Hello everyone. I am a MS-III at an American medical school and I am just now starting to look at some residency programs. I remember one of my attendings last semester advised me to avoid programs with a lot of Caribbean/DO/IMG residents, but why is that? Are they more likely to be malignant? Less competitive/desirable (ie, weaker training)? Or is he just being biased? I don't mean to offend anybody, I am just curious as I start looking at programs.
What does it mean if a program has a lot of IMGs, DOs, or Caribbean residents?
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In essence, if a program is good, it will attract better candidates.
The overall quality of FMG/Carib/DO training is on average not as good as that of allopathic LCME-accredited MD training. If a program has to fill its ranks with such individuals, it means that the program wasn't good enough for whatever reason to take in more consistently high-quality candidates. It could also mean that the program pays no mind to the education and quality of resident and recruits whomever it can to fill the call roster and maintain GME funding - if the program cared about reputation, it would have left spots empty rather than fill them with chaff.
The overall quality of FMG/Carib/DO training is on average not as good as that of allopathic LCME-accredited MD training. If a program has to fill its ranks with such individuals, it means that the program wasn't good enough for whatever reason to take in more consistently high-quality candidates. It could also mean that the program pays no mind to the education and quality of resident and recruits whomever it can to fill the call roster and maintain GME funding - if the program cared about reputation, it would have left spots empty rather than fill them with chaff.
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Wow.
At my DO program, some of my peers are amazingly bright. Yes, there are always a few people that make you scratch your head and make you wonder how they managed to get into medical school. But for the most part, I have been very impressed by the work ethic and intelligence of my colleagues. I was recently talking with an MD attending at a nearby ACGME (MD) residency program, and he mentioned one of the DO graduates of my school (who I also happened to know), and he told me that she was the best resident he has ever come across - MD or DO. I think it's really sad to have such prejudiced attitudes.
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Le sigh.
Emphasis is mine, obviously. And - just because your jimmies clearly got rustled - Substance never directly compared all DOs to "chaff". Rather, he compared DOs who would end up at programs also filled with FMGs and IMGs as chaff. That's a pretty safe assumption, and it would be equally true of any MDs at the same programs. I know a number of brilliant DOs, as well, but my series of anecdotes does not equal data. So, let's not turn this into an MD vs. DO thing, but just agree that 1) in general, Substance is correct and 2) we should maintain enough of an open mind to reserve judgment about both programs and individuals until we have sufficient first-hand experience.
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One of the main flaw in your argument is that the D.O. match is much earlier than the M.D. match, so pretty much the majority of D.O.'s are in a program by the time the M.D. match takes place. So how do these unpopular M.D. residencies land crummy D.O.'s 🙄 There can be a few who didn't match into D.O. spot, didn't scramble to fill a D.O. spot, didn't match into M.D. and then SOAPed into a M.D. spot... but those are the minority to the extreme. I have never heard of anyone doing that.
To the O.P:
D.O's either partake in pure osteopathic residencies (100% will be D.O.s), purely allopathic residencies (may be majority of M.D.s but a few D.O.s who forgo the D.O. match and apply to allopathic match, these applicants usually tend to be strong applicants) or they match into dually accredited programs (mostly through the D.O. match). Dually accredited programs usually have a # spots for D.O.s and a # spots for M.D.s they reserve. So that's how D.O.s get into the mix.
As for foreign students, there are fantastic foreign medical schools around the world... The fact that a program may accept more may be due to the fact that they have had residents from that school before and liked the results. Or they like the program to be multicultural. OR how about the fact that the applicant was competitive and they liked them? LOL.
Yeesh, I totally didn't mean to start a firestorm. I have friends in osteopathic medical schools and they definitely are smart, and I didn't mean to suggest anything otherwise (that goes for Caribbean and IMG candidates as well). I guess one of the things I was wondering about was whether allopathic residency programs had any specific disincentives (whether it be policy, immigration, funding-related, etc.) for accepting non-AMG MD students and if so, why there seem to be specific programs that tend to field classes full of them?
All things equal, is there a general hierarchy with which residency programs tend to prefer medical school graduates for residency? I don't know any Caribbean students so I can't attest to their level of training but how are they viewed?
All things equal, is there a general hierarchy with which residency programs tend to prefer medical school graduates for residency? I don't know any Caribbean students so I can't attest to their level of training but how are they viewed?
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Your question is legitimate, I don't think you were being offensive in any way.
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Let's be honest here. Top programs in the US will take an FMG who is strong and whose training is considered on par with American training. At each Ivy league institution you will see a few FMGs, and all will be excellent. But the fact is that out of say 50 residents in a program, 5 will be FMG.
However, if you go to other programs at the lower end of the spectrum, you'll see mostly FMGs, Caribs, and maybe the occasional DO (though the latter probably not very frequently since DOs have their own match). It is because 1. American grads have better credentials and training and thus better options 2. The programs don't really care about resident quality and want to take whatever comes for financial/rostering reasons.
In my experience I've seen that programs that rely on heavy FMG recruitment tend to have really poorly-performing residents and very weak educational systems, with very poor boards pass rates. I've met residents from other programs at my training institution who could not speak English and did not know the basic tenets of medical practice - if I were a staffman at that point I would have raised a huge fuss about it because it was certainly hazardous to patient care, though each of them did fail the rotations. I would not be surprised if these FMGs bought counterfeit degrees abroad and jumped through the few hurdles required to get a shot at the system.
Call me a hardliner, but I'm all for blocking the match off to anyone who hasn't obtained an LCME accredited medical education. None of this FAIMER garbage - too much variability in quality. If a foreign national wants to practice medicine in the US, they are very much welcome to write the MCAT and apply to medical schools here.
The poster below makes a good point about checking out board scores rather than generalizing. Patterns are patterns, and though nothing is absolute, one must have their radar a bit more finely tuned when assessing FMG-heavy programs.
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It all depends. Look at the residency you're interested in and check out the board scores, any score cut-offs, etc.
Nothing is black/white.
Nothing is black/white.
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I think it's tough to go with these generalizations. You won't really know if a Program is full of foreign medical grads because it has to stoop to fill, or if it just happens to have landed a handful of superstars from other lands in the same interval. The sad thing is when a program has to think long and hard about med student perceptions before doing the latter. I've definitely seen both -- very good programs that gave a few spots to amazing non-US people, and not so great places that filled with foreign grads outside the match. In general, if they are filling in the match you really don't want to make those generalizations.
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Just wanted to add that location can also be a factor. There are some nice programs in undesirable locations, which negatively impacts their match. Move the identical program to a metropolitan area, they would get flooded by AMGs.
ROFL. Really... ROFL...
If this had been truth you would have a much better results/output of treatment than any other country all over the world. But you don't. Just FYI there are many countries where they have on average the same results as US (in some fields worse in other fields better) even with much lower budget. You are not a brain of the world.. you just have much more money which brings the brains from whole world there and helps them together with 'us brains' to transfer it into the best possible outputs (and ofc make even more money for the US). Your medicine just hugely rely on advanced technologies than other do. So it's let say little bit ridiculous to try to be a part of such a health-care system if you saw MRI just on a picture. I could say that average US medical student here (abroad) is a terrible student too since it's true... but I don't want to make such a simplification.
Have you ever tried to think like this - you can open a residency program and make it look really really IMG-friendly (for first year match just on program's websites let say) and then what's going to happen? Yes you are going to get a hundreds or thousands of applications from IMGs, USIMGs and maybe other... and now what? Do you think that you have to fill these 20 spots up with noobs??? No you really don't. You can pick the top of the tops from these thousands of applicants and despite the fact that there is a chance that the really top IMGs are going to match at really top programs (you call it ivy league I guess) still those who are going to match to your program are the best graduates from their countries and on average they are going to be much much better than average USgrad.. I can guarantee it to you. So you are going to have a much stronger program than any other silly USgrad-only oriented program has. BTW that is the exactly same principle as the one about - how US were established and how they have became world leading country.... just the strongest were picked up and just the strongest of the strongest survived and settled there... ;-)
So do it.. block IMGs from the match.. and you will see what's going to happen.. that your health-care system is going to get on a downward spiral.
And just FYI ... my guess is that less then 1ppt of those IMGs who are going to be an excellent physicians there (thanks to the match and open policy to residency) would be able to survive studies there.. not b/c of skills or anything like this but b/c of money. Student loan is not a problem since you don't have to pay it immediately but the living expenditures are. For majority of IMGs there is no way how to survive there until they get paid thus until a residency. And FYI the expenditures just to match to residency may exceed their (or their parent's) whole year salary by multiple times (and unless like in the US no one is willing to borrow them ofc 🙂 despite the fact how excellent physicians they can become there)....
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To be fair, I don't think anyone is (or should be) suggesting that people in the US are smarter or will be better doctors, per se. I think it's more of an issue of integrating seamlessly into the US system that often makes IMGs a second choice. There can be language issues, culture issues or a lack of understanding of US healthcare roles generally that can make PDs choose to go with even an objectively weaker US grad. The training might not be "better" but it will be more targeted to the expectations here. And that matters to the PD who, above all things, doesn't want to hear from annoyed attendings at 3 am.
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I use to hold this misguided belief that if there are less AMG the program would automatically be bad. However, I have realized that this is not the case. I agree with some of the post that an undesirable location usually tends to not attract AMG, BUT these programs are usually really awesome and caring and want you to succeed as a resident.
The question is why a program in a desirable location do not attract more AMG. And during my interviews I have noticed that these programs are going through changes. For example couple programs got new program directors who are on the cusp of changing the program for the better. Initially, they did not attract AMG, but now since the program is growing/improving are trying heavily to recruit AMG. The hope is they continue recruiting better AMG candidates -- because if one comes more will apply.
The point should be noted that attracting AMG does not mean they are taking the best resident -- because there are many many non-AMG that are amazing residents. Sadly, the
misconception that "predominately AMG programs are better" is still held strongly by the medical community
The question is why a program in a desirable location do not attract more AMG. And during my interviews I have noticed that these programs are going through changes. For example couple programs got new program directors who are on the cusp of changing the program for the better. Initially, they did not attract AMG, but now since the program is growing/improving are trying heavily to recruit AMG. The hope is they continue recruiting better AMG candidates -- because if one comes more will apply.
The point should be noted that attracting AMG does not mean they are taking the best resident -- because there are many many non-AMG that are amazing residents. Sadly, the
misconception that "predominately AMG programs are better" is still held strongly by the medical community
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It only means one thing - the program is probably less competitive. More competitive programs usually fill with US grads, while less competitive programs attract more IMGs/DOs. We can debate the reasons forever, but that's not relevant to the initial question.
Now, what "less competitive" means can be variable. Relevant factors include the following:
- Location. It'll probably be easier to get into WashU than Mt. Sinai, even though WashU has a "higher ranked" med school. It'll probably be easier to get into Mayo than any other program with similar reputation, since nobody wants to live in Minnesota. Based on that, you'll see more IMGs at Mayo than you'll see at most academic programs in California. You can generally assume that a program in the Midwest is automatically less competitive.
- Malignant programs are usually harder to fill, but you can't assume that a less-competitive program is malignant.
- Community hospitals are usually less competitive than academic hospitals, and you can assume that this will automatically make a program less competitive.
- Quality of training is usually proportional to competitiveness, but you can't make assumptions about this.
- and many other things
First of all, I think there needs to be a differentiation between an international medical graduate and an American citizen who went to an international/ Caribbean school. Most international grads who are competitive here in the US and have amazing usmle scores and are very smart, many of them were already physicians in their home countries and know way more than you and me.
American citizen Caribbean grads face more prejudice because people assume they were not competitive enough to get into an American school, but I don't think it is fair to generalize any group. Every student is different and their cases are reviewed on an individual basis. One of the smartest doctors I have ever met went to a Caribbean medical school. Caribbean schools tend to accept way too many people and charge a ton of money and those who can't take it or pass everything don't make it to boards or match. Those who match here at a good or decent program likely are smart people and had solid board scores and likely have the same basis of knowledge you do.
As a soon to be DO I think honestly the prejudice tends to be specialty dependent. In one of my primary care interviews at an md program the director told me he prefers DOs (this is a reputable program near a big city and is fairly competitive for family). It's all program dependent on what they look for and the experiences with previous residents.
What school the people in their program went to doesn't necessarily matter, that's why there are board scores and interviews to even the playing field. Surgical fields and highly snooty specialties don't tend to be as DO friendly, however I have classmates who scores higher on the usmle than most md students and are set to match in highly competitive fields. Every student has their own story. MDs and DOs have essentially the exact same education, maybe I needed 2 or 3 points less on my mcat to get into my school than yours but I have learned the same things and qualify for the same board exams and residencies as you (and I can also crack your back).
American citizen Caribbean grads face more prejudice because people assume they were not competitive enough to get into an American school, but I don't think it is fair to generalize any group. Every student is different and their cases are reviewed on an individual basis. One of the smartest doctors I have ever met went to a Caribbean medical school. Caribbean schools tend to accept way too many people and charge a ton of money and those who can't take it or pass everything don't make it to boards or match. Those who match here at a good or decent program likely are smart people and had solid board scores and likely have the same basis of knowledge you do.
As a soon to be DO I think honestly the prejudice tends to be specialty dependent. In one of my primary care interviews at an md program the director told me he prefers DOs (this is a reputable program near a big city and is fairly competitive for family). It's all program dependent on what they look for and the experiences with previous residents.
What school the people in their program went to doesn't necessarily matter, that's why there are board scores and interviews to even the playing field. Surgical fields and highly snooty specialties don't tend to be as DO friendly, however I have classmates who scores higher on the usmle than most md students and are set to match in highly competitive fields. Every student has their own story. MDs and DOs have essentially the exact same education, maybe I needed 2 or 3 points less on my mcat to get into my school than yours but I have learned the same things and qualify for the same board exams and residencies as you (and I can also crack your back).
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Question is, Is it the chef or the kitchen?
Is it the FMG/Carib/DO conglomerate (BTW Caribs and DOs hate to be lumped with FMGs.) or the hospitals? Or both?
If I would pick one reason I would say it is desirability.
As an AMG I wouldn't get too concerned with that. Programs that have majority IMGs aren't your target (as you attending said) they are usually smaller hospitals in undeserved section of town. Usually but not always NOT a university hospital and thus less reputable less known , faculty to trainee ratio is lower, not much funding and they usually serve the poor ..who wants to do that !!! (by who I mean not only trainees but also faculty and specialist faculty) . I think I just defined the Community Hospital.
Lets be realistic as a doctor you want to have a big name university as your credential, it is not about what you have discovered or how many patients you have served or how much suffering you have alleviated it is all about what institution(s) you been to. For one everybody wants to bee part of something big that is the dream right? I might sound sarcastic but this is the truth when you look for employment after residency or further training employer will know your big name place right away.
Future earnings and career opportunities depend on this $h1t.
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Not necessarily. What you described is more likely to be a County hospital rather than a community hospital.
Community hospitals may be very well funded with a very high ratio of private insurers as compared to indigent patients. Im sitting in one right now with a Starbucks in the lobby, a grand piano being played by a nice older gentleman and a full service spa in the hospital where patients can get manicures pedicures facials etc. while in house. Remember, even the Mayo Clinic is considered a community hospital.
Excuse me - I'd like a cinnamon scone to go with my cappuccino. 😉
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Just to clear up some terms.
IMG: US citizen who graduated from medical school outside the USA
FMG: non US citizen who graduated from a medical outside the US
Caribbean grads can be FMG (there are a lot of non US citizens who go there too).
IMG: US citizen who graduated from medical school outside the USA
FMG: non US citizen who graduated from a medical outside the US
Caribbean grads can be FMG (there are a lot of non US citizens who go there too).
It depends, I guess.
Here maybe/sometimes yes. Officially.. no.
Talking about allo residencies there are basically just three options - USgrad (everyone with MD degree from US university) / US DO grad (dtto but DO degree) / IMG (everyone with every degree that is considered to be equivalent to MD from university outside the US).
ofc you can be the US citizen / US perm resident / NonUS resident - visa holder ... but this has not much to do with your residency training and even less with your pre-grad training.
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In many of the competitive residencies there are really just two categories:
1. US allo grads, and
2. Everyone else. Lots of shades of gray stuffed in here, but the analysis is always the same -- how exceptional is this person and to what extent will taking him/her make our program look to future applicants like we have to take people outside of category #1.
Most competitive allo programs at times cherry pick the best people from the other categories. The guy who is the top med school grad from India is often better than a lot of the US grads on top programs rank lists and it would be silly to at least not interview him. But it can't be denied that a program that fills 6 of it's 8 spots with foreign grads is going to look really bad/desperate to future applicants, even if these six are the best the rest of the world has to offer, so no "top" program would do this. You can get away with one or two items off the regular menu every couple of years, but it can't be a regular thing. To some extent it's a shame that perceptions outweigh merit, but most of life is like that.
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actually for NRMP the categories are US allopathic senior (those in the 4th yr of an MD program), and independent applicants (so L2D is correct). Independent applicants include IMGs, DOs, canadian med school grads, 5th pathway grads,and USgrads (those who have already graduated from a US MD program). Is a bit interesting that Canadian school grads are separate from IMGs
however on a forum like sdn there is a unofficial listing to help distinguish between different applicants…and drcrispmd's is one that is typically used.
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Canadian school grads are separated because their education is considered equivalent to US MD education.
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uh…so are the domiciled medical schools of other countries…
it probably more because the LCME and CACMS work together….
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The biggest reason is that Canadian Medical Schools are LCME accredited so they are not considered to be IMG schools in the eyes of residency programs (unless they have a personal bias against Canadians/Canadian training).
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There's a difference between DO students at the top of their class, who most likely would have made it to MD schools, and everyone else below them - a.k.a. the average D.O.
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No, actually you defined those underfunded, underserved hospitals. Community hospitals tend to serve the upper middle class and affluent (i.e. non-Medicaid). Most of suburban America does not go to "academic" facilities that have residents for their usual healthcare needs. They want to see the attending (w/o the resident) and get out.
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*sigh
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Are you saying I'm wrong? You seriously believe that the average MD (in the middle of his/her class) vs. the average DO (in the middle of his/her class) are usually equal?
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Yes.
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Yes, they are. MD and DO students take the same courses and essentially have the same medical training.. The only difference is that DO's receive that extra training in osteopathic manipulation. So it seems to me that the average DO student is actually better in one way than the average MD student since they not only have the same educational requirements as allopathic students, but also have that extra training in manipulation.
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i would imagine that many of the applicants in the DO school also had applications at the MD school…
determining that one school is better than another by the number of applications it receives is not really a good gauge…
and students with high stats may very well choose your school, but you know for a fact that they chose it over an MD school? some may have, some may have never applied to an MD program so that too, is a poor way to gauge the quality of a school.
seems like you have slight chip…there is a bit of passive/aggressive attitude in that you point out that a DO has become chief at an allo program (maybe they were just harder working, brighter people than the other residents) and that people with very high stats choose DO (implying that they rejected the MD).
you are correct in that this seems to be more a perception of those who are not in medicine as a practitioner…once you are out in the real world (other than academia) people don't care…patients want a doctor that cares about them and is knowledgable enough to take care of them, colleagues are going to want someone they can work with and knowledgable enough that they can trust their opinions…MD, DO, MBBS…doesn't matter
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I'm neither a premed nor a medical student, as I've already graduated from medical school, so you'll have to try harder to dismiss me. There's a reason that D.O. students are not highly sought after by programs. D.O. student applications to residency are harder to gauge as they tend to rotate in community hospitals that are not directly connected to medical schools, where patients are more affluent and tend to not be as sick vs. academic hospitals which tend to treat patients with more medical problems and thus are more complex, and thus are more rigorous.
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If they "take the same courses and essentially have the same medical training" - then why do D.O. students (on average) have a lower passing rate on the USMLE? D.O. students also tend to more often rotate at different community hospitals that aren't directly under the auspices of a medical school, thus there is no standardization of grading bc the faculty at these hospitals are not medical school faculty that have to report to anyone.
By the way, you know damn well, that most osteopathic physicians don't do their osteopathic manipulation techniques(OMT), once they get into residency and become attendings, esp. since OMT, for all intents and purposes, is complete BS not supported by evidence based medicine. The only reason D.O. students do OMT training is due to tradition in the osteopathic philosophy, not bc they actually want to do it. Not to mention the COMLEX test would cease to exist as a moneymaker if D.O. schools stopped teaching OMT, and students all took the USMLE instead.
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Why does this argument always come up? Its just a bunch of generalizations followed by anecdotes. Go study and learn about taking care of patients.
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This turned into another M.D. vs D.O. thread 
It doesn't mean anything, or it means a lot, it all dependso nt eh program. I was worried about mine when I saw the matchlist contained a couple DO's and a Carribean student in class of 10. Turns out the residency director was a DO (and a brilliant doctor who was double boarded), and had just started carefully picking carrib students after having good luck with them in the past (high board scores and top of class). Happens to not mean much at my program and a couple others I know. But I see other programs that are very heavy on those and sometimes it's a matter of them having trouble filling spots.
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Then you'd be incorrect.
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This "we are better" attitude is one of the stupidest things DOs say currently, and this is coming from a DO.
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You completely missed the point of my post. DermViser was saying that the average MD student was better than the average DO student. I was saying that the DO students follow the same educational requirements as the MD students and have that extra training in osteopathic manipulation to make the point that the allopathic pathway is not necessarily better. In short, my post was a rebuttal to Derm Viser's post.
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You're right, how could anyone possible interpret this "So it seems to me that the average DO student is actually better in one way than the average MD student since they not only have the same educational requirements as allopathic students, but also have that extra training in manipulation." as stating that DOs are better than MDs.
The crap you spouted above is repeatedly stated on this website and makes DOs look like insecure little children. It needs to stop, period.
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Chill out. Go drink a few beers and relax. Maybe I should have worded it differently. But I was making the point that an MD student is not necessarily superior to a DO student. I'm not even a DO, so its not like I have a vested interest in defending them. And its very interesting how you jump down my throat for actually defending DO students, and yet you don't call out DermViser for making the reverse argument. But fine. Can we agree that neither MD or DO is superior? That is all. Thank you.
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Yes, one can see how much DO's use OMT techniques once they hit residency. Almost NONE of the time. OMT is only a relic that is taught to somehow make the DO school "different" in curriculum from LCME schools.
Of course DO schools also lie saying that DO is made for primary care medicine, when in fact many of their students try to go for specialties. I'm sure it's no coincidence either that a sizable number of DO students go to ACGME residencies, and not their own AOA residencies, of which their administration continues to create more schools, but not enough residencies for their own students.
The point is that Program Directors want their programs to be competitive for medical school applicants. Taking in IMGs, Carribeans, and DOs lowers that competitiveness.
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You know what, I really have no interest in getting into a pissing match between MDs and DOs. Neither is inferior, neither is superior. Let's just leave it at that.
And FWIW, I have worked with a variety of physicians from different types of schools during my residency and career as an attendings: MD, DO, Carib, FMG. I have seen brilliant ones from each group, and I have also seen lazy and incompetent ones from each group. In the end, its really not the school that determines what type of physician a person will become, its the individual.
And FWIW, I have worked with a variety of physicians from different types of schools during my residency and career as an attendings: MD, DO, Carib, FMG. I have seen brilliant ones from each group, and I have also seen lazy and incompetent ones from each group. In the end, its really not the school that determines what type of physician a person will become, its the individual.
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given that there are ~ 6000 DO grads a year and something like 2500 apply to the NRMP match, i wouldn't call that "sizable"...
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You don't think 42% of all DO applicants entering MD residencies is sizable?
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