Are the IMGs applications usually bad, and that's why most programs don't look at them? I feel that the answer to most posts asking for advice is "Apply broadly and everything will be fine", and I do think I will match somewhere, but I got curious about the general view about the subject.
A lot of this has already been addressed, but some other things to emphasize a bit:
1. Quality of foreign programs is often uncertain. Other than a few very well known schools, many PDs probably have no idea if X university from another country is strong or not. I can honestly say I know zero Brazilian medical schools and would have no idea what their quality is despite knowing a relatively large number of people from Brazil (and S. America in general). Why take the risk on someone with an uncertain background when you know even the weaker candidates from the US should at least be able to meet minimum standards? If an FMG or IMG is accepted but then can't pass Step 3, it's essentially a waste of resources which were already in excess of what would be needed for a US grad.
2. Language barriers are a huge deal, especially in psych where nuances in language can be so important. While I do understand that there can be implications to not taking those who aren't native English speakers, it's also a patient safety concern (even with translators). An example: When I was in med school we were treating a Mexican woman who we believed was psychotic because she kept saying she could hear her "ancestors" (the exact word from multiple translators) in the room above her yelling at her and telling her to do things. A week later her son came to visit and we found out her parents lived in the apartment above her and would yell at her to do chores for them. So a woman who was just moderately depressed got antipsychotics for a week because we thought she was psychotic because of what the translators were telling us. Fortunately there weren't any adverse effects, but it could have been pretty bad.
3. Visas can be a pain, and given the recent political climate I don't think anyone is really sure what the status would be, which can make an already risk-averse group of people even less likely to be willing to take that risk.
I've met some IMGs and FMGs who have been really amazing to work with and exceptional attendings. I've also worked with FMG/IMG residents or med students who legitimately scared me that they would be treating any patient (unfortunately more frequentnly than US grads who I'd worry about treating patients).
It is common to hear people say they would never attend a program with many IMGs and/or FMGs because that is considered a sign of a program that can only match low performing students. This of course is not always true, and there is sometimes a flavor of racism and tribalism about such statements. Basically, how immigrants are often perceived negatively by some.
True, but it's also a case by case basis. I wouldn't want to attend most programs where there were no US grads because it really does say something about the program (if it's not malignant or poor, why wouldn't
any US grads be going there?). There are a few exceptions, one in the NE which I can't remember off the top of my head but is clearly a solid program but with a focus on diversity and more of a global aspect. There are also programs where the vast majority of IMGs are coming from the same 1 or 2 schools, which should be a clear red flag. I think it's usually pretty easy to tell which programs with a lot of FMGs (rarely do IMGs land at prestigious programs) are still strong as the foreign individuals are coming from stronger schools and have CVs that make it obvious why they got into a stronger program (per their bios on the residency website).
Wow, that's cheap! When and where did you go to school? I understand if you don't wish to share. I don't think all schools subsidize students like that. Med school cost me $150k before student loan interest, including living expenses and books with a family. Many single students I speak with these days who attend U.S. med schools recently have $200,000 or more in student loan debt before interest. I doubt their room and board and books run $42k per year.
When I was applying to med school (2013) Hawaii, Texas, and Louisiana all schools with tuition rates less than $15k/year for residents. A few schools were as low as $5k/year for in-state residents with total COA being around $12k/year after grants or stipends. Made me really jealous because the cheapest school in my state for residents was $37k/year in tuition alone (minimum COA was ~$55k/yr with some as high as $70k for in-state residents). Room and board may not be $42k/yr, but some med students just take the max anyway because as a whole doctors are surprisingly financially stupid.
