1.5% of medical students?

 

[BabyPsychDoc]

I think both IMGs, FMGs and AMGs have already made their points very clear on this thread. I think the consensus is that America is for Americans, though others are welcome based on demand. I suggest now ignoring this thread, as we are just feeding into DERMOLOVER's insecurities.

DERMLOVER, it is about time you got a hobby.

 

[Law2Doc]

I send a post earlier, that only 1.5% of Ortho residents are African American which is obviously disproportionate. this is the only article about the possible discrimination in a highly competetive residency as far as a I know. Do you think that in general AA applicants are less than caucsians? or are they only make 1.5% of medical students?

The problem with that assertion is that you are assuming that african americans as a group are proportionately interested in ortho, which you'd need to show to suggest discrimination. First, african americans don't make up a huge percentage of med students. Looking at the AAMC website, it appears that of the 16,000 matriculants in each of the last few years, only about a thousand were African American. So we are talking single digit percentages. This has less to do with med school admissions and more to do with grade school education and college level hurdles. Second, a lot of african american students feel compelled to give back to their communities (something someone going into derm might not get), and to do that, a primary care field is more appropriate. So you see a much larger percentage of folks choosing things like FM, OB, IM. Third, Ortho has long been a specialty of white male ex-jocks. So a lot of african american students might not choose to go into that field, and surround themselves with that crowd. That folks don't apply doesn't make discrimination.

I'm still not sure how suggesting US race discrimination makes your argument stronger. IMG's who are white face the same hurdles you do; it's simply not racism. And African American US med school grads are much better off in the match than IMGs; if anything the nation's history of racism can work in their favor when programs seek diversity.

The more you argue along these lines, the further you seem to get from convincing anyone. I agree with the prior poster that maybe a hobby is in order.

 

[DERMLOVER]

Answering your question:
Wake up! They already do!
Now, suppose somebody says "yes" when you ask "can you please give me a ride?", then would you say "but I want to seat next to the window!" when all his kids want to do it and there are more kids than windows in the car???!!!! You can always give up the ride, the kids can't and shouldn't and won't! It's their father's cars!
So... be grateful for the "yes". Forget the view if the ride is all you want, or take the next bus.

those windows are supposed to be the gifts of a competition.all of a sudden, the losers come and claim that since these gifts are paid out of their father's pocket they are more deserve to get them. ok, but you cann't call it a fair game.....
it is not a hobby for me, but sometimes i just cann't ignore some of the posts.
That article about the AA percentage in Ortho was a fact that raised many concerns at the time its publication. Don’t try to justify or ignore its facts. I think here in this country, we need a stronger lobby in AMA to make IMGs familiarized with their rights. It is really disappointing and shameful to see that some FMGs, belittle their community and try to show that it is their right to be ignored. The fact is 25% of AMA are IMGs and this country needs our services.
What I learned from this forum, is that we should be more active as an IMG and we should be more supportive to get our professional rights.

 

[RTrain]

those windows are supposed to be the gifts of a competition.all of a sudden, the losers come and claim that since these gifts are paid out of their father's pocket they are more deserve to get them. ok, but you cann't call it a fair game.....
it is not a hobby for me, but sometimes i just cann't ignore some of the posts.
That article about the AA percentage in Ortho was a fact that raised many concerns at the time its publication. Don’t try to justify or ignore its facts. I think here in this country, we need a stronger lobby in AMA to make IMGs familiarized with their rights. It is really disappointing and shameful to see that some FMGs, belittle their community and try to show that it is their right to be ignored. The fact is 25% of AMA are IMGs and this country needs our services.
What I learned from this forum, is that we should be more active as an IMG and we should be more supportive to get our professional rights.

What are you even talking about? What rights? Which rights do you think are being abridged here??

You clearly have zero understanding of what a "right" is. You have a right to submit an application to whatever specialty you choose. Your application will then be evaluated using the appropriate criteria. No one is saying otherwise, but that is where the concept of "rights" in this example ends. You seem to think that unless there is a representation of foreign grads in all specialties exactly proportionate to the number of applicants, that some "right" is being violated, but you are mistaken. There is nothing more to be said. Your understanding of the American system - of medical training, of competition, of rights and responsibilities - is incorrect, wrong, flawed.

GIVE. UP.

 

[Law2Doc]

What are you even talking about? What rights? Which rights do you think are being abridged here??

You clearly have zero understanding of what a "right" is. You have a right to submit an application to whatever specialty you choose. Your application will then be evaluated using the appropriate criteria. No one is saying otherwise, but that is where the concept of "rights" in this example ends. You seem to think that unless there is a representation of foreign grads in all specialties exactly proportionate to the number of applicants, that some "right" is being violated, but you are mistaken. There is nothing more to be said. Your understanding of the American system - of medical training, of competition, of rights and responsibilities - is incorrect, wrong, flawed.

GIVE. UP.

Totally agree. Rights are creations of the state. In the US, we have a bill of rights that gives certain rights to certain people. Freedoms of discrimination are provided under our federal laws to certain groups, "protected classes", but not IMGs. OP can try as hard as he wants to create convoluted arguments about how his rights are being trampled, but honestly, you have to be in a group which has been granted certain rights before they can be trampled. That african americans aren't proportionately getting ortho certainly doesn't lend any support to the notion that more IMGs should get derm. It's a nutty argument, and a waste of typing.

 

[exPCM]

The percentage of caucasians in medical school is declining every year and is now below the percentage of caucasians in the US overall. Dermlover, I guess this must be discrimination as well.

 

[exPCM]

Only ~25000 first year residency spots and Medicare with a cap on residency funding and no plans or money to fund any more spots.There are roughly 22000-23000 first year allopathic US residency spots (see http://www.aamc.org/newsroom/pressrel/2008/080320.htm) and 2300 funded osteopathic spots ( http://blogs.do-online.org/dailyreport.php?itemid=3947 ). Therefore we are now approaching parity between the number of US graduates and the number of US residency spots. Any of you med students graduating in 2012 and beyond want to give up on doing a residency so that programs can take deserving IMGs instead?

 

[Nebraska1]

I think it is quite obvious that DERMLOVER is trying to stir up something here, so let's stop feeding into her/his "reasoning" or lack there of.

I am an IMG and I meet other IMGs all the time who definitely believe that US residency spots are for US Grads, the other unwanted "opportunities" then become available for other grads, we all know this, so let's stop spending anymore time explaining anything else to DERMLOVER, unless he/she has a valid question about something else!

Have a good weekend ya'll. 🙂

 

[jiy76]

U.S Residency spots go to AMG's if possible first. USIMG's and FMG fight for the rest. Program directors want the best applicant a lot of the FMG's are fluent in english and have no problem in an american system. I am a USIMG but since i didnt go to a U.S school I can't whine about the fact I can't get into harvard.Of course I think U.S residencies should prefer their own students and they do, they prefer AMG. Everyone else should be on an even playing field.Enough with this tax-paying bs its just sour grapes.

 

[Law2Doc]

U.S Residency spots go to AMG's if possible first. USIMG's and FMG fight for the rest. Program directors want the best applicant a lot of the FMG's are fluent in english and have no problem in an american system. I am a USIMG but since i didnt go to a U.S school I can't whine about the fact I can't get into harvard.Of course I think U.S residencies should prefer their own students and they do, they prefer AMG. Everyone else should be on an even playing field.Enough with this tax-paying bs its just sour grapes.

The only one expressing sour grapes on this thread is the IMG who started it, who is concerned s/he won't get derm... The rest of us were just trying to explain why the system is what it is, which is why the taxpayer discussion came up. I see no AMG's on this thread opposed to the notion that IMGs get the remaining slots not taken by AMGs, just that OP IMG asserting that some people allegedly are opposed. Don't buy it. We welcome IMGs to the extent we have open slots -- they serve a necessary function. But we won't have open slots forever, the US schools are rising to meet demand. So you guys should get in while the getting's good, and just don't peg your hopes on things like derm.

 

[medicienne]

Guys we are in medicine and most of us are at the low end of the totem pole ( students, non-students, interns, residents). Even if we were attendings we would only have power (if at all) within the little ecosystem of our clinics and hospitals.
Why bother to overanalyze the politics, the system if we can't influence it? Its a dog-eat-dog world and no matter who you are there is almost always someone who is better/more hardworking than you. We can't take ourselves too seriously and we can only try our best. The most successful people are those who learned to work with the existing system including the 1-2 IMGs who occasionally match into the competitive residencies (ROAD)

 

[Ice dude]

All I would say is, preferring AMG in US residency programs is pretty normal and y shouldn't they be preferred, it's their residency programs. If an IMG wants a position, he/she needs to prove that he/she is better than the rest of the crowd.
And yes y worry who thinks wht about u, just go ahead apply and see how it folds out.