Why are so many non US IMG filling residency spots?

[Small Cell Carcinoma]

Ok so I am currently a rising 4th year medical student currently getting ready to apply to the upcoming match cycle and I have noticed something very upsetting over the past year since I started clinical rotations. I am at a Caribbean medical school, and at the city hospital I have been rotating at (low tier residency programs) roughly 70-75% are non-US citizen IMGs. Most of them don't even have green cards and are basically here on a J1 visa (or something similar). I find it astonishing how there can be qualified doctors who can't find a job in their own country while residency spots are being given to people who can hardly speak English and have never set foot on US soil prior to the week preceding their residency start date. When I was on medicine floor, a lot of them even said that they have no intention to stay long after they finish training. Many just wish to make enough money as attendings for a few years before returning to their home country. How can the system be this flawed to allow such exploitation of our healthcare? I've heard the argument that there are more applicants than there are spots available but that is only true if you consider non-citizens who are applying. If it were not for them, every US citizen AMG or IMG would have a spot. Only after all those spots are filled should a non-US IMG even be considered. I don't understand at all how people who have no real business in the USA (many are from countries that Trump banned immigration from and are already working in their home countries as MDs) can be permitted to steal training spots from Americans in their own country. This is something I never realized when I was in basic sciences and I just can't believe something like this has gone uncorrected for so long. If even one USIMG goes unmatched while a non-USIMG does, this seems to be a problem. In literally every other developed country on Earth, a foreigner would never be given priority over another qualified individual who is a citizen. Why would a non-citizen never be considered seriously for medical school, but then frequently be given spots in residency training programs? This is not meant to be an inflammatory thread, and is something that it difficult to publically talk about nowadays (due to PC culture, etc), but does anyone have any input on this? I simply cannot be the only person who has noticed this and sees it as a major problem.

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[olabrador23]

Ok so I am currently a 4th year medical student currently getting ready to apply to the upcoming match cycle and I have noticed something very upsetting over the past year since I started clinical rotations. I am at a Caribbean medical school, and at the city hospital I have been rotating at (low tier residency programs) roughly 70-75% are non-US citizen IMGs. Most of them don't even have green cards and are basically here on a J1 visa (or something similar). I find it astonishing how there can be qualified doctors who can't find a job in their own country while residency spots are being given to people who can hardly speak English and have never set foot on US soil prior to the week preceding their residency start date. When I was on medicine floor, a lot of them even said that they have no intention to stay long after they finish training. Many just wish to make enough money as attendings for a few years before returning to their home country. How can the system be this flawed to allow such exploitation of our healthcare? I've heard the argument that there are more applicants than there are spots available but that is only true if you consider non-citizens who are applying. If it were not for them, every US citizen AMG or IMG would have a spot. Only after all those spots are filled should a non-US IMG even be considered. I don't understand at all how people who have no real business in the USA (many are from countries that Trump banned immigration from and are already working in their home countries as MDs) can be permitted to steal training spots from Americans in their own country. This is something I never realized when I was in basic sciences and I just can't believe something like this has gone uncorrected for so long. If even one USIMG goes unmatched while a non-USIMG does, this seems to be a problem. In literally every other developed country on Earth, a foreigner would never be given priority over another qualified individual who is a citizen. Why would a non-citizen never be considered seriously for medical school, but then frequently be given spots in residency training programs? This is not meant to be an inflammatory thread, and is something that it difficult to publically talk about nowadays (due to PC culture, etc), but does anyone have any input on this? I simply cannot be the only person who has noticed this and sees it as a major problem.

I read that the common thinking is that non-US FMGs are top students in their countries while U.S. IMGs went abroad because they mostly are not qualified for U.S. schools (not top students).

I agree with you that U.S. IMGs should be prioritized over non-U.S. as residency spots are funded by U.S. tax payers. There should be laws about this.

 

[7331poas]

this is next level. A carribean medical student complaining that medical students from other countries (not Caribbean) are getting residency spots.

This sounds very self serving. If you asked me, no foreign medical students (including carribean) should be getting spots.

It should be USMD -> DO -> debate about the rest.

 

[Sephirakra]

Ok so I am currently a 4th year medical student currently getting ready to apply to the upcoming match cycle and I have noticed something very upsetting over the past year since I started clinical rotations. I am at a Caribbean medical school, and at the city hospital I have been rotating at (low tier residency programs) roughly 70-75% are non-US citizen IMGs. Most of them don't even have green cards and are basically here on a J1 visa (or something similar). I find it astonishing how there can be qualified doctors who can't find a job in their own country while residency spots are being given to people who can hardly speak English and have never set foot on US soil prior to the week preceding their residency start date. When I was on medicine floor, a lot of them even said that they have no intention to stay long after they finish training. Many just wish to make enough money as attendings for a few years before returning to their home country. How can the system be this flawed to allow such exploitation of our healthcare? I've heard the argument that there are more applicants than there are spots available but that is only true if you consider non-citizens who are applying. If it were not for them, every US citizen AMG or IMG would have a spot. Only after all those spots are filled should a non-US IMG even be considered. I don't understand at all how people who have no real business in the USA (many are from countries that Trump banned immigration from and are already working in their home countries as MDs) can be permitted to steal training spots from Americans in their own country. This is something I never realized when I was in basic sciences and I just can't believe something like this has gone uncorrected for so long. If even one USIMG goes unmatched while a non-USIMG does, this seems to be a problem. In literally every other developed country on Earth, a foreigner would never be given priority over another qualified individual who is a citizen. Why would a non-citizen never be considered seriously for medical school, but then frequently be given spots in residency training programs? This is not meant to be an inflammatory thread, and is something that it difficult to publically talk about nowadays (due to PC culture, etc), but does anyone have any input on this? I simply cannot be the only person who has noticed this and sees it as a major problem.

You're focusing on the wrong thing. The FMGs haven't done anything wrong - all they did was apply for a job. I don't really consider what you've described to be a problem, but if anyone is to "blame" for it, it would be the PDs who are selecting the FMGs over their American-trained counterparts.

 

[Rekt]

this is next level. A carribean medical student complaining that medical students from other countries (not Caribbean) are getting residency spots.

This sounds very self serving. If you asked me, no foreign medical students (including carribean) should be getting spots.

It should be USMD -> DO -> debate about the rest.

Should be a multi-tiered match. USMDs should get a first round match, since they're incredibly superior. Then us peasant DOs can get a second round mixed in with the FMGs. Carib kids can go third.

 

[Osminog]

If one of your parents were to become gravely ill, would you rather their physician be a top graduate from an elite Chinese medical school or an underachiever who barely graduated from a for-profit diploma mill in Saint Vincent and the Grenadines? I'm a US taxpayer, and I'd choose the Chinese doctor without thinking twice.

The system should be meritocratic, not based on people's countries of origin. If we want to have the most competent physicians practicing in our country, excellent FMGs will have to be chosen over mediocre US MDs, DOs, and US IMGs.

 

[7331poas]

Should be a multi-tiered match. USMDs should get a first round match, since they're incredibly superior. Then us peasant DOs can get a second round mixed in with the FMGs. Carib kids can go third.

At the very least, there should be zero USMD and DO students going unmatched (unless there is a professionalism issue).

 

[jurassicpark]

Most FMGs I've met at least WANT to stay in the US. As people have pointed out though, remember most of those FMGs were the TOP of their country to get into their medical schools. In addition, many of them had to learn English AND take OUR boards (most likely learning a whole new system of test-taking),, then interview well to get into a residency program. My senior-partner aka boss used to work at a motel while he studied for his boards.

THEN look at those FMGs who achieved fellowship. They overcame all of the above and beat the snot out of US-born and raised Residents. One of my neurologists was an ophthalmologist in his country, so I grab him whenever I have an issue with the eyes. A fellow internist used to be OB/Gyn, etc. The wealth of knowledge and experience you have available to you is astonishing if you get off your high horse. Reminds me of that guy from South Park, "THEY TOOK OUR JOBS!"

Let me also add, in response to your issue with it being "PC," I would think no matter where you stood on the immigration debate short of complete isolationism aren't these the EXACT type of immigrants we would want? Trained highly educated and motivated individuals bringing desirable skills into the country? But they can't work in our system without going through Residency first, so why not let them compete with the rest of us? Viva La American Dream!

 

[Small Cell Carcinoma]

this is next level. A carribean medical student complaining that medical students from other countries (not Caribbean) are getting residency spots.

This sounds very self serving. If you asked me, no foreign medical students (including carribean) should be getting spots.

It should be USMD -> DO -> debate about the rest.

The bolded line is exactly what I am trying to draw attention/“debate” about. Most of us US IMGs would be content working at some malignant community hospital program that most others wouldn’t want to be at. However if you look at match data roughly 60% of USIMGs AND 60% of non USIMGs are matching. What this says is that there no priority being given over whether someone is a US citizen or not. Further this also indicates that there are spots available for every US applicant but they are giving some spots to non-US applicants and leaving some Americans unmatched. Why should someone who only trained for a total of 5-6 years in Yemen (who is likely already practicing there) be given a spot that an American who also passed his boards and needs to pay off his loans/work in their own country. There is no reason that 100% of US AMGs/IMGs could not be matching. These foreigners can then go fight over what is left for their shot at the “American Dream”. This would actually be a fair way of approaching things, but it seems to be something that most people don’t want to discuss for some reason.

 

[7331poas]

The bolded line is exactly what I am trying to draw attention/“debate” about. Most of us US IMGs would be content working at some malignant community hospital program that most others wouldn’t want to be at. However if you look at match data roughly 60% of USIMGs AND 60% of non USIMGs are matching. What this says is that there no priority being given over whether someone is a US citizen or not. Further this also indicates that there are spots available for every US applicant but they are giving some spots to non-US applicants and leaving some Americans unmatched. Why should someone who only trained for a total of 5-6 years in Yemen (who is likely already practicing there) be given a spot that an American who also passed his boards and needs to pay off his loans/work in their own country. There is no reason that 100% of US AMGs/IMGs could not be matching. These foreigners can then go fight over what is left for their shot at the “American Dream”. This would actually be a fair way of approaching things, but it seems to be something that most people don’t want to discuss for some reason.

The non-US IMGs are usually higher quality

 

[Small Cell Carcinoma]

The non-US IMGs are usually higher quality

That soundn’t matter, a US citizen who actually pays taxes that supports these programs should always be given precedence over someone who is not American. Regardless of board scores or other metrics. I seriously doubt their home countries would do the same for us under any circumstances. To think that some refugee from Syria could get a job in one of the most prestigious careers in our country, while simultaneously leaving a qualified born/raised American unemployed is honestly sickening.

 

[jurassicpark]

That soundn’t matter, a US citizen who actually pays taxes that supports these programs should always be given precedence over someone who is not American. Regardless of board scores or other metrics. I seriously doubt their home countries would do the same for us under any circumstances. To think that some refugee from Syria could get a job in one of the most prestigious careers in our country, while simultaneously leaving a qualified born/raised American unemployed is honestly sickening.

Couple of points,. If there is a qualified US Graduate odds are greatly in their favor that they would get a spot somewhere, not necessarily their preferred spot, they are already preferred., But if you're asking a "qualified" US IMG Graduate that becomes another story. US IMGs (for the vast majority) have had their chance(s) to get into a US medical school where they were "born/raised." They didn't.

They have to prove their education and experience is up there with the best to an institution that already for the most part looks down on FOREIGN for-profit schools taught by a fair number of *gasp* non-US professors.

But let me ask another question. "Some refugee from Syria," is something that's making you upset. What about a foreign trained doctor from England? Graduated from Cambridge, top of their class, cardiologist etc. Wants a spot in the US, would that upset you?

 

[Sephirakra]

That soundn’t matter, a US citizen who actually pays taxes that supports these programs should never be given precedence over someone who is not American. Regardless of board scores or other metrics. I seriously doubt their home countries would do the same for us under any circumstances. To think that some refugee from Syria could get a job in the most prestigious careers in our country, while simultaneously leaving a qualified born/raised American unemployed is honestly sickening.

Pfft, taxes. Have you ever paid taxes? Don't complain about something you haven't done.

My money being used to train physicians - regardless of where they're from - is one of the least objectionable things the government can do with it. If the thought of foreign-trained physicians being accepted to US residencies sickens you, then you're gonna have one helluva time next year. Oh, and the rest of your career.

 

[7331poas]

That soundn’t matter, a US citizen who actually pays taxes that supports these programs should always be given precedence over someone who is not American. Regardless of board scores or other metrics. I seriously doubt their home countries would do the same for us under any circumstances. To think that some refugee from Syria could get a job in one of the most prestigious careers in our country, while simultaneously leaving a qualified born/raised American unemployed is honestly sickening.

90% of medical students have never paid taxes in their life. Additionally, whether the doctor came from North Carolina or Syria, they will still be paying taxes in the 250k income bracket.

 

[Small Cell Carcinoma]

That soundn’t matter, a US citizen who actually pays taxes that supports these programs should never be given precedence over someone who is not American. Regardless of board scores or other metrics. I seriously doubt their home countries would do the same for us under any circumstances. To think that some refugee from Syria could get a job in the most prestigious careers in our country, while simultaneously leaving a qualified born/raised American unemployed is honestly sickening.

Couple of points,. If there is a qualified US Graduate odds are greatly in their favor that they would get a spot somewhere, not necessarily their preferred spot, they are already preferred., But if you're asking a "qualified" US IMG Graduate that becomes another story. US IMGs (for the vast majority) have had their chance(s) to get into a US medical school where they were "born/raised." They didn't.

They have to prove their education and experience is up there with the best to an institution that already for the most part looks down on FOREIGN for-profit schools taught by a fair number of *gasp* non-US professors.

But let me ask another question. "Some refugee from Syria," is something that's making you upset. What about a foreign trained doctor from England? Graduated from Cambridge, top of their class, cardiologist etc. Wants a spot in the US, would that upset you?

Only because it directly leaves an American without a job. I’m all for allowing these people a shot at training, but only if there are actually unfilled spots that no US citizen wants. This is not the case, hence is why it upsets me. The Syria reference was just an example, but it applies to all other nations. This is our country and we have a right to live and work here, and frankly they don’t.

 

[hungrydoc710]

If one of your parents were to become gravely ill, would you rather their physician be a top graduate from an elite Chinese medical school or an underachiever who barely graduated from a for-profit diploma mill in Saint Vincent and the Grenadines? I'm a US taxpayer, and I'd choose the Chinese doctor without thinking twice.

The system should be meritocratic, not based on people's countries of origin. If we want to have the most competent physicians practicing in our country, excellent FMGs will have to be chosen over mediocre US MDs, DOs, and US IMGs.

Doctors don't become good doctors in medical school.
Doctors become good (or great) doctors through thier residency years.

But to the point everyone is making... MD first round, DO second round, then FMG's, then US-IMG, lastly non-US IMG

 

[Schwifty]

While I am all for taxpayer money going back into the hands of American, I really don't think that saying because positions are tax funded is the best argument as to why US citizens should be prioritized. If a non US IMG gets a residency in the US, they are going to pay taxes in the US, they are going to be working (at least while in residency) in the US, and they will be treating *wait for it* US citizens. Also, like others said, they will pry continue to work in the US after residency and then be paying in the top tax bracket.

 

[Dave1980]

 

[jurassicpark]

Only because it directly leaves an American without a job. I’m all for allowing these people a shot at training, but only if there are actually unfilled spots that no US citizen wants. This is not the case, hence is why it upsets me. The Syria reference was just an example

There are a million and ten different reasons a US graduate will not match.

Only because it directly leaves an American without a job. I’m all for allowing these people a shot at training, but only if there are actually unfilled spots that no US citizen wants. This is not the case, hence is why it upsets me. The Syria reference was just an example

Being an American citizen who graduated from medical school should and passed boards should NOT be a guarantee for residency. A US grad (not a US IMG grad) already gets preferential treatment from Residency committees. There are many reasons a US grad would not match, and some of the reasons thankfully so. There are many places that will be locked out to most FMGs and US-IMGs short of a herculean effort or curing cancer. And kudos to whomever does either.

But seeing that you're a Caribbean student, I think as a US IMG you are concerned that you are on the same level as the FMGs. Fear not, a good many of the residency programs that take international students do favorably look at US IMGs because they may already know the system, and more likely not to have a cultural/language/system issue. But don't think institutes think you're ANY better than an FMG in terms of education. You're not. IMGs had to go out of their country to a for-profit institute often taught by foreigners catering primarily to passing the boards, The only thing your citizenship should guarantee at this point is the US Marines coming ashore again if the school gets invaded by the Cubans.

 

[Dave1980]

Doctors don't become good doctors in medical school.
Doctors become good (or great) doctors through thier residency years.

But to the point everyone is making... MD first round, DO second round, then FMG's, then US-IMG, lastly non-US IMG

WTH is the difference between a FMG and a non-US IMG?!?!

 

[Osminog]

WTH is the difference between a FMG and a non-US IMG?!?!

Perhaps FMGs are non-US citizens who attend legitimate medical schools in their home countries, while non-US IMGs are non-US citizens who attend offshore for-profit institutions?

 

[Small Cell Carcinoma]

Medical students show different levels of promise. That's why residency programs use academia criteria to sort through them.

Being American doesn't make a US MD or DO a better diagnostician or more skilled surgeon than a top foreign student from an international medical university. If we want the system to be meritocratic, nationality shouldn't play a role in the match. Practicing favoritism on the basis of nationality prevents us from recruiting the best of the best to serve American communities.

I strongly disagree. I am primarily referring to low level programs at places like the charity hospital I am rotating at. Most patients are either drug addicts, homeless, undocumented, or some combination of the three. They could care less about the academic qualifications of who is treating them.

 

[Dave1980]

I strongly disagree. I am primarily referring to low level programs at places like the charity hospital I am rotating at. Most patients are either drug addicts, homeless, undocumented, or some combination of the three. They could care less about the academic qualifications of who is treating them.

Couldn't*

 

[Sephirakra]

I strongly disagree. I am primarily referring to low level programs at places like the charity hospital I am rotating at. Most patients are either drug addicts, homeless, undocumented, or some combination of the three. They could care less about the academic qualifications of who is treating them.

Not sure what your point is here.

 

[IMGASMD]

Medical students show different levels of promise. That's why residency programs use academia criteria to sort through them.

Being American doesn't make a US MD or DO a better diagnostician or more skilled surgeon than a top foreign student from an international medical university. If we want the system to be meritocratic, nationality shouldn't play a role in the match. Practicing favoritism on the basis of nationality prevents us from recruiting the best of the best to serve American communities.

True.

A lot of medicine is based on culture. I can guarantee you with all else being equal, patient prefer someone who can understand them and vice versa.

Worked with plenty of brilliant minds, but cannot convey information adequately, albeit, English is not their first language; English is one of their first languages, English is their first language, but speaks with a “funny” accent perceived by Americans. First impression counts for a lot, trying to change impressions is very difficult.

The system is not fair; the world is not fair; you need to first join them then to fight them within. Back to your regular programming.

 

[chaim123]

I strongly disagree. I am primarily referring to low level programs at places like the charity hospital I am rotating at. Most patients are either drug addicts, homeless, undocumented, or some combination of the three. They could care less about the academic qualifications of who is treating them.

Perhaps the patient's don't. However, I would say it would be extremely unethical to say that we should be treating this population with a lesser quality physician just because they either don't care or don't understand the difference in care they are receiving. Why should this marginalized group be subjected to care from individuals just because they are US citizens, and not because they were the best of the applicants that applied?

 

[GoSpursGo]

If it were not for them, every US citizen AMG or IMG would have a spot.

This is not true for AMGs. In 2019, only 42 AMGs failed to match in Family medicine (2.8% of all AMG applicants). Only 63 AMGs failed to match in internal medicine (1.8%). In contrast, 18.9% went umatched in dermatology, 14.9% went unmatched for neurosurgery, 13.9% went unmatched in OB/Gyn, etc. The only reason that an AMG fails to match is because they overestimate their competitiveness for a specific field. If an AMG is realistic about a field and the number of programs they need to apply, then only a handful with professionalism issues should have any trouble matching.

If you are a US citizen who went abroad for your training, that was a decision that you made knowing the risks. With the exception of SGU, nobody knows the quality of training at any of the Caribbean schools, so it's incumbent on you to be a rockstar on the USMLEs and make it clear that you're on par with students who trained in the US.

 

[hungrydoc710]

This is not true for AMGs. In 2019, only 42 AMGs failed to match in Family medicine (2.8% of all AMG applicants). Only 63 AMGs failed to match in internal medicine (1.8%). In contrast, 18.9% went umatched in dermatology, 14.9% went unmatched for neurosurgery, 13.9% went unmatched in OB/Gyn, etc. The only reason that an AMG fails to match is because they overestimate their competitiveness for a specific field. If an AMG is realistic about a field and the number of programs they need to apply, then only a handful with professionalism issues should have any trouble matching.

If you are a US citizen who went abroad for your training, that was a decision that you made knowing the risks. With the exception of SGU, nobody knows the quality of training at any of the Caribbean schools, so it's incumbent on you to be a rockstar on the USMLEs and make it clear that you're on par with students who trained in the US.

Why is SGU an exception?
Just curious.

 

[7331poas]

True.

A lot of medicine is based on culture. I can guarantee you with all else being equal, patient prefer someone who can understand them and vice versa.

Worked with plenty of brilliant minds, but cannot convey information adequately, albeit, English is not their first language; English is one of their first languages, English is their first language, but speaks with a “funny” accent perceived by Americans. First impression counts for a lot, trying to change impressions is very difficult.

The system is not fair; the world is not fair; you need to first join them then to fight them within. Back to your regular programming.

Sounds like the same argument applied to black physicians.

 

[GoSpursGo]

Why is SGU an exception?
Just curious.

They just have name recognition at this point. SGU isn't on par with other US schools by any means, but there are enough SGU grads in residency programs that a PD who gets an SGU app has some idea of what kind of training that person had. For other Caribbean schools, nobody really will know off what kind of training a grad received.

 

[sella.turcica]

someone who only trained for a total of 5-6 years in Yemen...

some refugee from Syria

I think these 2 quotes say everything about you.

 

[hungrydoc710]

I think these 2 quotes say everything about you.

Lol you forgot his... "These foreigners can then go fight over what is left for their shot at the American Dream"

 

[Small Cell Carcinoma]

I think these 2 quotes say everything about you.

Call me insensitive if you want, but I only used these two examples because they both described residents I worked with in my rotations.
But on this topic, these people have basically no debt and also have no US clinical experience whatsoever. I still fail to see how anyone who trained in these places is a better candidate than a US Carib grad.

 

[NotAProgDirector]

Wondering how you would make such a system work? Even if there was a 2 stage match, programs that would rather have a higher performing FMG rather than a low performing US-IMG would just save spots for the second round. I guess it's possible that some programs that currently take all non-US IMG's might decide to match a few US IMG's, but perhaps not and we end up in the same place. It would be very awkward to end up with some US IMG's unmatched at the end of round 1, and then somehow force programs to take them. Realistically you'd need to decide how many US applicants and slots there are, subtract the two, then have some sort of a lottery to decide which FMG's get to even try to fill slots -- and that sounds like a nightmare. Plus given how long it now takes to get visas, pushing the timeline out further is problematic.

You're at SGU per your prior posts, which seems a decent school. But quite a few US citizens go to very shady schools, and giving them priority so they are guaranteed a match seems problematic.

 

[Small Cell Carcinoma]

To give a little more clarity to what I am saying since I am not sure how how well I presented it, I read and attached the most recent NRMP match data (2018). Ignoring US MD and DO since the vast vast majority do match and only focusing on applicants with IMG status, there were a total of 5075 USIMGs and 7067 non-USIMGs in that cycle. Of those 2505 USIMGs matched as did 3490 non USIMGs for at total of 5995 positions. If non USIMGs we taken out of the equation there would be enough spots to accommodate all US Citizens applying with a remainder of 920 open slots. I think the best non USIMGs should then be considered to fill these positions only. There would still be room for a sizable number of them and this would ensure that no American goes unemployed in this field. If anything this would ensure even more so that only the best non-US citizen MDs get spots. Does this not sound reasonable?

Note this also makes a key assumption that these two groups are competing for similar tier spots which is for the most part almost certainly true.

http://www.nrmp.org/wp-content/uploads/2018/06/Charting-Outcomes-in-the-Match-2018-IMGs.pdf

 

[DrWhozits]

Call me insensitive if you want, but I only used these two examples because they both described residents I worked with in my rotations.
But on this topic, these people have basically no debt and also have no US clinical experience whatsoever. I still fail to see how anyone who trained in these places is a better candidate than a US Carib grad.

The line between “refugee” and “immigrant” sure seems blurred these days.

What exactly makes a person who applied for a visa and an ACGME residency a refugee?

 

[DrWhozits]

To give a little more clarity to what I am saying since I am not sure how how well I presented it, I read and attached the most recent NRMP match data (2018). Ignoring US MD and DO since the vast vast majority do match and only focusing on applicants with IMG status, there were a total of 5075 USIMGs and 7067 non-USIMGs in that cycle. Of those 2505 USIMGs matched as did 3490 non USIMGs for at total of 5995 positions. If non USIMGs we taken out of the equation there would be enough spots to accommodate all US Citizens applying with a remainder of 920 open slots. I think the best non USIMGs should then be considered to fill these positions only. There would still be room for a sizable number of them and this would ensure that no American goes unemployed in this field. Does this not sound reasonable?

Note this also makes a key assumption that these two groups are competing for similar tier spots which is almost certainly true.

http://www.nrmp.org/wp-content/uploads/2018/06/Charting-Outcomes-in-the-Match-2018-IMGs.pdf

Also, not you specifically because I don’t definitively know your political stances...but does it seem like the same people always clamoring for a “free market!” and “deregulation!” are always the ones begging for regulation to protect them from a free market, or is it just me?

If an immigrant is more qualified, why shouldn’t he/she get that job?

 

[Small Cell Carcinoma]

Also, not you specifically because I don’t definitively know your political stances...but does it seem like the same people always clamoring for a “free market!” and “deregulation!” are always the ones begging for regulation to protect them from a free market, or is it just me?

If an immigrant is more qualified, why shouldn’t he/she get that job?

I think the answer to this is subjective and really depends on your political stance too, but IMO they are not really immigrants in the traditional sense. They don't have citizenship (most don't even have green cards) and are here on a temporary visa that can be revoked at any time. I have no problem with someone who immigrates to the US, gets citizenship and establishes themselves here with a commitment to this nation, and then pursues a career in medicine. But for someone who just decides to try their luck in matching here so they can tap into our highly compensated system (when I've asked many of them why they've wanted to come here this has been almost unanimously their response) and leaving thousands of qualified Americans unemployed with unthinkable debt, this really makes it hard for me to be sympathetic towards their goals.

 

[mrbreakfast]

think the best non USIMGs should then be considered to fill these positions only. There would still be room for a sizable number of them and this would ensure that no American goes unemployed in this field. Does this not sound reasonable?

I guess the question is "why do this?" If you want any semblance of a meritocracy, you'll have non-US IMGs absolutely crushing grads from some shady island or DO program on paper (and, likely, in track record of produced physicians).

leaving thousands of qualified Americans unemployed with unthinkable debt, this really makes it hard for me to be sympathetic towards their goals.

I am at a Caribbean medical school

Isn't this kind of what it comes down to? You can't compete with people who have trained at actual MD programs? I've worked with plenty of IMG residents and attendings, and lemme tell ya, they worked VERY hard to get here. Who cares about the accent if the care is good? Patients don't, believe me. The only requirements to enroll in a Caribbean med school are a pulse and a checkbook, which is why the reward is generally a diploma on the wall and nothing more.

When you write "qualified Americans," I would personally give much more weight to the word "qualified" than "American" when looking for a physician or selecting a residency candidate.

 

[MSTPlease]

Don’t understand the people saying we “need” a tiered residency system. We already have one. There’s a reason why US MDs and US DOs match at higher rates than foreign trained people even when controlling for things like step scores. Just look at any charting outcomes and residency program rosters and you’ll see our system is already tiered.

 

[DokterMom]

Not sure what your point is here.

I'm pretty sure his point is that the inferior [foreign] doctors should be able to practice on the inferior patients.



Wonder why he wasn't admitted to a USMD school?

 

[wontonsoup]

Another point which I think is hardly ever brought up is how taking lots of FMGs into the US residency system impacts healthcare in the countries these doctors are coming from. I don't blame people for wanting to practice in the US, but poaching (often the very best) foreign doctors absolutely contributes to brain drain and negatively impacts healthcare in the developing world. From the perspective of their home countries, they invested in their future by providing (generally) highly subsidized medical education and got absolutely nothing in return. Also, going through a US medical school and accruing massive debt only to fail to match when there are more spots than American citizen applicants is ridiculously unfair to American students.

 

[Small Cell Carcinoma]

I guess the question is "why do this?" If you want any semblance of a meritocracy, you'll have non-US IMGs absolutely crushing grads from some shady island or DO program on paper (and, likely, in track record of produced physicians).



Isn't this kind of what it comes down to? You can't compete with people who have trained at actual MD programs? I've worked with plenty of IMG residents and attendings, and lemme tell ya, they worked VERY hard to get here. Who cares about the accent if the care is good? Patients don't, believe me. The only requirements to enroll in a Caribbean med school are a pulse and a checkbook, which is why the reward is generally a diploma on the wall and nothing more.

When you write "qualified Americans," I would personally give much more weight to the word "qualified" than "American" when looking for a physician or selecting a residency candidate.

Perhaps in some places. But they kick out most people who don't demonstrate the necessary competency and we still need to pass all the boards. And besides that is what the boards are meant to do in the first place. Establish whether the student is qualified or not. Beyond that I do believe it should come down to citizenship. This is our home. It isn't theirs.

 

[Sephirakra]

Another point which I think is hardly ever brought up is how taking lots of FMGs into the US residency system impacts healthcare in the countries these doctors are coming from. I don't blame people for wanting to practice in the US, but poaching (often the very best) foreign doctors absolutely contributes to brain drain and negatively impacts healthcare in the developing world. Also, going through a US medical school and accruing massive debt only to fail to match when there are more spots than American citizen applicants is ridiculously unfair to American students.

No one is being "poached". These foreign-trained physicians apply to match voluntarily.

 

[Sephirakra]

Perhaps in some places. But they kick out most people who don't demonstrate the necessary competency and we still need to pass all the boards. And besides that is what the boards are meant to do in the first place. Establish whether the student is qualified or not. Beyond that I do believe it should come down to citizenship. This is our home. It isn't theirs.

And yet, you left your home for medical training. Just like the people you're criticizing.

 

[studentdocftw]

The amount of entitlement in this thread is nauseating. Nobody "deserves" a residency. If you want to practice medicine in the US, make yourself a competitive applicant. While some slip through the cracks, the vast majority of people who don't match are not qualified to match. Whether it is poor board performance, professionalism issues, poor clinical evaluations, etc....the FMG that obtained a spot over a US graduate didn't "steal" it...he/she earned it, period.

/EndThread

 

[jurassicpark]

Perhaps in some places. But they kick out most people who don't demonstrate the necessary competency and we still need to pass all the boards. And besides that is what the boards are meant to do in the first place. Establish whether the student is qualified or not. Beyond that I do believe it should come down to citizenship. This is our home. It isn't theirs.

'Murica! Heck yeah!

Outside of the flagrant jaw dropping statement in your last sentence. Have you wondered where our country would be without the inflow of highly trained immigrants who want to work in this country in the field of Science, tech field?

But let me ask a question, you're a fourth year. Have you matched?

 

[nimbus]

I have no problem with training programs selecting the best candidates regardless of where they attended medical school. If you look at the resident and faculty rosters of a place like MGH or UCSF, you’ll see a smattering of FMG’s from China, Brazil, Nigeria, Scotland,etc. I’m sure their qualifications are much better than the typical USIMG. America first does not necessarily mean Americans first.

 

[GoSpursGo]

There would still be room for a sizable number of them and this would ensure that no American goes unemployed in this field. If anything this would ensure even more so that only the best non-US citizen MDs get spots. Does this not sound reasonable?

Frankly, we Have no way of knowing if a Caribbean grad is qualified. The “curriculum” at these places is such a mixed bag that just because you have a piece of paper that says you’re a doctor and were able to memorize enough of first aid to barely pass doesn’t prove anything about what your training actually entailed. This is why people advise sooooo strongly against going to the Caribbean, and if you didn’t follow that advice then it’s on you to prove that you are qualified beyond simply having a piece of paper. At the end of the day, the only standardized benchmark we have to judge your training is USMLE scores, and if the average matching non US IMG has a score 13 points higher than a non matching USImg, then it is difficult to argue that the US IMG is demonstrably more qualified.

 

[nimbus]

Ok so I am currently a 4th year medical student currently getting ready to apply to the upcoming match cycle and I have noticed something very upsetting over the past year since I started clinical rotations. I am at a Caribbean medical school, and at the city hospital I have been rotating at (low tier residency programs) roughly 70-75% are non-US citizen IMGs. Most of them don't even have green cards and are basically here on a J1 visa (or something similar). I find it astonishing how there can be qualified doctors who can't find a job in their own country while residency spots are being given to people who can hardly speak English and have never set foot on US soil prior to the week preceding their residency start date. When I was on medicine floor, a lot of them even said that they have no intention to stay long after they finish training. Many just wish to make enough money as attendings for a few years before returning to their home country. How can the system be this flawed to allow such exploitation of our healthcare? I've heard the argument that there are more applicants than there are spots available but that is only true if you consider non-citizens who are applying. If it were not for them, every US citizen AMG or IMG would have a spot. Only after all those spots are filled should a non-US IMG even be considered. I don't understand at all how people who have no real business in the USA (many are from countries that Trump banned immigration from and are already working in their home countries as MDs) can be permitted to steal training spots from Americans in their own country. This is something I never realized when I was in basic sciences and I just can't believe something like this has gone uncorrected for so long. If even one USIMG goes unmatched while a non-USIMG does, this seems to be a problem. In literally every other developed country on Earth, a foreigner would never be given priority over another qualified individual who is a citizen. Why would a non-citizen never be considered seriously for medical school, but then frequently be given spots in residency training programs? This is not meant to be an inflammatory thread, and is something that it difficult to publically talk about nowadays (due to PC culture, etc), but does anyone have any input on this? I simply cannot be the only person who has noticed this and sees it as a major problem.

Imagine that you are the residency director. Why in the world would you match someone from a foreign country who barely speaks English? Could it be that over the years these people have performed better during residency than the alternative US born USIMG?