Should we allow IMGs, get into residencies

[DERMLOVER]

It seems that there is a strong argue about the core issue of whether US Tax Payers funded residencies, be filled with questionable IMGs. I am an IMG and I developed a thread to discuss about the possibility of being accepted as an IMG into a high competitive area like Dermatology, and surprisingly some of our friends started a discussion that as an IMG (regardless of your qualifications, including USMLE scores and research and experience background) we should only be allowed for certain unfilled spot here in the USA, at most. That when there are 8.5 million unemployed Americans we should not be here. It appears that we arenot welcome in this country and we are scapegoat for the health system malfunction in the US
I need to know your idea about this discussion
you can referto the thread: IMGs and Dermatology any chance at all

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[dragonfly99]

I wouldn't argue that no IMG's should be allowed in US residency. In fact, I have a good friend who is a psych resident who is an IMG. However, I would argue that in the case of two comparable applicants, one being an IMG and another being a US grad, the US grad should probably get the spot. This is because the US grad already lives here, has (presumably) a commitment to treat US patients, may relate better to US patients (being of similar cultural background to at least some if not most of them), probably understands the way a US hospital runs better than the IMG (because the US student has trained in just such a hospital). Also, this US graduate and his/her family have been paying taxes that go to Medicare, which is the main US government entity that funds residency programs. Also, the US graduate is a citizen of the US (or permanent resident) and thus presumably plans to stay in the US and treat his/her fellow citizens. The US student is unlikely to quit the residency, will likely have better family support, friends in the area, etc.

Also, the US graduate is unlikely to require a VISA or other time consuming paperwork that the residency program would have to deal with. Many US programs (at least some) prefer students from their own medical schools, and/or students from the same geographic region. For example, New York City or Chicago programs may give some preference to local applicants due to knowing that these students have family ties, understand and like living in the big city, etc. Residency programs (particularly those in very competitive specialties like ortho or dermatology) often prefer students who have only very high/"honors" grades in medical schools which are known to that particular residency program to be rigorous and/or similar in their educational philosophy to that particular residency program. They may also prefer students who have rotated at that particular teaching hospital as a 4th year medical student (because it's like a "working interview"), which most IMG's are unlikely to have done.

Overall, selection of residents by a residency program is a very subjective process. There were people who had lower USMLE scores accepted into competitive fellowship programs over me. That's just the way it is - whether you are a US grad or an IMG. The fact that someone has a very high USMLE score is only one factor in residency program selection, so someone having a high USMLE I and II score doesn't entitle someone to a competitive residency. The program has to think you are well suited to a particular field, that you are interested, that you will fit in well at that particular institution, and that you will relate well to your peers and your supervising doctors. And yes, many programs may prefer an American grad over an IMG. Remember, our medical schools were set up to train doctors for the system of medical care in the US. I'm sure I trained at some school in Europe (Spain, etc.) or in Russia or some other country, there would be things I learned there that I didn't over here, and vise versa. You can't say that an IMG not being picked (for a very competitive specialty like derm or ortho) is blatantly unfair. If you are an IMG and want to do a field like this, go for it, but have a backup. Nobody is entitled to whatever they want. You might have to decide if you have greater passion to
a) immigrate to the US and do something like internal medicine instead of derm if that is necessary or
b) pursue your passion for dermatology, but maybe not in the US

You may not be able to have your cake and eat it too.

 

[psychman]

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.

 

[exPCM]

It seems that there is a strong argue about the core issue of whether US Tax Payers funded residencies, be filled with questionable IMGs. I am an IMG and I developed a thread to discuss about the possibility of being accepted as an IMG into a high competitive area like Dermatology, and surprisingly some of our friends started a discussion that as an IMG (regardless of your qualifications, including USMLE scores and research and experience background) we should only be allowed for certain unfilled spot here in the USA, at most. That when there are 8.5 million unemployed Americans we should not be here. It appears that we arenot welcome in this country and we are scapegoat for the health system malfunction in the US
I need to know your idea about this discussion
you can referto the thread: IMGs and Dermatology any chance at all

You have misrepresented and warped the views and opinions expressed on the other thread.

 

[Pinkertinkle]

Why do IMG's always use some strange font/formating? Just use the SDN default.

 

[DERMLOVER]

You have misrepresented and warped the views and opinions expressed on the other thread.

I will be happy to know your main concept about us, I thhink it was exactly what you said about these spots that are filled by IMGs

 

[DERMLOVER]

Why do IMG's always use some strange font/formating? Just use the SDN default.

what is your point , what is the default font, that we don't use 😳

 

[cbass1350]

Its those IMGs again. Taking up all the important jobs like dishwashing and selling oranges on the highways.

 

[Law2Doc]

I will be happy to know your main concept about us, I thhink it was exactly what you said about these spots that are filled by IMGs

First, I think most of us in the other thread told you to go ahead and apply. I sure did. Second, I agree that you misrepresented the point. The point is that for spots where there are equally qualified (not just equal board scores) US students/citizens, as there always is in an ultracompetitive field such as derm, the spot needs to go to such US students/citizens, because this is US taxpayer money. If there isn't equally qualified US students, or if the spot is likely to go unfilled, then whoever wows the PD the most should get it. The goal isn't to dole out education globally. The goal is to service US healthcare needs. You do that best by giving spots to folks who are from here, unlikely to move elsewhere once trained. Additionally, we don't pay our taxes to train the world, we pay taxes to train ourselves. Your country likely doesn't allow Americans to freely enter its professional fields willy nilly, and nor should the reverse be expected.

 

[DERMLOVER]

First, I think most of us in the other thread told you to go ahead and apply. I sure did. Second, I agree that you misrepresented the point. The point is that for spots where there are equally qualified (not just equal board scores) US students/citizens, as there always is in an ultracompetitive field such as derm, the spot needs to go to such US students/citizens, because this is US taxpayer money. If there isn't equally qualified US students, or if the spot is likely to go unfilled, then whoever wows the PD the most should get it. The goal isn't to dole out education globally. The goal is to service US healthcare needs. You do that best by giving spots to folks who are from here, unlikely to move elsewhere once trained. Additionally, we don't pay our taxes to train the world, we pay taxes to train ourselves. Your country likely doesn't allow Americans to freely enter its professional fields willy nilly, and nor should the reverse be expected.

why don't you all have this discussion about those students who come here to get their PhDs and then go back to their country. you are paid because you offer your services and hard work in this system and a minimal amonut of salary are paid instead. Do you believe that the value of your work as a resident is 40-50k, but we all accept it as a transitional, educational period. almost all may wanna continue and work and a few may wanna go back. it is not a gifted position that you talk about, in many small community hospitals, you hardly can find appropriate education.
and again I am totally agree with you that in equally qualified situation it is your right to choose the American Graduated. My argue was not about that, our friend told me that with any qualification you shouldn't offered any spot like Derm....sorry if i misrepresented the case

 

[DERMLOVER]

Its those IMGs again. Taking up all the important jobs like dishwashing and selling oranges on the highways.

Has anyone of us, taken your chance to become a great doctor? I am kind of new to this world, is that a normal, typical vision that most of American graduated have or it is only ur opinion??😉

 

[Joe Richards]

This post is going to go nowhere. 😡

 

[Law2Doc]

why don't you all have this discussion about those students who come here to get their PhDs and then go back to their country. you are paid because you offer your services and hard work in this system and a minimal amonut of salary are paid instead.

Because it's a totally different argument. First, the money comes from different places in residency vs PhD. Second, PhD slots aren't as rationed. Residencies are. We have a finite number of residencies, and they theoretically represent a careful balance between cost and need. (There certainly are people who object to PhD stipends for folks who aren't going to stay -- I'm not sure why pointing that out helps your argument).

As for IMGs not getting derm (or some of the other competitive fields), I think the prior poster was trying to say that that is a field where there are always far more very qualified US students than slots. So given that, it's hard to make the argument that such a slot should ever go to an IMG, given that it is US taxpayer money being used, and given that PDs will be more familiar with the US programs and can better evaluate a US students qualifications (this isn't totally board driven), and given that the average board scores of the US schooled individuals who get into derm are already adequately high (remembering from the other thread that this test was really designed only to measure minimum competencies). This has nothing to do with the resident salary -- it is what it is. And again, the goal of US healthcare isn't to give open access to the best education, so if someone ends up at a community hospital where the education isn't that great, that's sort of how the cookie crumbles. Life isn't fair. US students would face at least the same obstacles trying to break into a profession in another country, on the other country's taxpayers' dime.

And again I'm not telling you you shouldn't pursue your dream. Send out the apps -- it's not for me to decide your future. There have been IMGs who have gotten competitive residencies. It's not the norm, but you might not be either.
But I certainly get the bias in favor of US students, given that this is a US federally funded system.

 

[DERMLOVER]

Because it's a totally different argument. First, the money comes from different places in residency vs PhD. Second, PhD slots aren't as rationed. Residencies are. We have a finite number of residencies, and they theoretically represent a careful balance between cost and need. (There certainly are people who object to PhD stipends for folks who aren't going to stay -- I'm not sure why pointing that out helps your argument).

They are limited and even their students are paid and you can see a lot of foreigners not only in a small state university but in the best ones. Why?? I think because their acceptance is mainly based on their achievements. Do you really think that GRE and GMAT is a much better evaluating tool than USMLE, but they trust this system and it works for them, and maybe because there are scientists who choose their students, they love science and there is no difference if you get it from Europe or Asia or India. But medicine is not just about medicine anymore, who cares if you can approach the patient better or if you can prevent an EXPENSIVE diagnostic test by just asking a few more questions. It is a business and in this business you SHOULD not avoid that EXPENSIVE test, because there are many which their lives are based on this system. My point was that in this business, I shouldn’t expect to see respect because I know more, I would receive acceptance only if I know how to facilitate this wheel.
And in response to your discussion about the importance of developing our human being dimension before med school, it seems that these educations have not made Am Graduated more caring about their patients but they made them hungrier for making money that even cannot tolerate the presence of their colleagues in this country. Why don’t these More Caring Am Graduated apply for primary care spots in this their nation, it is just about money buddy, and it is sad.

 

[DERMLOVER]

This post is going to go nowhere. 😡

at first I was angry but now I know more, that is he purpose of this post. the best way to make a good relation with our future colleagues is first to know what are they thinking about our presence, I don't agree with many things that other writers post, but I am so thankful to all of them, because now I can see better and I can understand their feelings toward us and it help me to don't take it personally in future. That is why I posted this thread and I think it will help us(IMGs) to have a better relationship and friendship with our Am Graduated in our residency

 

[Winged Scapula]

what is your point , what is the default font, that we don't use 😳

The default is Times New Roman, size 2.

You are using Calibri in an enlarged size 3 in your first post. You are still using Calibri but in a smaller size, hence the questions about why aren't you using the default font.

 

[cleansocks]

Because it's a totally different argument. First, the money comes from different places in residency vs PhD. Second, PhD slots aren't as rationed. Residencies are. We have a finite number of residencies, and they theoretically represent a careful balance between cost and need. (There certainly are people who object to PhD stipends for folks who aren't going to stay -- I'm not sure why pointing that out helps your argument).

As for IMGs not getting derm (or some of the other competitive fields), I think the prior poster was trying to say that that is a field where there are always far more very qualified US students than slots. So given that, it's hard to make the argument that such a slot should ever go to an IMG, given that it is US taxpayer money being used, and given that PDs will be more familiar with the US programs and can better evaluate a US students qualifications (this isn't totally board driven), and given that the average board scores of the US schooled individuals who get into derm are already adequately high (remembering from the other thread that this test was really designed only to measure minimum competencies). This has nothing to do with the resident salary -- it is what it is. And again, the goal of US healthcare isn't to give open access to the best education, so if someone ends up at a community hospital where the education isn't that great, that's sort of how the cookie crumbles. Life isn't fair. US students would face at least the same obstacles trying to break into a profession in another country, on the other country's taxpayers' dime.

And again I'm not telling you you shouldn't pursue your dream. Send out the apps -- it's not for me to decide your future. There have been IMGs who have gotten competitive residencies. It's not the norm, but you might not be either.
But I certainly get the bias in favor of US students, given that this is a US federally funded system.

As a AMG couples matching with a USIMG, I'm biased, but I think IMG's should be given a chance even in these competitive fields.

1. Residents are paid ~$8/hr. The vast majority of taxpayer money is going into other areas of healthcare.

2. Even if the taxpayer money thing were a real issue, it is paying someone who is willing to work like a dog for 4+ years for very little money vs be an attending or train for many fewer years in their home country. Also, the application process for an IMG is extraordinarily time consuming and expensive. So the vast majority of people are staying in the US to work.

So the vast majority of IMG's who are screened properly for these competitive fields and still qualify will stay and will be excellent physicians. There are a few, of course, that will not and this will result in a very small loss of tax payer money. However, there are also a few (understatement?) AMG's who go into these fields strictly for lifestyle and will be sub-par physicians. So why should there be discrimination against IMG's for a few "potentially detrimental residents" when such people also exist, perhaps to a greater extent, in the US?

 

[DERMLOVER]

The default is Times New Roman, size 2.

You are using Calibri in an enlarged size 3 in your first post. You are still using Calibri but in a smaller size, hence the questions about why aren't you using the default font.

you are right, we can use but maybe the main reason is that I used to use word office before posting anything and then I copy and paste it into the framed place to avoid having dictating mistakes during typing. Do you think we shouldn't or it was just a curiosity🙂🙂🙂🙄

By the way, you are an intresting person with attention to details

 

[Law2Doc]

1. Residents are paid ~$8/hr. The vast majority of taxpayer money is going into other areas of healthcare.

It's not about quantity. These slots are taxpayer funded -- that's all there is to it. The amount is irrelevant. And FWIW the federal money that goes to the hospital per resident is LOT more than the resident sees.

 

[Law2Doc]

you are right, we can use but maybe the main reason is that I used to use word office before posting anything and then I copy and paste it into the framed place to avoid having dictating mistakes during typing. Do you think we shouldn't or it was just a curiosity🙂🙂🙂🙄

By the way, you are an intresting person with attention to details

You shouldn't. The posts are VERY HARD TO READ when you use different and smaller fonts.

 

[BabyPsychDoc]

at first I was angry but now I know more, that is he purpose of this post. the best way to make a good relation with our future colleagues is first to know what are they thinking about our presence, I don't agree with many things that other writers post, but I am so thankful to all of them, because now I can see better and I can understand their feelings toward us and it help me to don't take it personally in future. That is why I posted this thread and I think it will help us(IMGs) to have a better relationship and friendship with our Am Graduated in our residency

No, it won't. In fact, your attitude is getting quite annoying - and I am an FMG.

BTW, your other thread was far more interesting to read

 

[JackBauERfan]

at first I was angry but now I know more, that is he purpose of this post. the best way to make a good relation with our future colleagues is first to know what are they thinking about our presence, I don't agree with many things that other writers post, but I am so thankful to all of them, because now I can see better and I can understand their feelings toward us and it help me to don't take it personally in future. That is why I posted this thread and I think it will help us(IMGs) to have a better relationship and friendship with our Am Graduated in our residency

Just comparing the PhD track and the MD track shows that you're really not sure how the system differs between different countries.
I've had many friends/family members in both MD, PhD, and MD/Phd situations and like Law2Doc said it is a big difference where the money comes from and the job situation. Main difference I think being the number of spots available. You can get a PhD spot if you have the qualifications somewhere, I mean maybe not a particular institution, but somewhere, whereas if you are trying to get a spot in dermatology, you may be qualified, but no spots after certain amount are taken.

Saying that PhD programs take more IMG's because all they care about is how qualified you are is just wrong.

 

[iamcatwoman]

agreed

 

[DERMLOVER]

Just comparing the PhD track and the MD track shows that you're really not sure how the system differs between different countries.
I've had many friends/family members in both MD, PhD, and MD/Phd situations and like Law2Doc said it is a big difference where the money comes from and the job situation. Main difference I think being the number of spots available. You can get a PhD spot if you have the qualifications somewhere, I mean maybe not a particular institution, but somewhere, whereas if you are trying to get a spot in dermatology, you may be qualified, but no spots after certain amount are taken.

Saying that PhD programs take more IMG's because all they care about is how qualified you are is just wrong.

You mentioned correctly, the numbers are different but not in favor of PhD programs, they are much more limited and still you can find many foreigners(not IMGs because many are not doctors but they are foreigners who got their masters somewhere else outside the US) and I didn’t mean getting PhD somewhere I mean getting PhD at very decent Universities like Harvard, Stanford, Chicago, northwestern, George Washington and you know better than me that most of their money comes from NIH at least in the health science fields. And if you have the qualifications, if you know the lab techniques, nobody asks you about the origin of your knowledge. But in medical residency, even if you are qualified, even if you MORE QUALIFIED (how many percentages of residents in dermatology have 3-4 articles in the best dermatologic journals and 3-4 years research background) they don’t even look at your resume, why? Because it doesn’t matter that how good, or how better you are, who cares. That is discrimination, I believe.
Yes it is the right of this country to close its border and just like many other countries like Canada, UK and Australia officially tell the IMGs that you are just welcomed in these limited fields. But it is ridiculous to see that they say we will accept everyone regardless of race and nationality and even in their family medicine residency for the past 5 years you cannot see any IMG. Does it mean that an IMG with great USMLE scores is not even equal to an AMG who failed its board?
I think if there were evaluating programs for residencies, by any criteria and there would be an objective report of their residents accomplishments, this discrimination would disappear.

 

[DERMLOVER]

agreed

I am not still started my residency, but I see that some of my friends and alot of AMG don't get along well with each other, as if we are part of their problems. you see in many forum sites, a good residency program(AMG point of view) is a program that you cann't see an IMG. why???😕😕😕

 

[RTrain]

This is ridiculous. To the OP: Do you want to have a discussion or do you want to argue and pick fights? You asked a question, others are attempting to give answers. It is more than clear at this point that your view of the residency interview and matching process in competitive residencies does not agree with the prevailing viewpoint, but it seems that you are being obtuse. "Qualifications" for residency selection are not a matter of mathematical formulations such that USMLE scores + number of publications = 1/rank list position. It is a subjective process just like any interview process, in which PD's use all information available to judge the suitability of candidates for the position in question.

YES, there is absolutely no question that American grads are favored in the US residency system. That is a bummer for FMG's. But why you would think that this is unfair, discriminatory, or anything other than completely understandable is totally incomprehensible to me. No other medical education system in the world is even remotely as open to graduates from other countries as the US is. Many many FMG's are successfully matched here. But we have our own graduates to train (and they are not flocking to other countries for training!), and they went to medical schools that PD's are familiar with and have the opportunity to be named to AOA (or achieve other honors that make sense to PD's). Furthermore (and I know this may touch a nerve), they generally speak English natively, and there is understandable trepidation in hiring residents who can't be understood by patients or colleagues!

Of course you don't like it, because you're on the short end of this stick, but you are not about to convince anyone that it is wrong, and we should chuck the interview system and just fill programs based on numerical qualifications. If you really want to work toward better understanding and friendship between us, try to listen to what we are explaining. In any event, good luck in the match.

 

[iamcatwoman]

I am not still started my residency, but I see that some of my friends and alot of AMG don't get along well with each other, as if we are part of their problems. you see in many forum sites, a good residency program(AMG point of view) is a program that you cann't see an IMG. why???😕😕😕

Who cares?

Listen, if you want to give working in the US a go, then just apply. Why on earth are you worrying about what some people that you MIGHT end up working with MIGHT think of you. Are you going to let the possibility that some AMG's may resent you stop you from applying?

Didn't think so.

Medicine is a dog eat dog world full of Type A's and over acheivers. If you work in this world, then you can expect to work with some/several A**holes. Not getting along with each other is just the nature of the Beast. All that matters is whether you can still work with each other.

A candidate with great scores (regardless of FMG v AMG)? Not all that special in this profession. Programs will employ the person that they want to work with. If they don't offer you a position, it's because they would rather work with someone else, for WHATEVER reason. In that case, just move on. Similarly, if you get an offer, it's because someone thought that you were worth employing. If that's the case you'd better make sure that you're worth keeping.

Grow some confidence and stop over-analysing things.

 

[Faebinder]

Who cares?

Listen,
.
.
*snip*
.
Medicine is a dog eat dog world full of Type A's and over acheivers. If you work in this world, then you can expect to work with some/several A**holes. Not getting along with each other is just the nature of the Beast. All that matters is whether you can still work with each other.
.
*snip*
.

Truer words never been spoken before. Expect yearly struggle at all levels even at the attending level.

 

[DERMLOVER]

Many minority faculty report experiencing racial/ethnic bias in academic medicine and have lower career satisfaction than other faculty. Despite this, minority faculty who reported experiencing racial/ethnic discrimination achieved academic productivity similar to that of other faculty.

Peterson NB, Friedman RH, Ash AS, Franco S, Carr PL. Faculty self reported experience with racial and ethnic discrimination in academic medicine.J Gen Intern Med. 2004 Mar;19(3):259-65.

it seems it is just the start of this endless story in this country🙁

 

[DERMLOVER]

YES, there is absolutely no question that American grads are favored in the US residency system. That is a bummer for FMG's. But why you would think that this is unfair, discriminatory, or anything other than completely understandable is totally incomprehensible to me. No other medical education system in the world is even remotely as open to graduates from other countries as the US is. Many many FMG's are successfully matched here. But we have our own graduates to train (and they are not flocking to other countries for training!), and they went to medical schools that PD's are familiar with and have the opportunity to be named to AOA (or achieve other honors that make sense to PD's). Furthermore (and I know this may touch a nerve), they generally speak English natively, and there is understandable trepidation in hiring residents who can't be understood by patients or colleagues!

.

Hey buddy, do you know that US citizens who graduate from other countries(US IMGs) with more than 25000 physicians are the biggest group of IMGs.........

 

[DERMLOVER]

Who cares?

Listen, if you want to give working in the US a go, then just apply. Why on earth are you worrying about what some people that you MIGHT end up working with MIGHT think of you. Are you going to let the possibility that some AMG's may resent you stop you from applying?

Didn't think so.

Medicine is a dog eat dog world full of Type A's and over acheivers. If you work in this world, then you can expect to work with some/several A**holes. Not getting along with each other is just the nature of the Beast. All that matters is whether you can still work with each other.

A candidate with great scores (regardless of FMG v AMG)? Not all that special in this profession. Programs will employ the person that they want to work with. If they don't offer you a position, it's because they would rather work with someone else, for WHATEVER reason. In that case, just move on. Similarly, if you get an offer, it's because someone thought that you were worth employing. If that's the case you'd better make sure that you're worth keeping.

Grow some confidence and stop over-analysing things.

it is just a hypothetical discussion, we all do what we think is best for all of us. It is not about the Medicine, I talked to many other IMGs with different background, it is just here that people tear up each other to get the better position, and it is new and shocking for most of us

 

[RTrain]

Hey buddy, do you know that US citizens who graduate from other countries(US IMGs) with more than 25000 physicians are the biggest group of IMGs.........

Yes, I do. What's your point? That seems to prove my point rather than yours - you want to attribute the struggles of the FMG to racism and bias (as you try to link your argument to minority experience of race in the academic world in your next post), but that is not the point. People who graduate from foreign medical schools, whether they are US citizens or not, face a harder road in attaining US residency positions. Period.

As for racism, bias, and discrimination in America, believe me, "buddy," you don't want to go there. That is a Gordian knot that has plagued our country for hundreds of years, and we are always and constantly working as a country to improve our response to being a non-homogenous group of people who strive to see each other as brothers and sisters. We have a very long way to go, there is no doubt, but the problem of racism already has enough thorns. To pretend that the FMG's difficulty matching into derm has anything to do with racism, IMHO, cheapens the struggles of Americans who face racism in their lives, and borders on disrespectful of both the successful FMG's/IMG's and the AMG's of color here.

 

[JackBauERfan]

Yes, I do. What's your point? That seems to prove my point rather than yours - you want to attribute the struggles of the FMG to racism and bias (as you try to link your argument to minority experience of race in the academic world in your next post), but that is not the point. People who graduate from foreign medical schools, whether they are US citizens or not, face a harder road in attaining US residency positions. Period.

As for racism, bias, and discrimination in America, believe me, "buddy," you don't want to go there. That is a Gordian knot that has plagued our country for hundreds of years, and we are always and constantly working as a country to improve our response to being a non-homogenous group of people who strive to see each other as brothers and sisters. We have a very long way to go, there is no doubt, but the problem of racism already has enough thorns. To pretend that the FMG's difficulty matching into derm has anything to do with racism, IMHO, cheapens the struggles of Americans who face racism in their lives, and borders on disrespectful of both the successful FMG's/IMG's and the AMG's of color here.

I wrote a long response to this (just so you know I wasted some time) then I realized its no point in trying to educate the OP.

 

[JackBauERfan]

Yes, I do. What's your point? That seems to prove my point rather than yours - you want to attribute the struggles of the FMG to racism and bias (as you try to link your argument to minority experience of race in the academic world in your next post), but that is not the point. People who graduate from foreign medical schools, whether they are US citizens or not, face a harder road in attaining US residency positions. Period.

As for racism, bias, and discrimination in America, believe me, "buddy," you don't want to go there. That is a Gordian knot that has plagued our country for hundreds of years, and we are always and constantly working as a country to improve our response to being a non-homogenous group of people who strive to see each other as brothers and sisters. We have a very long way to go, there is no doubt, but the problem of racism already has enough thorns. To pretend that the FMG's difficulty matching into derm has anything

Plus DERM is soooo boring, I dont care who gets in it haha.

 

[Law2Doc]

As for racism, bias, and discrimination in America, believe me, "buddy," you don't want to go there. That is a Gordian knot that has plagued our country for hundreds of years, and we are always and constantly working as a country to improve our response to being a non-homogenous group of people who strive to see each other as brothers and sisters. We have a very long way to go, there is no doubt, but the problem of racism already has enough thorns. To pretend that the FMG's difficulty matching into derm has anything

Seriously. Two generations back minorities in this country couldn't even use the same water fountains or lunch counters. To whine about not giving a fair shot at a dermatology residency to NON-US citizens borders on the absurd, given how far we have come. We have issues we are working for in this country, and the strives toward divrsity in this country are monumental, but you get no sympathy on this one. It's somewhat of a miracle that medicine has come as far as it has.

Not everyone gets a derm residency. Most people who apply are eminently qualified. There is no real yardstick out there for who is best qualified -- we don't consider board scores the end all be all that perhaps other countries do (and in fact the creators of the USMLE are extremely unhappy with this kind of unintended use and are even talking about making it P/F someday not too many years down the road). Residency selection is not an objective process -- it is subjective, and PDs will weigh a variety of factors. And of course the factors they are most familiar with will be weighted more heavily accordingly. So if a PD doesn't know much about the quality of XYZ medical school in ABC country, that applicant won't get as much mileage from doing well there as someone who got A's at a school the PDs are familiar with and have matched many successful residents from. Such is life. That's not unfair, that's common sense.

And then when you add to that the political pressure of using not giving away federally funded slots to comparably qualified US individuals, it makes the decision awfully easy. We have plenty of residency needs for which we need to import talent, but that is driven by necessity, not equity. Dermatology isn't really one of those areas where the supply of qualified US individuals is lacking. If you were hoping for FM or OB, the story would be different.

And again, nobody is telling you not to apply, to take your shot. Just to understand that the odds may not be with you, and there are reasons why that have nothing to do with fairness or racism. And to a great extent, they have to do with selection criteria different than the numerical objective things you are focusing on.

 

[silas2642]

While I certainly believe that program directors need to priortize and pick the most qualified applicants, weeding out those who would not make competent physicians, I certainly believe that US citizenship should play a role in their ranking. It's the United States, funded by US tax payers, and US citizens should take at least somewhat of a priority due solely to the fact that they are citizens.

As for OP being bitter about his disadvantage for the match, I'm sorry. It's the way it goes, and nobody said that life was fair. You have a serious chance of not matching into derm, but with those scores and publications, you will match somewhere into some specialty, which is more than can be said for a lot of IMG's. Unfortunately, with the competitiveness of derm, there is no shortage of extremely qualified US applicants, and if you do not match into derm, I'm sure that there is an equally qualified US applicant somewhere out there who could take your place. From what I know, that's the match, that's how it works-- it's not fair, but we have to accept it so stop whining.

As for the racism issue, you need to stop complaining about that too because US citizens face that everyday. Get over it, do your job and move on with your life. People are jerks, and you need to learn to roll with it and move on with your life. You can't do anything about what is said to you or done to you, you can only affect your reaction to it.

 

[Southpaw]

Seriously. Two generations back minorities in this country couldn't even use the same water fountains or lunch counters. To whine about not giving a fair shot at a dermatology residency to NON-US citizens borders on the absurd, given how far we have come. We have issues we are working for in this country, and the strives toward divrsity in this country are monumental, but you get no sympathy on this one. It's somewhat of a miracle that medicine has come as far as it has.

Great point, Law. Look it makes sense to me that since US students take on US debt and pay taxes into the Medicare system, they should therefore be trained in this system and make profit in this system.

Crying apples about IMGs not getting spots is just beyond lame in my mind. This US has more diversity in its medical education system than any other country, and there ain't a close second. IMGs come over here with at a younger age and absolutely NO debt because their country financed their medical education, and feel ENTITLED to get a residency spot. It's unbelievably annoying. Try for Derm, if you can't get it, then be happy in FM or IM. Once you're out in practice you can design your practice to see all the derm your IMG heart desires.

Look, if you're an IMG and you've got the goods (Step 1 - 99, Step 2 - 99) and you've got good letters showing you're a hard worker, then you should compete for a spot with a US grad who passes boards (regardless of scores) and graduated from a US med school (regardless of grades). But if it's even remotely close, and I mean remotely, then the US grad should be taken for a multitude of reasons explained already in this thread.

 

[yaah]

I think part of the reason many IMGs have difficulty in landing competitive residency slots is simply because there is too much unknown about their individual backgrounds. US grads go to US med schools which are somewhat regulated as to curriculum, rotations are done at US hospitals which while different are all relatively similar. In a sense, PDs are taking a large leap of faith when they give a spot to a foreign graduate when they really don't know what kind of standards and training was undertaken there. This is why so many FMGs become more successful at residency when they attain experience here (through PhD or whatever), make contacts here who can then vouch for them. With enough studying, it is not out of the ordinary for even unqualified people to score highly on board exams. Thus PDs have a lot to weigh.

I think you will find that most competitive and prestigious residencies have IMGs in them. Ones that don't are more likely to simply be ones that appeal to a lot of local students who want to stay local for their training, and thus PDs have a vested interest at matching them because they know they will stay and likely work hard. And unfortunately a large part of the problem for qualified and excellent FMGs is the sheer number of basically incompetent FMGs who everyone that has gone through the US system has encountered - it is not the qualified person's fault that these individuals are around, but they may feel the consequences. We can whine all we want about how unfair that is, but it is a fact of life - until when and if it becomes easier to evaluate prospects and skills of foreign graduates, it is going to continue to be something of a crapshoot for PDs.

As an example, in my program we have a few FMGs (maybe 20% of the program, including fellows). Some are outstanding. Some are less than outstanding if not outright dangerous. Their resumes or interviews were not necessarily different, and it was difficult to predict future performance. With US grads, this problem also exists but it is somewhat minimized by US med schools' extensive evaluation systems.

 

[yaah]

The other thing I would add is that part of being an excellent physician in the US is simply integration into american society, having a knowledge of american culture, the language, etc. I suspect it is not a coincidence that the best FMG residents and attendings I have seen are the ones who seem to fit in really well and have a great understanding of this country.

 

[exPCM]

I posted these numbers on your other thread.

IMHO with the expansion of US allopathic and osteopathic medical school enrollment to roughly 25000 per year in the next 3-4 years (see: http://www.ama-assn.org/amednews/2008/06/23/prsb0623.htm ) we will see a decreasing number of good US students going to Caribbean schools. The Caribbean schools will be increasingly populated by marginal students. I also have disdain for the business model of the Caribbean schools as I think their main goal is to extract tuition money from their students and whether the students succeeds or fails is not a primary concern. I also do not think they place a high enough priority on the problems their students face in getting into US residencies.
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. I think this makes it inevitable that IMGs will be squeezed out. I certainly would not like to see US grads piling up large debts and passing the USMLE or COMLEX exams and then not be able to get into residencies due to spots being taken up by IMGs. I think you can take it to the bank that with the current cost cutting pressures in Medicare due to our looming US Social Security and Medicare shortfalls, you will not see increased funding for new residency positions. I think you will just see an expansion of midlevels (who do not need to go through Medicare funded residencies) to fill the gap.
The competition for prime residency spots will become severe with the expansion of US med school enrollment. I see no sense in adding foreigners to the mix. In addition there will be significant numbers of US students forced into primary care whether they like it or not due to this competition. I think that seeing students having to go into fields they are not interested in will not be positive development

So bottom line DermLover, do you think it is just fine to have more and more US medical students not be able to get into a US residency so we can give more spots to FMGs like you?

 

[dragonfly99]

agree with yaah, Rtrain and silas.
The original poster seems to think he/she is entitled to a derm spot due to having multiple publications and 250 USMLE scores. The thing is, there are multiple US students with multiple publications and USMLE scores in that range. Also these students have gone through a US educational system and hospital rotations that are known to the dermatology program directors in the US. It only makes sense that the program directors would likely prefer those people over Dermlover, who is from a school in another country that they are probably totally unfamiliar with. I personally had pretty high USMLE scores and a couple of publications, and went to very highly ranked US medical school, but I seriously doubt that I could have gotten a derm spot. One of the differences between the medical training system in this country vs. some others is that there is a strict limit on the number of students accepted into US medical schools, and also a strict limit on the number of residency positions. We don't have a system that just picks all the "qualified people". Other factors are taken in to account, such as "How many dermatologists will we need in 5-10 years in X state (say, Florida, for example)". Then the powers that be plan, "OK, well let's accept 'X' number of medical students into school in Florida, and allow 'X' number of residency positions in family practice but only 'Y' number in derm since we don't need as many dermatologists as we do family doctors".

Also, I think it is wrong for Dermlover to compare PhD with MD degree since they require different skills and attributes. PhD just requires that you be good at science and can produce scientific results. For medicine, being able to communicate well with your patients is critical. Here in the US most patients expect a very collaborative relationship with their physician, and will ask a lot of questions and want to discuss a lot of things with you (the physician). Therefore, it is important that a physician be able to speak and write English very, very well and it's very helpful to understand the social and cultural background of one's patients. I just think this is very hard for many IMG's (the ones who are not US citizens, and/or haven't spent large amounts of time in the US). It would be very hard for me to communicate with patients if I was just "off the boat" from the US to some other country as well. It just takes time to habituate to a new place, and there are so many subtle cultural cues, etc. that I just think it's hard for many IMG's to pick up on. I have friends who are IMG's and I don't blame them for this - how can they help it? It does affect patients though. I have had many patients complain to me about "foreign doctors" and not being able to understand them. It's worse with the patients who don't have a high educational level and have trouble communicating with us docs in the first place because it's hard for them to explain what is wrong, and hard for them to understand our instructions to them.

Also, as pointed out by someone above, I agree that I have encountered both stellar IMG's and ones who were really bad clinically. And some of the ones who are bad clinically did have high test scores. The USMLE just isn't that hard of a test, and one can easily study for it. Getting a high score probably tells you something about someone's IQ, I would hazard to guess, but it doesn't necessarily translate to clinical competence. It's just very hard for US program directors to evaluate what the clinical competence of any particular IMG is going to be, particularly if that person doesn't have clinical experience working in the US. That's not racism - it's just a fact.

 

[Joe Richards]

I agree with the post below AND let me add that regardless of where you do you residency, Medicine is a life long learning experience. When you pass your Board exams that means you are a board certified doctor.

If you feel weak in a certain area (and ALL doctors have an area and sometimes more than one area that they may feel weak in) then go to seminars and CME to get better at it. That is how it is done in medicine and all other fields.

Stop thinking about getting some AMG or IMG or whatever to like you better.

Just get the best residency that you can get, work hard and get on with your life.

When you start looking for jobs 95% of jobs don't care where you did your medical school or residency.

They ask two main questions first:

1. Is he / she board certified or eligible
2. Can I work with this person. Is this person a good long term investment?

Who cares?

Listen, if you want to give working in the US a go, then just apply. Why on earth are you worrying about what some people that you MIGHT end up working with MIGHT think of you. Are you going to let the possibility that some AMG's may resent you stop you from applying?

Didn't think so.

Medicine is a dog eat dog world full of Type A's and over acheivers. If you work in this world, then you can expect to work with some/several A**holes. Not getting along with each other is just the nature of the Beast. All that matters is whether you can still work with each other.

A candidate with great scores (regardless of FMG v AMG)? Not all that special in this profession. Programs will employ the person that they want to work with. If they don't offer you a position, it's because they would rather work with someone else, for WHATEVER reason. In that case, just move on. Similarly, if you get an offer, it's because someone thought that you were worth employing. If that's the case you'd better make sure that you're worth keeping.

Grow some confidence and stop over-analysing things.

 

[BabyPsychDoc]

never mind

 

[Law2Doc]

Just get the best residency that you can get, work hard and get on with your life.

When you start looking for jobs 95% of jobs don't care where you did your medical school or residency.

They ask two main questions first:

1. Is he / she board certified or eligible
2. Can I work with this person. Is this person a good long term investment?

I think you may have missed the thread where the OP is shooting for derm. So it's not really a function of getting the best residency s/he can get, it's getting one of the most competitive residencies. I think that changes the analysis significantly, because while lots of IMGs have no difficulty getting "a" residency, the same cannot be true for "a residency in X specialty".

 

[Joe Richards]

I think you may have missed the thread where the OP is shooting for derm. So it's not really a function of getting the best residency s/he can get, it's getting one of the most competitive residencies. I think that changes the analysis significantly, because while lots of IMGs have no difficulty getting "a" residency, the same cannot be true for "a residency in X specialty".

You are right. I missed that. If they are trying to get into derm then even AMGs are going to have a tough time with that.

 

[Joe Richards]

Is that really so? Forgive my ignorance, this is a sincere question. So, once an FMG/IMG has completed the US residency and applying for a job as an attending, most employers would not really care where the said FMG has done their residency? I mean, ok, big shots hospitals/academic posts aside.

YES IT IS TRUE. With the exception of some university programs or as you say big shot hospitals.

Here is a good example.

I personally know of several IMGs (pulmonologist, GI, critical care etc.) that are working in top notch hospitals.

In fact they are thought of as some the top notch doctors to go to in their specialty.

They work along side the AMG trained docs. There is no discrimination in salary or benefits.

They work their a ss off, know what they are doing.

 

[fakin' the funk]

To pretend that the FMG's difficulty matching into derm has anything to do with racism, IMHO, cheapens the struggles of Americans who face racism in their lives, and borders on disrespectful of both the successful FMG's/IMG's and the AMG's of color here.

Great post.

 

[DERMLOVER]

Yes, I do. What's your point? That seems to prove my point rather than yours - you want to attribute the struggles of the FMG to racism and bias (as you try to link your argument to minority experience of race in the academic world in your next post), but that is not the point. People who graduate from foreign medical schools, whether they are US citizens or not, face a harder road in attaining US residency positions. Period.

My answer was about your discussion of why AMGs should favor IMGs, cause of their familiarities with this culture and language and I said even if you are USIMG which means you can speak fluently and can understand the people culture as well as AMG you still have the same problem.

 

[DERMLOVER]

Seriously. Two generations back minorities in this country couldn't even use the same water fountains or lunch counters. To whine about not giving a fair shot at a dermatology residency to NON-US citizens borders on the absurd, given how far we have come. We have issues we are working for in this country, and the strives toward divrsity in this country are monumental, but you get no sympathy on this one. It's somewhat of a miracle that medicine has come as far as it has.

Why are you mad at me, I am not talking about DERM any more and if you like I can change my name too, and that is why I post this thread instead of that one. I am talking about other important things that are the preoccupation of many other IMGs who wanna start their rsidency here and have been told many things about social problems they face in their work.It is a fact that African Americans are only 1.6% of Orthopedics residents, I am not trying to use it as an excuse for why I cann't be a dermatologist. Although I cann't change the facts, but at least I can talk about them. Yeah I have applied for derm and IM and I am not giong to fight with PD and their ideas about who is more qualified in their view. As you said, it their job and their responsibilties, but I am talking about the ideal way of matching in MY OPINION and want to know other opinions about that....that is why we are still spending our time in writing and posting replies..

 

[DERMLOVER]

How many foreign nations accept non-citizens educated in the U.S. into their post-graduate training programs? Just curious.

I think except UK and Australia you are welcome everywhere, I mean without evaluating exams