What constitutes discrimination?

[Shjanzey]

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[Top Gun]

Its not discrimination. Residency spots in the US naturally go to AMGs first, because they trained in this country. Residency programs are more familiar with the education provided by US med schools, and that's why AMGs get selected first. In your own country, you would be selected for residency ahead of a US grad. IMGs get considered second. That's the way it is. If an IMG wants to do residency in the US, there are plenty of residency programs without a graduation-year cutoff. And how is it unreasonable to expect an IMG to learn English and pass Step 1 and Step 2 before starting residency here in the US. How will s/he communicate with patients if s/he cannot even grasp the fundamentals of English? And, like it or not, USMLE is the only standardized way of measuring a residency candidate's knowledge, and comparing it with that of US grads. And if an IMG doesn't like the rules, s/he can simply stay in his/her home country and practice there.

 

[Shjanzey]

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[gutonc]

Can someone please explain to me how this "policy" is not discrimination?

Because "Year of Graduation" doesn't constitute a protected class.

This policy is identical to not taking candidates with Step 1 scores less than a certain value. Or not taking candidates who require a visa (as a non-citizen you don't qualify for protected class status). There are million similar policies that programs have. None of them are discrimination, at least as it is legally defined.

 

[tkim]

I have a question about what constitutes discrimination in the matching/SOAP/and post-SOAP process.

My wife is an IMG who has been seeking to match this year. When the SOAP process was opened to allow applicants to contact several institutions one in particular said she would not be considered citing a "3 year graduation" rule.

As I see it, this rule seems to be specifically designed so that the program can automatically disqualify any IMG applying to their program. Why? Many IMG's when they graduate have to give compulsory service to their country as a GP for one or more years. This means that IF they decide to go immediately to the US afterwards, they must learn a new language and pass step 1 and 2 in two years or less. That is an unreasonable expectation. Also, most IMGs decide to go well after they have graduated from medical school in their native country.

Can someone please explain to me how this "policy" is not discrimination?

And yet, thousands of IMGs match every year. I'm sorry that the rules don't accomodate your wife, but it does not appear in any way 'discrimination'.

 

[gutonc]

I don't think it is too much to ask, for a program that has a post SOAP opening to consider an IMG as a possible candidate. In fact most reasonable people would conclude that it would be a great idea at that point in time, because they have had their shot at all the AMGs.

As I pointed out above, this is just a screening tool. Those programs who got applications post-SOAP probably had several hundred apps for, at most, 1 or 2 spots. As a PD, you need to have some way to pare them down. YOG is one of many. I assure you that your wife wasn't the only one.

On a related note, did she not match in the regular Match, or just not participate? Because there are tons of programs that would have (and possibly will again next year) consider her regardless of YOG.

 

[Shjanzey]

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[IamnotFreud]

I have a question about what constitutes discrimination in the matching/SOAP/and post-SOAP process.

My wife is an IMG who has been seeking to match this year. When the SOAP process was opened to allow applicants to contact several institutions one in particular said she would not be considered citing a "3 year graduation" rule.

As I see it, this rule seems to be specifically designed so that the program can automatically disqualify any IMG applying to their program. Why? Many IMG's when they graduate have to give compulsory service to their country as a GP for one or more years. This means that IF they decide to go immediately to the US afterwards, they must learn a new language and pass step 1 and 2 in two years or less. That is an unreasonable expectation. Also, most IMGs decide to go well after they have graduated from medical school in their native country.

Can someone please explain to me how this "policy" is not discrimination?

Is this question a joke or are you serious? For one, no program in the US owes anyone, anything. If they did though, they would "owe" them to AMGs. The programs can also set up whatever rule they want as long as they don't discriminate based on sex, race, color, religion. So if the program wants to say you have to be able to stand on your head for 3 minutes while giving a presentation and citing the Krebs cycle, they can do that.

Also, it's your wive's responsibility to fulfill the program's requirements, not the other way around. YOU and your wife are coming into a foreign country and expect anything? Seriously?!

In the US we all have to pass steps 1-3 to practice, so you have to comply with that. You have to comply with all the requirements the US demands, and if you don't like it, you can stay home and practice there. Given that it is the US, you also have to speak English (gasp!) how shocking is that?

If I went to say Mexico or Spain, I would have to speak Spanish, wouldn't I?

So how is meeting the country's and program's requirements discrimination? This is why we should do things like Canada-no foreigners until all AMGs match. Unbelievable, seriously.

 

[umean2tellme]

I said that it is unfair to expect someone to learn a new language and pass step1 and step 2 in 2 years or less.

Do people generally decide to practice in the U.S. on a whim or a dare? If someone is considering practicing in another country and doesn't speak the language, shouldn't they take the necessary steps well in advance to ensure they learn the language before they apply? It's not like you have to wait until you graduate to learn the new language. Just saying...

 

[IamnotFreud]

In the context I am speaking of it doesn't make sense. SOAP has ended, and they still have a spot open yet they still refuse to consider her candidacy.



My friend you need to check your reading comprehension skills. How did you pass VR on the MCAT? I said that it is unfair to expect someone to learn a new language and pass step1 and step 2 in 2 years or less.

Can you learn a new language in less than 2 years? Let me answer that for you. No you can't. IF you even speak a second language, which judging by your attitude I doubt, it generally takes five years to master if you were not brought up speaking it. I know this because I have become fluent in several languages after I reached adulthood.

While you are learning that new language, would you also be able to re-do your first and second years of medicine in that new language and then take a test at the same time? Get off your high horse dude. You are being a dick for no reason.



You are a real piece of work. The rules state that in order to be considered for residency you need to be ECFMG certified. It does not state that you should first be American, then get ECFMG certified, and then beg every residency program to even look at your application to see if you are qualified. By the way, my wife is an American Citizen, who has naturalized so your 'MURCA argument is ridiculous.

IMG's go through more than American medical students, yet they are treated like second class citizens. I was hoping that when you read this that you would understand I am not implying that IMG deserve special treatment, just equal treatment or even a fair consideration.

I don't think it is too much to ask, for a program that has a post SOAP opening to consider an IMG as a possible candidate. In fact most reasonable people would conclude that it would be a great idea at that point in time, because they have had their shot at all the AMGs.

With your attitude, it's no wonder you guys can't match. You are not from here, so you don't get any special treatment. If you don't like it-practice in your OWN country. No one owes you anything.

And yes you can of course learn a language in less than 2 years - I sure as heck did. And you are incredibly rude and nasty to be replying to TopGun in the manner that you did.

Get it straight-AMGs get preference, you do not. As an IMG if there is anything left over, you MAY get it, but it's unlikely, because you are not preferred. Deal with it.

that's how it works for everyone. You graduate and within 3 years for some programs, you pass all the steps and learn English before that. Don't like it? Tough, practice in your own country.

This entitlement is nuts. How can foreign people be this entitled, that they are owed an education by the US? Nuts.

 

[Shjanzey]

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[IamnotFreud]

Hi, I am in my own country. Thanks. I am entitled to have an attitude when someone gets on a thread, insults me, and doesn't contribute anything positive to the thread.

No, if you want to work in the medical field in the US, I would suggest that you get a professional attitude. You won't make it here, in the US that you so desperately want to work in, with that attitude, particularly when well meaning people give you advice. No one has insulted you, but you have insulted others.

Sure you did. There is a difference between knowing a few words and being fluent. Most Americans who say they are fluent sounds like ******s in the language they think they speak. A semester in Guatemala doesn't make you fluent.

Of course I did, and you are so simple that you *assume* that English is my native language. Maybe if you were able to have a more developed level of reasoning, you'd realize that perhaps the language that I did learn WAS English. It took me less than a year to be fluent, and about 6-8 months to speak it with some issues. I won't even bother discussing which language is my native one, but I think it's pretty simple to figure out if you read the post. I have never been in Guatemala, so I wouldn't know, but it's funny that you insult Americans yet you and your wife are desperate to come here and practice. So how about you stay in your country, along with your unmatched wife, and practice there, especially since your wife does not speak the language? We don't need people who can't speak English. That's a lawsuit waiting to happen.

As for rude and nasty, I really held back. I am proud of that, however, you are an excellent white knight for Top Gunner. I am sure he needs all the help he can get defending his ignorant post.

Why do you continue bashing TopGun? He's a perfectly nice poster, who has provided you with nothing but appropriate advice.

I don't know why everyone keeps assuming I am an IMG, when I clearly stated it was my wife. But it is fun being reviled and told to go back to "my" country when I already live here. Take your blinders off and address this query for what it really is.

If your wife did not have luck this year, she will likely be even less competitive, with a further date of graduation, and even less likely to match.

Once again, I never asked for entitlement. I wanted sound professional advice from someone who knows. I wanted to establish whether it was discrimination or not. Gutonc answered this question excellently, with very nice evidence, while avoiding a knee-jerk emotional reaction. Thank you Gutonc

You did. Anyone with common sense would know that a program can set whatever types of requirements they want. Maybe your wife is not competitive and the programs simply don't want her. Maybe her English is atrocious, maybe she's uncompetitive even for IMGs. Why cry discrimination?

 

[Shjanzey]

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[umean2tellme]

This had me rollin' on the ground laughing lol

 

[labmouse87]

Look, i am a canadian img and i agree with posters that AMGs should have first dibs in the match. After all, they took out huge loans to fund their undergrad and medical school and have huge urgency to pay back these crazy loans. I, too, have loans and i understand that not being an AMG gives the applicant a huge disadvantage. Please don't cry discrimination as plenty of IMGs get in on their on accord and abilities.

I took IELTS and TOEFL to prove my english language communication skills. I applied and completed american clinical months at John Hopkins and Uni of Maryland, I graduated top 20% of my class in a canadian med school, i had LoRs from american doctors who worked with me during my internship, i did some medical research and published a couple of posters in conferences. I applied very broadly in my residency of interest and i got a spot. My advice to your wife is for her to keep her clinical skills current and try again next year. Program directors have a right to refuse those out of graduation >3 years as their clinical acumen may not be current or strong enough anymore. Prove yourself to be an excellent candidate and you will stand a chance. Complaining and trying to sue for discrimination gets you nowhere and your wife may lose the chance to ever get a decent residency spot.

 

[Shjanzey]

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[labmouse87]

Well, i took TOEFL during my med school. It is certainly not a requirement but i took it anyway just to prove that i have what it takes to communicate with patients as a doctor. Yes, she should do more observerships and built good relationships with attendings that she rotate with the possibility of asking a recent LoR from american attendings. Also, she can try to get involved in research projects or possibly apply for a prelim or transition spot next year. Finish all your steps including step 3 and make sure your wife gets good grades for all her steps. Lastly, be prepared to apply for smaller rural programs in kentucky, iowa, oklahoma etc or places that AMGs refuse to fill like alabama, bronx, detroit and memphis and pray for good luck.

You did not mention what your wife is interested in. Is it because she is trying for competitive residencies? Also, what are her step scores.

 

[Shjanzey]

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[labmouse87]

i am not really sure about the extend of competitiveness in neurology. If you are really curious to see how your wife stacks up against other applicants, why not search for the average scores for US grad who are accepted in neurology residencies and look into their CVs. If your wife's scores cannot match up to theirs or offer a 20-30 point advantage vs the AMGs, then her chances of matching is typically low. Gap years are also a no-no for matching, not just in IMGs but also in AMGs reapplicants. Every year that you reapply and failed also puts you in a huge red flag. PDs will question if this candidate is excellent, then why she did not get a spot in previous year. No program wants unwanted leftover candidates if they have plenty to choose from.

If her scores cannot match those AMGs who are competing for the same residency spots, be realistic and aim for another area like FM or IM or Psyc or Peds. Lastly, please check out nrmp data and statistics and aim where your chances lies the greatest. It is all up to your wife to do her research and be proactive of her application. Complaining of discrimination is the last thing you want to do.

http://www.nrmp.org/data/resultsanddata2012.pdf

 

[xrevision]

Discrimination...? She can always practice in her home country if she chooses. You can't fault a program for having requirements that your wife doesn't meet that aren't based on sex, color, religion, sexual preference, etc. What are your wife's scores? I also know of a lot of IMG's who take step 3 prior to applying for residency.

 

[Top Gun]

In the context I am speaking of it doesn't make sense. SOAP has ended, and they still have a spot open yet they still refuse to consider her candidacy.



My friend you need to check your reading comprehension skills. How did you pass VR on the MCAT? I said that it is unfair to expect someone to learn a new language and pass step1 and step 2 in 2 years or less.

Can you learn a new language in less than 2 years? Let me answer that for you. No you can't. IF you even speak a second language, which judging by your attitude I doubt, it generally takes five years to master if you were not brought up speaking it. I know this because I have become fluent in several languages after I reached adulthood.

While you are learning that new language, would you also be able to re-do your first and second years of medicine in that new language and then take a test at the same time? Get off your high horse dude. You are being a dick for no reason.



You are a real piece of work. The rules state that in order to be considered for residency you need to be ECFMG certified. It does not state that you should first be American, then get ECFMG certified, and then beg every residency program to even look at your application to see if you are qualified. By the way, my wife is an American Citizen, who has naturalized so your 'MURCA argument is ridiculous.

IMG's go through more than American medical students, yet they are treated like second class citizens. I was hoping that when you read this that you would understand I am not implying that IMG deserve special treatment, just equal treatment or even a fair consideration.

I don't think it is too much to ask, for a program that has a post SOAP opening to consider an IMG as a possible candidate. In fact most reasonable people would conclude that it would be a great idea at that point in time, because they have had their shot at all the AMGs.

Well, now that you're done throwing your little tantrum, you might actually look at what I wrote and consider it more carefully.

First of all, the SOAP has an extremely limited number of spots available. These are all the unfilled spots left over after the match. IMGs are considered for those spots, but AMGs get first dibs. And by the way, you are incorrect in your statement that the 3-year graduation cutoff is a blatant attempt to discriminate against IMGs. No, it isn't! The 3-year cutoff is in place because a candidate who graduated from med school 3 years before applying to residency may have had some deterioration in clinical skills. This goes for AMGs as well as IMGs. Doesn't sound like discrimination to me.

And second, I do know a second language, as a matter of fact. Spanish. After 2 years of studying it in high school, I knew enough to at least carry on a conversation. If I can do that, so can your wife. And no, its not unreasonable to expect her to pass Step 1 and Step 2 before applying to residency. That's what everyone else does, AMGs and IMGs alike.

And I am perfectly aware that an IMG can apply for residency as long as s/he is ECFMG certified, being an IMG myself. That doesn't mean an IMG is entitled to a residency. When I applied for residency, I knew that I would have to work harder and apply more broadly to obtain a position. Hell, I didn't match the first time either, but I just applied more broadly the next time and sent my application in earlier and matched that time. I didn't go around crying discrimination and acting like I was entitled to a spot.

And I'm sorry if you feel like I'm being a d**k, but when you come here with the attitude that your wife should be granted a residency spot, then a reality check is in order. And guess what, your wife was considered. For whatever reason, the residency programs found other candidates more desirable. Sorry. Tell her to apply more broadly next year and improve any weak areas in her application, and maybe she'll match for the following year.

 

[Shjanzey]

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[tkim]

You will have to forgive me, for a moment I forgot you are a doctor and we all know that makes you a super genius who can fluently converse in another language, take a USMLE level test and pass it with a 99 all with only 2 years of High School Spanish. Tell me about the time you were PGY-1, the Attending and the chief of residents at the same time you genius you.

You will get little useful answers with this attitude. If you are truly trying to understand or help your wife, humility is in order.

 

[Top Gun]

Funny enough, I don't recall mentioning anything about being a super genius, but I'm honored you think that about me, lol.

As for the part where you quoted me as saying "she should stay in her own country," you completely missed the point. If you're an IMG and you want to apply for residency here, fine. Do that. But jump through the necessary hoops first. If I were a PD, and I saw that you were an IMG with excellent credentials, I would probably invite you for an interview and possibly you would even match.

But if you don't want to put in the effort, then you may as well stay in your own country because you will not get a residency here unless you do everything necessary to make yourself a suitable candidate.

By the way, you haven't even mentioned anything about your wife's other qualifications: USMLE scores, clinical/research experience etc... It is possible that other factors could have been at play besides the 3-year cutoff, you know.

 

[Substance]

Funny enough, I don't recall mentioning anything about being a super genius, but I'm honored you think that about me, lol.

As for the part where you quoted me as saying "she should stay in her own country," you completely missed the point. If you're an IMG and you want to apply for residency here, fine. Do that. But jump through the necessary hoops first. If I were a PD, and I saw that you were an IMG with excellent credentials, I would probably invite you for an interview and possibly you would even match.

But if you don't want to put in the effort, then you may as well stay in your own country because you will not get a residency here unless you do everything necessary to make yourself a suitable candidate.

By the way, you haven't even mentioned anything about your wife's other qualifications: USMLE scores, clinical/research experience etc... It is possible that other factors could have been at play besides the 3-year cutoff, you know.

Man, this dude is a piece of work. His wife is an IMG and expects a spot?!

If it were up to me, and people should be very happy it isn't, there would be no spots for applicants who did not complete medical school at an LCME-accredited institution. Full stop. If you want to get a US residency you're free to write the MCAT and apply to medical school.

 

[cheruka]

If you are in FM, IM or psych in theory you need even better communication skills.

 

[umean2tellme]

OP, what are your wife's other stats (USMLE, USCE, etc.)? What specialty did she apply to? How many apps did she send out? How many interviews did she receive?

 

[xrevision]

You will have to forgive me, for a moment I forgot you are a doctor and we all know that makes you a super genius who can fluently converse in another language, take a USMLE level test and pass it with a 99 all with only 2 years of High School Spanish. Tell me about the time you were PGY-1, the Attending and the chief of residents at the same time you genius you.

That 99 is not what you think it means. Thats the score IMG's always quote but it means pretty much nothing.

 

[cheruka]

During my third yr FM rotation, I watched a resident from another country interview a 19 yo young man. It was terrible. The resident could not understand what the kid was saying, the kid did not understand what the doc was saying. It was astonishing that these ppl get through the clinical skills exam...

 

[45408]

My friend you need to check your reading comprehension skills. How did you pass VR on the MCAT? I said that it is unfair to expect someone to learn a new language and pass step1 and step 2 in 2 years or less.

Can you learn a new language in less than 2 years? Let me answer that for you. No you can't. IF you even speak a second language, which judging by your attitude I doubt, it generally takes five years to master if you were not brought up speaking it. I know this because I have become fluent in several languages after I reached adulthood.

Wouldn't you anticipate that you plan to work/train in a country for years in advance and train accordingly? It's unfair to expect that residencies would want someone who had graduated from medical school 5-6 years ago. Why would they? Someone will lose a significant amount of clinical acumen if they are out of practice. If they are in clinical practice, they can still find programs willing to take them, just not all.

While you are learning that new language, would you also be able to re-do your first and second years of medicine in that new language and then take a test at the same time? Get off your high horse dude. You are being a dick for no reason.

It's not discrimination, under any established federal guideline. It just isn't.

IMG's go through more than American medical students, yet they are treated like second class citizens. I was hoping that when you read this that you would understand I am not implying that IMG deserve special treatment, just equal treatment or even a fair consideration.

They go through more hoops, because they trained in a separate system, and they need to demonstrate that their education is equivalent to an AMGs. If they stayed in their own country, they wouldn't have to "go through more." If I wanted to practice in the UK, I'd have to go through more than a UK graduate.

I don't think it is too much to ask, for a program that has a post SOAP opening to consider an IMG as a possible candidate. In fact most reasonable people would conclude that it would be a great idea at that point in time, because they have had their shot at all the AMGs.

So does this program accept any IMGs?

Hi, I am in my own country. Thanks. I am entitled to have an attitude when someone gets on a thread, insults me, and doesn't contribute anything positive to the thread.



Sure you did. There is a difference between knowing a few words and being fluent. Most Americans who say they are fluent sounds like ******s in the language they think they speak. A semester in Guatemala doesn't make you fluent.

As for rude and nasty, I really held back. I am proud of that, however, you are an excellent white knight for Top Gunner. I am sure he needs all the help he can get defending his ignorant post.



I don't know why everyone keeps assuming I am an IMG, when I clearly stated it was my wife. But it is fun being reviled and told to go back to "my" country when I already live here. Take your blinders off and address this query for what it really is.

Once again, I never asked for entitlement. I wanted sound professional advice from someone who knows. I wanted to establish whether it was discrimination or not. Gutonc answered this question excellently, with very nice evidence, while avoiding a knee-jerk emotional reaction. Thank you Gutonc

Your attitude is extremely unprofessional and rude.