Why do some good IMG applicants not get interviews?

[ThreadMaker]

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I know a img (non-us citizen) who had 240+ on his steps, few months clinical rotations in the US and still did not get any interview from the Neurology programs he applied to. I know you obviously can't tell me in his case why he didn't get invited for the interview but in general what are some of the reasons IMGs who are not US citizens, and perhaps even those who are, don't get invited for an interview?

 

[typhoonegator]

Bad letters, personal statement written in crayon in a foreign language, bad marks in his clinical rotations, bad visa status, etc. A good step score is not enough to overcome other serious limitations in an application.

 

[DrSnips]

I know a img (non-us citizen) who had 240+ on his steps, few months clinical rotations in the US and still did not get any interview from the Neurology programs he applied to. I know you obviously can't tell me in his case why he didn't get invited for the interview but in general what are some of the reasons IMGs who are not US citizens, and perhaps even those who are, don't get invited for an interview?

What neurology programs did he apply to? If you're asking how a 240+ step score isn't getting you into top programs, you should know that those programs have their pick of applicants with good scores. If you just want to know why IMGs are looked upon less favorably than US grads, it is for the same reasons reiterated on these forums ad nauseum. They have different training abroad that most Americans will consider to be inferior to our training here. Your friend did a few months of US rotations? Every American grad did a full 2 years of them.

 

[rokshana]

What neurology programs did he apply to? If you're asking how a 240+ step score isn't getting you into top programs, you should know that those programs have their pick of applicants with good scores. If you just want to know why IMGs are looked upon less favorably than US grads, it is for the same reasons reiterated on these forums ad nauseum. They have different training abroad that most Americans will consider to be inferior to our training here. Your friend did a few months of US rotations? Every American grad did a full 2 years of them.

there is no "training" abroad so to speak...at least from those go who go straight from med school to residency

many IMGs spend 2 years in clinical training in the US...

the reason for a non US citizen is mostly that...they need a visa and a whole host of problems can (and often do) arise with visa issues...you can have fantastic scores (and a 240 is a 240..it IS a standardized test after all) but if you have the potential not to be able to work on time then many places would just rather not deal with it.

and really? are you so xenophobic (or ethnocentric) that you think that the US training is superior to the training that physicians receive in their home countries? So someone trained in England or India or Singapore are not properly trained? US clinical exposure helps with knowing the US healthcare system and, yes, having exposure to the US system if you want to training in the US is going to give you a leg up, but its not because our system of training is so much better than other countries...

 

[shan564]

It's because programs want a safe bet. If somebody went to med school in the US, you know the exact standards that they had to meet in order to graduate, so the risk of a dud is lower. If they went to med school overseas, you might have a chance of getting a brilliant superstar who just couldn't find a spot due to IMG status, but you also risk getting a person who is unable to communicate well with patients, make holistic clinical decisions, or effectively function in a complex healthcare system. Even if 90% of applicants are good doctors, you don't want to risk having one bad doctor out of every 10 people you accept.

That said, with scores of 240/240 (which are above average, but not super-impressive), you should be able to match into neuro programs if everything else is good enough. If your friend applied broadly and didn't get any interviews, I'd imagine that his personal statement and/or his rec letters were not suggestive of strong communication skills, a commitment to the specialty, and/or appropriate clinical demeanor.

I went to med school in Australia, I have several relatives who went to med school in Pakistan, and I'm currently training at a residency program attached to a "top 5" med school in the US, where I work very closely with the MS3/4 students. I also did some rotations at an "average" school in the US. Based on that experience and knowledge, I can say with fair certainty that the med school training here is most certainly NOT superior to the better schools in other countries, but it most certainly IS superior to the average school in other countries.

 

[Medstart108]

It's because programs want a safe bet. If somebody went to med school in the US, you know the exact standards that they had to meet in order to graduate, so the risk of a dud is lower. If they went to med school overseas, you might have a chance of getting a brilliant superstar who just couldn't find a spot due to IMG status, but you also risk getting a person who is unable to communicate well with patients, make holistic clinical decisions, or effectively function in a complex healthcare system. Even if 90% of applicants are good doctors, you don't want to risk having one bad doctor out of every 10 people you accept.

That said, with scores of 240/240 (which are above average, but not super-impressive), you should be able to match into neuro programs if everything else is good enough. If your friend applied broadly and didn't get any interviews, I'd imagine that his personal statement and/or his rec letters were not suggestive of strong communication skills, a commitment to the specialty, and/or appropriate clinical demeanor.

I went to med school in Australia, I have several relatives who went to med school in Pakistan, and I'm currently training at a residency program attached to a "top 5" med school in the US, where I work very closely with the MS3/4 students. I also did some rotations at an "average" school in the US. Based on that experience and knowledge, I can say with fair certainty that the med school training here is most certainly NOT superior to the better schools in other countries, but it most certainly IS superior to the average school in other countries.

Don't you think though that the basic sciences are given more importance than in Australia/UK (very similar training systems).

We had a visiting prof from Illinois COM to teach us 1st years (keep in mind we are basically just out of high school).

Clearly she didn't know the UK system well because she was making jokes about how "the math majors won't have trouble with this one" before introducing some sort of question.

She was teaching us about molecular biology and pathogens but we were all totally lost. Every time she asked us a question the room was completely silent lol. Needless to say made me think that we aren't learning enough.

I know very well that our 1st year is not equivalent to a US med student 1st year, we have fewer hours of class and we haven't covered as much.

 

[Winged Scapula]

Don't you think though that the basic sciences are given more importance than in Australia/UK (very similar training systems).
.

Most of the Australian schools are now Graduate entry, following the US model.

If anything, the common complaint is that the basic sciences are much much weaker than what is taught in US medical schools. The trade-off may be more focus on clinical skills especially with regard to physical examination.

Your visiting lecturer from the states obviously misunderstood the level of prerequisite coursework required at your program. Unlike most US medical schools, the Australian schools do not prescribe basic science prerequisites and it has been observed that students without those or without a science major often do much more poorly.

 

[bambi]

Most of the Australian schools are now Graduate entry, following the US model.

If anything, the common complaint is that the basic sciences are much much weaker than what is taught in US medical schools. The trade-off may be more focus on clinical skills especially with regard to physical examination.

Your visiting lecturer from the states obviously misunderstood the level of prerequisite coursework required at your program. Unlike most US medical schools, the Australian schools do not prescribe basic science prerequisites and it has been observed that students without those or without a science major often do much more poorly.

I would say basic sciences is quite school dependent in the UK whereas in the US everywhere is quite strong because they have to be for the USMLE.

In the UK clinical skills have a much greater emphasis than pretty much anywhere in the US. In my experience US students and junior residents are incredibly poor clinically.

 

[colbgw02]

and really? are you so xenophobic (or ethnocentric) that you think that the US training is superior to the training that physicians receive in their home countries? So someone trained in England or India or Singapore are not properly trained? US clinical exposure helps with knowing the US healthcare system and, yes, having exposure to the US system if you want to training in the US is going to give you a leg up, but its not because our system of training is so much better than other countries...

Can you really not see that Snips was conveying a widely held perception - not stating a fact or even a personal opinion?

 

[rokshana]

Can you really not see that Snips was conveying a widely held perception - not stating a fact or even a personal opinion?

maybe that's true...and he is just parroting info when he doesn't have real knowledge about the topic...but the perception shouldn't be quoted as fact...and he did exactly that.

the reasons I/FMGs receive interview invites and don't are varied...and to state that its because the training is inferior is the reason is at best naive or at worst xenophobic...both of which needs to be corrected.

 

[DrSnips]

maybe that's true...and he is just parroting info when he doesn't have real knowledge about the topic...but the perception shouldn't be quoted as fact...and he did exactly that.

the reasons I/FMGs receive interview invites and don't are varied...and to state that its because the training is inferior is the reason is at best naive or at worst xenophobic...both of which needs to be corrected.

So then rokshana, your opinion would be that most Americans regard foreign medical education as being equal to our education here?

 

[dozitgetchahi]

I would say basic sciences is quite school dependent in the UK whereas in the US everywhere is quite strong because they have to be for the USMLE.

In the UK clinical skills have a much greater emphasis than pretty much anywhere in the US. In my experience US students and junior residents are incredibly poor clinically.

I'd say I disagree. I'm in a pretty competitive IM residency program, and we match a few FMGs every year (in a class of about 40 incoming interns). To match here, the FMGs definitely have to be 'cream of the crop' etc. Given all the talk about how the average FMG is supposedly better trained and superior to most AMGs, I was wondering how the AMGs' (and my own) clinical skills would stack up against these people.

Turns out I really had nothing to worry about.

While these FMGs certainly seem competent, I'd argue that there's nothing overly special about them and nothing that really sets them apart from the rest of our intern class. Some AMGs in the class are clearly stronger than the FMGs.

 

[secants]

I've also rotating at various private and city hospitals where IMGs are residents. I don't doubt their medical knowledge base and some were very good teachers, it was really stuff we take for granted such as accent, not understanding the culture and obvious social norms that they just didn't seem to get. Also visa status is a major flag that programs don't want to deal with.

 

[shan564]

We definitely didn't learn as much basic science in Australia, but it's also clear that our 1st/2nd year was easier. If you want to come to the US, just spend that extra time learning stuff on your own, and prove your basic science knowledge by getting a good score on Step 1.

 

[Medstart108]

Yeah, i'm working on firecracker. I've heard its good for learning along your curriculum.

 

[Paddington]

I'd say I disagree. I'm in a pretty competitive IM residency program, and we match a few FMGs every year (in a class of about 40 incoming interns). To match here, the FMGs definitely have to be 'cream of the crop' etc. Given all the talk about how the average FMG is supposedly better trained and superior to most AMGs, I was wondering how the AMGs' (and my own) clinical skills would stack up against these people.

Turns out I really had nothing to worry about.

While these FMGs certainly seem competent, I'd argue that there's nothing overly special about them and nothing that really sets them apart from the rest of our intern class. Some AMGs in the class are clearly stronger than the FMGs.

Today's FMG's also seem to be of a different breed than those from a generation ago.

There used to be FMG's coming who were older guys out of school for a few years, maybe even practicing in their own countries, or with advanced training from other Western countries like England.

Today's FMG's seem to be overwhelmingly fresh out of med school in their own countries. I get the impression that these guys are well off back in their own countries because many take months or years off to complete the USMLE series, do rotations in the U.S., etc. while being supported by family.

 

[rokshana]

So then rokshana, your opinion would be that most Americans regard foreign medical education as being equal to our education here?

define most Americans...the layperson who is looking for a doctor?...frankly they don't care...they want a doctor that they feel listens to them and truly is interested in their health and has the ability to take care of their medical issues...i can count on less than one hand how many patients have asked me where i went to school (sure I new to this, so maybe by the end of my career i may have to use my fingers and toes, but you get the idea).

those in medicine? it will vary...i think those who are in the start of their career... prospective med students, med students, even some interns and residents have a perception that the US schools are the end all and be all...but as we have more interaction with those who have gone to school in other countries (esp those domiciled schools where only the best and the brightest are even eligible to go to med school), we realize that med schools abroad are like med schools in the US...some are amazing, some are adequate, and some are crap...

those PDs and Chairs of programs that are familiar with foreign schools as well as US schools are going to know the good schools and the bad...some of those bad are in the US as well...some will chose a rockstar graduating from AIIMS over the average student from the average state school...other will choose the AMG over the best I/FMG...just depends on what is important to the program.

point being is that the reason F/IMGs get less interviews (and this is debatable...i personally had way 20 interviews so less is probably not the right word) or don't get interviews at certain places is not just because everyone wholesale believes that a foreign education (or even training) is subpar to a US one...there are lots of reasons.

and i do find it a bit interesting that the sum of what a doctor's quality is being defined by the 4 years spent in med school and not by where they do residency and fellowship...IMHO I think the 3-10 years spent actually treating patients and learning from practicing physicians has a greater impact on the ability to be a competent physician.

 

[rokshana]

I'd say I disagree. I'm in a pretty competitive IM residency program, and we match a few FMGs every year (in a class of about 40 incoming interns). To match here, the FMGs definitely have to be 'cream of the crop' etc. Given all the talk about how the average FMG is supposedly better trained and superior to most AMGs, I was wondering how the AMGs' (and my own) clinical skills would stack up against these people.

Turns out I really had nothing to worry about.

While these FMGs certainly seem competent, I'd argue that there's nothing overly special about them and nothing that really sets them apart from the rest of our intern class. Some AMGs in the class are clearly stronger than the FMGs.

i dunno, it sounds like your program looks at the candidate and not necessarily the school they went to...

 

[ThoracicGuy]

define most Americans...the layperson who is looking for a doctor?...frankly they don't care...they want a doctor that they feel listens to them and truly is interested in their health and has the ability to take care of their medical issues...i can count on less than one hand how many patients have asked me where i went to school (sure I new to this, so maybe by the end of my career i may have to use my fingers and toes, but you get the idea).

The thing I run into from alot of patients in regards to some FMGs is that they don't speak English well or they talk down to patients or both. Yes, some AMGs probably do the same, but whenever they would mention the doctors name, it was usually foreign. So yes, patients in a way do notice.

 

[rokshana]

The thing I run into from alot of patients in regards to some FMGs is that they don't speak English well or they talk down to patients or both. Yes, some AMGs probably do the same, but whenever they would mention the doctors name, it was usually foreign. So yes, patients in a way do notice.

i think you are under a misperception that all FMGs are foreign born and speak with an accent...while some may find my Southern accent a bit hard to understand up here in the North, I usually have no problem making myself understood... "foreign" last name and all...🙂

 

[ThoracicGuy]

i think you are under a misperception that all FMGs are foreign born and speak with an accent...while some may find my Southern accent a bit hard to understand up here in the North, I usually have no problem making myself understood... "foreign" last name and all...🙂

No. I've got a pretty clear understanding of FMGs and IMGs. There are many foreign named people that speak perfectly good English. There are also many foreign named people that speak horrible English. I've had on more than one occasion a family saying they were glad I was there to see them since their last doctor couldn't even speak English enough to communicate with them. This was in the Midwest. Communication matters and unfortunately for some foreign-born doctors practicing in the US, it's just not there.

 

[bambi]

I'd say I disagree. I'm in a pretty competitive IM residency program, and we match a few FMGs every year (in a class of about 40 incoming interns). To match here, the FMGs definitely have to be 'cream of the crop' etc. Given all the talk about how the average FMG is supposedly better trained and superior to most AMGs, I was wondering how the AMGs' (and my own) clinical skills would stack up against these people.

Turns out I really had nothing to worry about.

While these FMGs certainly seem competent, I'd argue that there's nothing overly special about them and nothing that really sets them apart from the rest of our intern class. Some AMGs in the class are clearly stronger than the FMGs.

Only commenting on the clinical skills of UK trained doctors. I know those from certain other countries are lacking. In the UK our clinical skills are heavily tested, at some schools more than actual scientific knowledge. I was absolutely stunned by the lack of clinical skills of the US students I saw. This was only at one school but one that is considered excellent. You will always get the odd awful and excellent student everywhere but overall UK trained doctors are very good clinically.

 

[shan564]

Only commenting on the clinical skills of UK trained doctors. I know those from certain other countries are lacking. In the UK our clinical skills are heavily tested, at some schools more than actual scientific knowledge. I was absolutely stunned by the lack of clinical skills of the US students I saw. This was only at one school but one that is considered excellent. You will always get the odd awful and excellent student everywhere but overall UK trained doctors are very good clinically.

I went to med school in Australia, and I'm now doing residency in the US. I agree that we learned much more clinical skills in Aus, at the expense of basic pharmacology, pathology, etc. Also, American students learn much better skills with regard to extensive documentation so that the hospital can get paid by the insurance companies, which isn't an issue in Australia - our daily progress notes in Australia were probably about 1/4 the length of an average progress note in the US.

Now, you can take that statement and say "hey, look, the British/Aussie system teaches better clinical skills, so it's better... you can learn the pharmacology/physiology/pathology/microbiology in your specialty training, since you don't need to know the non-specialty-specific stuff anyway." But you could say the same thing about how the American system teaches better clinical science knowledge, since you don't need the specific clinical skills outside of your specialty. Yes, I learned a lot about how to diagnose the specific type of heart murmur in med school in Australia, but when is the last time that a non-specialist actually used that skill? Or the difference between a murmur and a rub and a click? Or the ability to percuss the liver span? Or the lid lag sign? Those things are no more useful to me than the ability to describe the structure of all of the common viral pathogens.

The point is - in the US, med students are trained to click right into the US residency training system. In Australia, they're trained to fit into the Australian system. Different systems emphasize different things at different stages of training. If you take an IMG, they were likely trained in a different system, and you run the risk that this person might not be as successful in the American system. That's why it's important to get rec letters from American clinical rotations to prove that a student functions well in this system.

 

[dragonfly99]

I think that visa issues, and possible language and cultural difficulties (for some applicants) and lack of very much documented clinical training in the US explains some of the problems some FMG's have matching in the US. Also, if a residency program director is not familiar with a particular med school (US or foreign, but more likely to be the case with foreign schools) then the PD and other attendings doing the "choosing" of candidates is not going to know how the person's training in med school stacks up against the US schools in that area of the country that he/she is familiar with. Therefore, taking a foreign medical grad in general would involve more "risk" on the part of the program, and they tend to be risk averse.
It's better to take 5 solid candidates from schools they know, versus take 4 solid ones and take a chance on a 5th one who is smart (240 USMLE) but perhaps they aren't sure about his/her ability to communicate with patients, or fit in with the way this particular hospital does things, and maybe not sure about his prior training.

I also have had multiple patients comment to me about foreign born docs not being able to communicate - it's certainly not all of them, but people who can't find the particular detailed words to communicate with patients, or who just have a heavy foreign accent, can be hard for patients to understand, especially if the patients are elderly and have hearing loss, or perhaps just have a low educational level.