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wow... clearly this is a hot topic :)

some questions for you guys:

-state medical schools favor in-state candidates over out-of-state students. They argue that their tax money should be reserved for state residents / students. They protect and reserve those coveted seats in their med schools for their own people. Anyone is losing sleep about that?

But it is ok to say that U.S. citizens do not deserve those residency spots funded by U.S. tax payer because they go to school over sea?

How about a bill and vote in Congress on this matter to see where the majority of the citizens of this country think and/or decide on instead of making the decision on this matter without asking what the American people think? I do not know if many of you have been paying taxes but I have paid plenty for decades, so a vote should be fair instead of someone throwing around their one opinion about what we should do.

If you think that non-FMG is superior to US IMG from the start, then do offer them residency on your own dimes. Until Congress votes otherwise, I want to spend my tax money on supporting qualified US IMGs first (yes they do have to prove themselves on standardized exams like anybody else). I want to support our own people first. Unless non-US FMG can prove that they are superior than US IMGs on those exams.

Answers to qualifications should be decided on standardized tests. Who gets the better score wins the spots. That should be fair then.

(Do you know many other countries would not let any foreign-trained doctor to ever practice there. E.g. Hongkong).

-Are the students with higher GPAs and MCATs always the ones who get admitted to US med schools?

-Step exams, the only standardized measure in the residency selection process, might possibly go P/F. Where is the meritocracy then?

-Some U.S. students fail Step multiple times (e.g. I read in some cases 6-7 times, USMLE - I finally passed! after failing 3 times) and still match. Can U.S. IMG and non-US FMG do the same? Does that sound like meritocracy?

-Some said that non-US FMG are top dogs in their own countries who are already experienced / established physicians there and should be favored over US IMG who went to Carib. Should those non-US FMG be superior to and favored in the residency match over most average US medical grads, MD and DO who have not even practiced yet?

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
-yes entitlement. Some already mentioned that US MD > DO >>> non US FMG > US IMG. Just b/c you go to schools to the U.S. or MD instead of DO does not mean you should be automatically favored in the match. You should prove your knowledge and skills on the same standardized exams to show that you are qualified and/or superior to anyone else in the same race regardless who you are, where you go to school, race, age, sex/gender, nationality, or religion (which are already stated by the Constitution-the Supreme Law of the land :) )

Imho, it is very hypocritical and self-serving to talk down US IMG as being not as qualified (they still have to prove themselves on the Steps like everyone else and do rotations in the US) or as self-serving. I see as much self-serving and hypocritical in the people who go to US med schools too. We all need to check ourselves in a mirror first :)
 
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gyngyn

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wow... clearly this is a hot topic :)

some questions for you guys:

-state medical schools favor in-state candidates over out-of-state students. They argue that their tax money should be reserved for state residents / students. They protect and reserve those coveted seats in their med schools for their own people. Anyone is losing sleep about that?

But it is ok to say that U.S. citizens do not deserve those residency spots funded by U.S. tax payer because they go to school over sea?

How about a bill and vote in Congress on this matter to see where the majority of the citizens of this country think and/or decide on instead of making the decision on this matter without asking what the American people think? I do not know if many of you have been paying taxes but I have paid plenty for decades, so a vote should be fair instead of someone throwing around their one opinion about what we should do.

If you think that non-FMG is superior to US IMG from the start, then do offer residency on your own dimes. Until Congress votes otherwise, I want to spend my tax money on supporting qualified US IMGs first (yes they do have to prove themselves on standardized exams like anybody else). I want to support our own people first. Unless non-US FMG can prove that they are superior than US IMGs on those exams.

Answers to qualifications should be decided on standardized tests. Who gets the better score wins the spots. That should be fair then.

(Do you know tha many other countries would not let any foreign-trained doctor to ever practice there. E.g. Hongkong).

-Are the students with highest GPAs and MCATs always the ones who get admitted to US med schools?

-Step exams, the only standardized measure in the residency selection process, might possibly go P/F. Where is the meritocracy then?

-Some U.S. students fail Step multiple times (e.g. I read in some cases 6-7 times, USMLE - I finally passed! after failing 3 times) and still match. Can U.S. IMG and non-US FMG do the same? Does that sound like meritocracy?

-Some said that non-US FMG are top dogs in their own countries who are alrady experienced / established physicians there and should be favored over US IMG who went to Carib. Should those non-US FMG be superior to and favored in the residency match over most average US medical grads, MD and DO who have not even practiced yet?



-yes entitlement. Some already mention that US MD > DO >>> non US FMG > US IMG. Just b/c you go to schools to the U.S. or MD instead of DO does not mean you should be automatically favored in the match. You should prove your knowledge and skills on the same standardized exams to show that you are qualified and/or superior to anyone else in the same race regardless who you are, where you go to school, races, age, sex/gender, nationality, or religion (which are already stated by the Constitution-the Supreme Law of the land :) )

Imho, it is very hypocritical to talk down US IMG as being not as qualified (they still have to prove themselves on the Steps like everyone else and do rotations in the US) or as self-serving. I see as much self-serving and hypocritical on the people who go to US med schools too. We all need to check ourselves in a mirror first :)
USMLE exams are not intended to to stratify quality.
Passing them indicates a baseline level of knowledge.
Passing them is only a small part of what defines an excellent candidate.
 
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USMLE exams are not intended to to stratify quality.
Passing them indicates a baseline level of knowledge.
Passing them is only a small part of what defines an excellent candidate.
Then, it is urgent that we have to make (a) standardized one(s) for that job quickly imho! Standardized is about being objective which gives transparency and fairness to the process.

My point is that, we are pretending like we are playing fair but we are not. We are only protecting our self-interests. Funny a bunch of us criticizes others as self-serving while doing the same or worse :)
 
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Sephirakra

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But it is ok to say that U.S. citizens do not deserve those residency spots funded by U.S. tax payer because they go to school over sea?
It could be argued that US citizens who study overseas (Caribbean, Australia, etc.) using federal student aid are diverting large sums of money to those countries instead of paying tuition to American universities to employ Americans. So why should we give special consideration to these students at match time when they didn't support our educational system for med school?

I'm not completely sold on this argument, but it's worth considering.
 
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It could be argued that US citizens who study overseas (Caribbean, Australia, etc.) using federal student aid are diverting large sums of money to those countries instead of paying tuition to American universities to employ Americans. So why should we give special consideration to these students at match time when they didn't support our educational system for med school?

I'm not completely sold on this argument, but it's worth considering.
Not all students going Carib are using Fed loans.

Also, why should we give special consideration to those students at match time when they did not support our educational system for med schools? Should we still consider giving special consideration to non-US FMGs too? They surely did not go to U.S. schools, right?

My point is that given same standardized consideration/measures (e.g. Steps exams), U.S. should be favored over non-U.S. Everything should be standardized! It is like in a family, it is only right that you take care of your own family members FIRST!
 

gyngyn

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Then, it is urgent that we have to make (a) standardized one(s) for that job quickly imho! Standardized is about being objective which give transparency and fairness to the process.
I guess you are a fan of CS...?
 
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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.
Yep. I go to a top 10-15 program for residency and the medicine class, for example, has several IMGs. We have some from South America who speak perfect English without an accent, if that'd otherwise be the source of an objection. We don't have any DOs or Caribs.

Then, it is urgent that we have to make (a) standardized one(s) quickly for the job imho!
If you think you can use a standardized test to tell who will be a good doctor, you're quite wrong. Guessing you're premed?

Also, to fill you in, the FMGs who come over here have absolutely smoked their Step scores, generally by studying for several times as long as US students are given to study.

This is our home. It isn't theirs.
Yikes. This from someone ostensibly dedicating themself to the compassionate care of others? I'd almost be worried about your future patients.
 
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If you think you can use a standardized test to tell who will be a good doctor, you're quite wrong. Guessing you're premed?

Also, to fill you in, the FMGs who come over here have absolutely smoked their Step scores, generally by studying for several times as long as US students are given to study.
I do not think that just because you cannot tell who will be a good doctor from the standardized tests that we are having now, we should use standardized testing any less. In fact, it should be the opposite. If we have not yet one to do the job, make one! It should be more standardized, not less!

Human societies around the world improve and progress on equal rules, transparency, and fairness for everyone. I doubt being subjective would be able to accomplish that.

Regarding the time to study for the Step, yes, the system is a mess. Why don't we fix the system and not putting our band aid solutions?
 
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USMLE exams are not intended to to stratify quality.
Passing them indicates a baseline level of knowledge.
Passing them is only a small part of what defines an excellent candidate.
Yeah that’s probably why there is all this discussion to make the step 1 pass/fail.
 
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If we have not yet one to do the job, make one! It should be more standardized, not less!
OK. 57 year old man comes in to the ED complaining of low back pain. He thinks he pulled something awhile back but the pain has been getting worse, not better. It's been affecting his life so much, he says, that he's lost 30 lbs in the past month or two and has no energy. His pain has become so unbearable that he came in because he can't take the pain. He wants some "strong NSAIDs" or maybe a muscle relaxant. Oh, he tells you as he puts on his gown, he's also had difficulty urinating lately, and has recently developed a cough and noticed it's harder to catch his breath.

A standardized test might ask how you'd work this guy up. A subjective test would assess how you'd handle what follows after the tests come back. Based on what this vignette is (hopefully heavy-handedly) pointing towards, which is more challenging?
 

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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.
IMG: US citizen who went to a foreign medical school, most often a Caribbean program.
FMG: foreign medical graduate. These can be grads of some of the best medical schools in the world (Aga Khan, Oxford, Heidelberg etc)

They fill residency spots because the programs are either:
1) bribed to take IMGs (note: not FMGs)
2) malignant programs/sweatshops and no one wants to work there.
3) in places that US grads don't want to do residency. Example, community hospital in Jonesboro, AR or Kalispell, MT

You made your bed, now lie in it.
 

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i don’t know what to say guys.

As US citizens you had first dibs on getting into US MD and DO schools. Failing getting admission to one of those schools where your odds of matching are much higher, you can score 13 points lower on the only standardized test to compare you to other foreign grads.

If that isn’t enough of an advantage for your then maybe you aren’t meant to be a doctor and you made a poor life decision in going abroad.
 
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i don’t know what to say guys.

As US citizens you had first dibs on getting into US MD and DO schools. Failing getting admission to one of those schools where your odds of matching are much higher, you can score 13 points lower on the only standardized test to compare you to other foreign grads.

If that isn’t enough of an advantage for your then maybe you aren’t meant to be a doctor and you made a poor life decision in going abroad.
Do non US citizens even have a remote chance of getting into an American medical school? The answer is an astounding no...... And it should be the same for the next phase of training in this profession as well.
 

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I can tell you that in my area a lot of residencies like to take in students from Latin countries as the population here is majority Spanish speaking
 

allantois

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Do non US citizens even have a remote chance of getting into an American medical school? The answer is an astounding no...... And it should be the same for the next phase of training in this profession as well.
I believe medical school admissions has a lot to do with the way our training is structured .differently from other countries as well as the ability of foreign students to secure loans for their education

Personally, I want the best and brightest doctors for myself as a patient, regardless of where they were born or went to medical school
 

chaim123

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Do non US citizens even have a remote chance of getting into an American medical school? The answer is an astounding no...... And it should be the same for the next phase of training in this profession as well.
Why? If someone wasn't good enough to get into an American medical school, why should they get priority to get into an American residency program?
 
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Mean step 1 of matched/unmatched US IMG: 222/212

Mean step 1 of matched/unmatched non-US IMG: 234/221
those data from what year?
anyway, that shows that non-US FMGs do earn their places as they prove themselves beyond doubt.

i don’t know what to say guys.

As US citizens you had first dibs on getting into US MD and DO schools. Failing getting admission to one of those schools where your odds of matching are much higher, you can score 13 points lower on the only standardized test to compare you to other foreign grads.

If that isn’t enough of an advantage for your then maybe you aren’t meant to be a doctor and you made a poor life decision in going abroad.
you have just assumed that everyone has the same chance to go to to med schools in the U.S.

some people HAVE to go Carib bc they do not have the chance to go to U.S. med schools.

Why? If someone wasn't good enough to get into an American medical school, why should they get priority to get into an American residency program?
b/c they have proved themselves at the time of residency application with their standardized test scores?

I am thinking if the same could be said for people get to higher tier med schools vs lower tier ones and/or MD vs DO schools. "Better" students go to high-tier schools and those were not "good" enough go to lower-tier schools.

Once you got into a good school, no need to prove yourself again. You are forever good and superior to everyone else who got into lower tier schools. You should be superior to the people who go to lower tier but work their @sses off for better grades and Step scores too. I guess you are supporting Steps going P/F?

OK. 57 year old man comes in to the ED complaining of low back pain. He thinks he pulled something awhile back but the pain has been getting worse, not better. It's been affecting his life so much, he says, that he's lost 30 lbs in the past month or two and has no energy. His pain has become so unbearable that he came in because he can't take the pain. He wants some "strong NSAIDs" or maybe a muscle relaxant. Oh, he tells you as he puts on his gown, he's also had difficulty urinating lately, and has recently developed a cough and noticed it's harder to catch his breath.

A standardized test might ask how you'd work this guy up. A subjective test would assess how you'd handle what follows after the tests come back. Based on what this vignette is (hopefully heavy-handedly) pointing towards, which is more challenging?
as long as the student can get a score from those tests using the same grading standard/rubric and be ranked against other test takers, then I am fine with that.
 
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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.

USIMG’s are Americans but they are not American-trained.
 

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b/c they have proved themselves at the time of residency application with their standardized test scores?

I am thinking if the same could be said for people get to higher tier med schools vs lower tier ones and/or MD vs DO schools. "Better" students go to high-tier schools and those were not "good" enough go to lower-tier schools.

Once you got into a good school, no need to prove yourself again. You are forever good and superior to everyone else who got into lower tier schools. You should be superior to the people who go to lower tier but work their @sses off for better grades and Step scores too. I guess you are supporting Steps going P/F?
Absolutely not. However, as we have already discussed, FMGs tend to score 13 points better in order to residency spots here, and so again, FMGs are superior in that sense. The question @Small Cell Carcinoma originally posed here had to do with citizenship, not merit.
 
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" 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."

Can someone actually STEAL a spot!? How so!??

I came to US 6 years ago and i am working to get my pharmacy license here and not planning to go back to my home country anytime soon .
I work as pharmacy tech at two different pharmacies , my english is not that great but i can communicate well and pay taxes(not a citizen) , did i #Steal these 2 positions from a US citizen!?? Or i just applied for a job and i interviewed same way the 6 people were with me on that day !??
On my 2nd job i had 8 people interviewing me from different backgrounds and Thank God no one had the" Foriegners stole our spots mentality " .
If You have what they need in these training spots,NO ONE can steal anything from you whether it is an immigrant like me or US citizen like you .


&Please Excuse my poor english
 

Goro

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I see the sense of entitlement hasn't changed since the last time I came up for air.
Have missed your sage counsel, colleague!!
 
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US IMGs who've studied abroad: Switzerland, Germany, Austria, France, etc., required to study in another language seem to have a motivation. I understand the task of learning the culture, language, and obstacles of these docs, and often select them for my family. Bias alert: (Daughter studied in Switzerland). The Caribbean conundrum remains to me a curious route, yet those who've matched often are defined professionally by residency (fellowship). Many have excelled, however more have not.

MD Class of `81
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Nobody is stealing spots. Any FMG at a desireable residency location or competitive field is a superstar like the rest of their class.

Places like where OP is rotating that are 75% FMG, aren't doing it by choice. If they could fill with US MD's or DO's they would absolutely do that. People going unmatched is not because this location chose FMG's over them, its because they didn't apply to undesirable locations like this one.
 

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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.
So much this. OP, the reason so many US IMGs don't match is because they're too incompetent to be physicians. Give me a qualified FMG over an unqualified US IMG any day of the week. Also, did you really think invoking the Trump name was going to help you win this argument?
 
OP
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So much this. OP, the reason so many US IMGs don't match is because they're too incompetent to be physicians. Give me a qualified FMG over an unqualified US IMG any day of the week. Also, did you really think invoking the Trump name was going to help you win this argument?
That doesn't make sense what you are saying. How can an applicant be incompetent if they've passed their boards. Isn't the purpose of these exams to establish a baseline level of competency that you either have or do not have? This is also a requirement to be considered for any residency program. No USIMG who goes unmatched has not passed their boards since if they did they would not have been able to apply in the first place.
 
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Mass Effect

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That doesn't make sense what you are saying. How can an applicant be incompetent if they've passed their boards. Isn't the purpose of these exams to establish a baseline level of competency that you either have or do not have? This is also a requirement to be considered for any residency program. No USIMG who goes unmatched has not passed their boards since if they did they would not have been able to apply in the first place.
The boards prove minimum competency in the material and only and it's sometimes attained after multiple tries. Just the fact that they didn't get into a US medical school is a huge red flag. Add on to that Step 1/2 failures or borderline pass scores and it's over. Third year clinicals matter too (both in location and in performance). Take all of that into account and add on an in person interview where you don't impress and you're done.
 

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How can an applicant be incompetent if they've passed their boards. Isn't the purpose of these exams to establish a baseline level of competency that you either have or do not have?
It is a test of knowlege, not competency.
 

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At the very least, there should be zero USMD and DO students going unmatched (unless there is a professionalism issue).
There would be close to zero if people were realistic about their own merits and everyone with mediocre and below average grades didn't still insist on applying to competitive specialties with limited spots and then fail to even consider a backup specialty. If you are not matching as a USMD chances are you either have serious red flags or aren't being realistic about which specialty you are applying for. It's more often the fault of the individual than the system when it comes to not matching.
 

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That doesn't make sense what you are saying. How can an applicant be incompetent if they've passed their boards. Isn't the purpose of these exams to establish a baseline level of competency that you either have or do not have? This is also a requirement to be considered for any residency program. No USIMG who goes unmatched has not passed their boards since if they did they would not have been able to apply in the first place.
What exactly are you asking for?

USIMGs have huge advantages already over FMGs. So you just want them to get the scraps of whatever US IMGs want? Regardless of score/grades/research/etc?
 
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There would be close to zero if people were realistic about their own merits and everyone with mediocre and below average grades didn't still insist on applying to competitive specialties with limited spots and then fail to even consider a backup specialty. If you are not matching as a USMD chances are you either have serious red flags or aren't being realistic about which specialty you are applying for. It's more often the fault of the individual than the system when it comes to not matching.
yeah, when the US MDs who fail Step multiple times and still are able to match, then what are those unmatched doing?
 

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There would be close to zero if people were realistic about their own merits and everyone with mediocre and below average grades didn't still insist on applying to competitive specialties with limited spots and then fail to even consider a backup specialty. If you are not matching as a USMD chances are you either have serious red flags or aren't being realistic about which specialty you are applying for. It's more often the fault of the individual than the system when it comes to not matching.
Not true. If you look at stuff like nsg, there are still some people going unmatched with great stats. A small number sure, but still a small amount.

Second, applying to a backup is an acceptable course of events for some, but it can limit the number of programs that you apply to (e.g not applying to a gen surg program at the same program where you are applying to a plastics residency).

Third, many people are not going unmatched because of the situation you described. Many are unmatched because of board failures and the need to stay in a certain geographic region.
 
OP
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There would be close to zero if people were realistic about their own merits and everyone with mediocre and below average grades didn't still insist on applying to competitive specialties with limited spots and then fail to even consider a backup specialty. If you are not matching as a USMD chances are you either have serious red flags or aren't being realistic about which specialty you are applying for. It's more often the fault of the individual than the system when it comes to not matching.
So there were a a total of 3 people if I remember correctly (out of over 100 residents) who were USAMGs and ended up at the IM program I was rotating at. I spoke to 2 of them and one of them failed step 1 AND 2 twice and the other one had sexual allegations directed against him that should honestly make anyone ineligible to practice medicine. But if you look at the link I posted there are still many USIMGs applying solely to uncompetitive specialties like family medicine who are still going unmatched who have presumably passed their steps on their first attempt and are not criminals. This is a little off topic from the original purpose of this thread but I do think it highlights how the "system" needs some overhaul.
 
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OP
Small Cell Carcinoma
Feb 25, 2018
86
58
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Medical Student
What exactly are you asking for?

USIMGs have huge advantages already over FMGs. So you just want them to get the scraps of whatever US IMGs want? Regardless of score/grades/research/etc?
Yes that is exactly what I am saying. I think if this topic was brought to the public eye a vast majority of people would agree.
 
OP
Small Cell Carcinoma
Feb 25, 2018
86
58
Status
Medical Student
Most of the people in this thread disagree. So you're basing your assumption on...?
You are right, it is merely an assumption since this issue has never really been brought up in legislation/media. It's just something that I feel many Americans outside of medicine would agree on.
 
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