Will the US ever lose its need for IMGs?

[CDI]

My solution involves the countries that these people train in allow them to do residency there.
I can't go practice in Germany. It's tough for my wife to do it in Australia. We both did school and residency in the US. Just because we have one of the highest incomes worldwide for physicians doesn't mean we need to have dedicated spots for IMGs. We don't have a physician number access problem, we have a physician access geography problem (which you noted at one point).

Right... so put them (us) in the boonies for 3 years and make em pay for it.

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[CDI]

Why would we ever do that??? The goal in the US isn't to give equal access to IMGs. If they fill a current demand we cant fulfill domestically that's fine, but to arbitrarily protect a set of jobs for IMGs beyond that is pretty ludicrous. There is no reason for us to "equal the scales" and an enormous list of reasons why the US should not. You have to realize that the US is already extremely generous in giving not US educated spots at all -- most countries won't. over time as US schools ultimately fulfill US needs there becomes no reason to take any more IMGs and so frankly we want no reason, contractual or otherwise, to feel obligated to take more.

Again, I get why you want this to be the case, but if you could step outside of your own interests, you would see that this notion sounds pretty wacky to most of us, and will never ever happen.

I'll be in residency and moving on in a year, or two at worse. So as much as you want to think I'm hardpressed for drastic measures...I'm not.

Question is how did I suggest equaling the scales? Less spots, boonies, pay for position, already higher exam fees...I must be missing something.

Its small minded thinking that stays where it is. The reason the US is able to do what it does is because it stays open and snags the best from the rest of the world. Close that angle and we'll only hurt ourselves.

Funny thing is some of the biggest leaders in medicine in the US are not even ECFMG certified and actually bypassed residency and fellowships all together. They practice medicine and teach AMGs and even make policies. This all happens at a higher level, where the ppl who are screaming "They took our jerbs!" don't even have a real voice.

 

[gutonc]

Right... so put them (us) in the boonies for 3 years and make em pay for it.

3 years in the boonies is not the problem. Keeping them there is.

 

[KnuxNole]

3 years in the boonies is not the problem. Keeping them there is.

Force them to work there for 5-7 years minimum.

There are lots of strong foreign grads from actual foreign countries. I doubt anyone is arguing in favor of caribbean students, which I'm sure everyone is on the same page in terms of them. But for FMGs, there are lots of highly intelligent physicians from other countries

 

[Law2Doc]

...
Question is how did I suggest equaling the scales?...

in your prior post you explicitly said "equal the scales".

Again, importing IMGs is a good idea when we are unable to domestically fill residency slots. IMGs fill a void. But we won't be in that situation for very long. so your "solution" will lock us into an arrangement we wouldn't want in a few short years.

Let's not pretend that the US med school grads are crummy while the IMGs coming here are all superstars. Thats the fiction that bolsters your argument, but its hardly accurate. In the US you have to have an amazing college transcript just to get into any US med school, even the lowest ranked one. And then you have to jump through a series of standardized hoops set by the LCME that far exceed many foreign med schools standards. And you do clinical rotations where attendings evaluate you in a US wards setting. So even the worst US med student is actually pretty polished by international standards, and ready to be a resident by the time they graduate. And they already know the culture, speak the language, have experience with US patients and the US healthcare system, and have some clinical rotation experience on the wards to boot. They really are the known commodity here, and most employers like known commodities. That's life. Just be happy the US healthcare system is open to IMGs at all -- in most countries it's a closed system.

 

[CDI]

in your prior post you explicitly said "equal the scales".

Yes, I meant in terms of finances. As in IMGs would have to pay up, to cover the cost of AMG spots which couldnt be funded otherwise by Medicare. They pay plenty already with tuition.

You say reserving residency spots is ludicrous but programs like GW already have reserved spots for training IMGs cause their country pays for it. (Not sure if they're board-eligible after that though or if they have to go back to their country once done.)

 

[Fenster]

What a hilarious argument. Keep it up guys.

 

[Law2Doc]

Yes, I meant in terms of finances. As in IMGs would have to pay up, to cover the cost of AMG spots which couldnt be funded otherwise by Medicare. They pay plenty already with tuition.

You say reserving residency spots is ludicrous but programs like GW already have reserved spots for training IMGs cause their country pays for it. (Not sure if they're board-eligible after that though or if they have to go back to their country once done.)

It's incomprehensible to suggest that the US, which is rapidly increasing it's own local med school enrollment, would even consider blocking off residency slots for non US grads. What country would do this? It's one thing to import doctors when we have a shortfall, but when there soon won't be, why consider it? The US sets up rules to benefit it's own citizens, not the world at large, as does every country. I think you haven't really thought this through or you are just arguing for something you'd like to be the case, even though for the US it really doesn't make any sense whatsoever.

The US subsidizes US med schools and loans a lot of money to US med students, and so it's a real problem if these people don't find residencies and end up defaulting on their debt. this isn't unique to the US, just that the US currently is more open than other countries. But as supply starts to equal demand we won't need to be. There is no reason to expect equal access to another countries medical training, and lots if reasons not to expect it. I think you are kidding yourself -- honestly I think the pendulum is swinging exactly in the opposite direction of what you have proposed.

 

[CDI]

It's incomprehensible to suggest that the US, which is rapidly increasing it's own local med school enrollment, would even consider blocking off residency slots for non US grads. What country would do this? It's one thing to import doctors when we have a shortfall, but when there soon won't be, why consider it? The US sets up rules to benefit it's own citizens, not the world at large, as does every country. I think you haven't really thought this through or you are just arguing for something you'd like to be the case, even though for the US it really doesn't make any sense whatsoever.

The US subsidizes US med schools and loans a lot of money to US med students, and so it's a real problem if these people don't find residencies and end up defaulting on their debt. this isn't unique to the US, just that the US currently is more open than other countries. But as supply starts to equal demand we won't need to be. There is no reason to expect equal access to another countries medical training, and lots if reasons not to expect it. I think you are kidding yourself -- honestly I think the pendulum is swinging exactly in the opposite direction of what you have proposed.

There are spots (with some restrictions, as to what they can do afterwards) blocked off for IMGs every year. Hospitals need all the money they can get.

It's obvious it's swinging the other way, or maybe its not. Back 20-30 years ago only ~30% of IMGs matched, now it's ~50%. People have always said IMGs are getting the boot, but it's never actually happened. Similar to how everyone always claims theres no money, to do anything, and then we just print more...

While we see things are changing (or should be based on some stats regarding med school spots), to think it's happening overnight is chicken little-esque.

I laughed at when you said ppl not finding residencies and defaulting on their debt, is a problem. As if to suggest the US actually cares about individual MDs, MBAs, JDs, who aren't competitive...welcome to the club.

 

[Law2Doc]

There are spots (with some restrictions, as to what they can do afterwards) blocked off for IMGs every year. Hospitals need all the money they can get.

It's obvious it's swinging the other way, or maybe its not. Back 20-30 years ago only ~30% of IMGs matched, now it's ~50%. People have always said IMGs are getting the boot, but it's never actually happened. Similar to how everyone always claims theres no money, to do anything, and then we just print more...

While we see things are changing (or should be based on some stats regarding med school spots), to think it's happening overnight is chicken little-esque.

I laughed at when you said ppl not finding residencies and defaulting on their debt, is a problem. As if to suggest the US actually cares about individual MDs, MBAs, JDs, who aren't competitive...welcome to the club.

The numbers are there, but raw percentage comparisons over time isn't illustrative because not all spots have always been in the match. There have been very real losses of spots by IMGs since the increase in US enrollment, the "all in" rule, and SOAP. It's not happening overnight but it's happening pretty fast. Whatever. I won't fight you further. If you think the US is going to change things to keep things "fair" for IMGs, you go on believing that.

 

[IMPD]

Great thread. One fact not mentioned (surprisingly, since most posters here are fairly well informed and had some new info for me) is the LCME requirement for entering the Match in 2019. This is a atom-bomb level change for IMGs. If LCME doesn't certify your school, you can't enter the Match.

This will likely end 80% of IMG doorways.

Although the details on this are still unclear (and will perhaps be watered down), LCME accreditation really is the major change that will hurt IMGs the most.

The interplay in AAMC politics, hospital finances and US budget politics is extremely complicated and not worth trying to predict. What is clear is that doors are closing for IMGs. I think the time frame is still 3-5 years for the squeeze to really start.

 

[Obnoxious Dad]

Great thread. One fact not mentioned (surprisingly, since most posters here are fairly well informed and had some new info for me) is the LCME requirement for entering the Match in 2019. This is a atom-bomb level change for IMGs. If LCME doesn't certify your school, you can't enter the Match.

This will likely end 80% of IMG doorways.

Although the details on this are still unclear (and will perhaps be watered down), LCME accreditation really is the major change that will hurt IMGs the most.

The interplay in AAMC politics, hospital finances and US budget politics is extremely complicated and not worth trying to predict. What is clear is that doors are closing for IMGs. I think the time frame is still 3-5 years for the squeeze to really start.

If the LCME gets to certify or choke off applicants from various schools, what will happen to DOs? Will DOs from certain schools only have access to the DO match? There aren't enough DO spots for half of the DO grads.

Since the LCME is simply a joint venture of the AMA and the AAMC, the uncertified DO schools and offshore schools could make a good case that noncertification is simply a ploy to restrict competition in violation of the Sherman Act. This is a lawsuit in the making.

 

[IMPD]

If the LCME gets to certify or choke off applicants from various schools, what will happen to DOs? Will DOs from certain schools only have access to the DO match? There aren't enough DO spots for half of the DO grads.

Since the LCME is simply a joint venture of the AMA and the AAMC, the uncertified DO schools and offshore schools could make a good case that noncertification is simply a ploy to restrict competition in violation of the Sherman Act. This is a lawsuit in the making.

I don't see the LCME certification of IMG schools leading to a lawsuit....

The DO question is playing out right now. The ACMGE is bringing about the closure of ACGME fellowships. DOs will have to enroll in ACGME "primary" (i,e. pre-fellowship) programs in order to apply to fellowships starting in 2015, I believe.

Although there is a chance that ACGME and AOA will come back and work this out, the material I have read shows this is unlikely.

DOs will still have access to ACGME "primary" residencies, which is not being disputed by the LCME.

 

[gutonc]

If the LCME gets to certify or choke off applicants from various schools, what will happen to DOs? Will DOs from certain schools only have access to the DO match? There aren't enough DO spots for half of the DO grads.

Since the LCME is simply a joint venture of the AMA and the AAMC, the uncertified DO schools and offshore schools could make a good case that noncertification is simply a ploy to restrict competition in violation of the Sherman Act. This is a lawsuit in the making.

Serious question.

Does the Sherman Antitrust Act pertain to non-US corporations?

I don't have any idea where the various and sundry off-shore schools pretend to be located for tax purposes but I'm going to assume it's not the US.

 

[Obnoxious Dad]

Serious question.

Does the Sherman Antitrust Act pertain to non-US corporations?

I don't have any idea where the various and sundry off-shore schools pretend to be located for tax purposes but I'm going to assume it's not the US.

The tax law has nothing to do with this. This is about restraint of trade.

Foreign domiciled corporations can bring antitrust actions against American companies in American courts if the opportunities of the foreign companies are limited in the U.S. by the actions of others. Furthermore the graduates of DO and foreign schools would also have standing to sue because they would be aggrieved by the anticompetitive actions of the LCME.

In the end if certain states can't get FMGs and DOs to practice anymore in rural areas we may see an end to the LCME's strangle hold on medical education. It ought to be clear to any objective observer that the LCME has done its best to limit access to medical education in the U.S. When Milton Friedman said that the AMA was the strongest labor union in America, he wasn't kidding.

 

[Silent Cool]

The tax law has nothing to do with this. This is about restraint of trade.

Foreign domiciled corporations can bring antitrust actions against American companies in American courts if the opportunities of the foreign companies are limited in the U.S. by the actions of others. Furthermore the graduates of DO and foreign schools would also have standing to sue because they would be aggrieved by the anticompetitive actions of the LCME.

In the end if certain states can't get FMGs and DOs to practice anymore in rural areas we may see an end to the LCME's strangle hold on medical education. It ought to be clear to any objective observer that the LCME has done its best to limit access to medical education in the U.S. When Milton Friedman said that the AMA was the strongest labor union in America, he wasn't kidding.

Yup.

'Milton Friedman -- Healthcare in a Free Market'

https://www.youtube.com/watch?v=-6t-R3pWrRw

 

[gutonc]

The tax law has nothing to do with this. This is about restraint of trade.

Foreign domiciled corporations can bring antitrust actions against American companies in American courts if the opportunities of the foreign companies are limited in the U.S. by the actions of others. Furthermore the graduates of DO and foreign schools would also have standing to sue because they would be aggrieved by the anticompetitive actions of the LCME.

In the end if certain states can't get FMGs and DOs to practice anymore in rural areas we may see an end to the LCME's strangle hold on medical education. It ought to be clear to any objective observer that the LCME has done its best to limit access to medical education in the U.S. When Milton Friedman said that the AMA was the strongest labor union in America, he wasn't kidding.

I wasn't really asking about tax law (although it's relevant WRT where one of these sketchy offshore schools chooses to set up). I was actually just asking whether foreign corps could file Anti-Trust claims in the US which you (eventually, sort of, mostly opaquely, like a "good" lawyer would be expected to) did. So thanks. I guess.

 

[NotAProgDirector]

One fact not mentioned (surprisingly, since most posters here are fairly well informed and had some new info for me) is the LCME requirement for entering the Match in 2019. This is a atom-bomb level change for IMGs. If LCME doesn't certify your school, you can't enter the Match.

What exactly are you referring to here? AFAIK, the NRMP has made no announcement of changes planned for the match. The ACGME has released a change to their core program requirements that would require any prerequisite GME training to be ACGME / ACGME-I / RCPSC accredited. This will prevent DO students in AOA residencies from obtaining PGY-2 spots in ACGME programs, and (mostly) prevent them from ACGME fellowships (there is an exception clause). But this has nothing to do with the match and almost nothing to do with IMG's. Also, there already was a loose limit of AOA trained residents going into ACGME fellowships, as programs had to prove that 80% of their grads were eligible to sit for the boards, and only an ACGME trained resident could do so.

The ACMGE is bringing about the closure of ACGME fellowships. DOs will have to enroll in ACGME "primary" (i,e. pre-fellowship) programs in order to apply to fellowships starting in 2015, I believe.

Again, I'm not certain what you're referring to here. As above, the ACGME has proposed (and will almost certainly implement) a requirement that all ACGME fellows be ACGME residency trained. This will prevent AOA trained residents from accessing ACGME fellowships, and DO's from using AOA TRI's as prelims before ACGME residencies. That is certainly correct. Theoretically, if there are not enough ACGME trained residents interested in fellowships, then some programs will close or downsize -- I'm assuming that's what you mean. But I don't see any data from the NRMP that addresses this concern -- all of the data tables published look only at what school the candidates came from (USMG/US IMG /Non US IMG / DO) and not what type of residency program they went to (i.e. no table divides the DO's into those that were in an ACGME residency from those that were not). If the vast majority of DO students going into ACGME fellowships were in ACGME residencies to begin with, then this change will have little effect.

 

[CDI]

What exactly are you referring to here? AFAIK, the NRMP has made no announcement of changes planned for the match. The ACGME has released a change to their core program requirements that would require any prerequisite GME training to be ACGME / ACGME-I / RCPSC accredited. This will prevent DO students in AOA residencies from obtaining PGY-2 spots in ACGME programs, and (mostly) prevent them from ACGME fellowships (there is an exception clause). But this has nothing to do with the match and almost nothing to do with IMG's. Also, there already was a loose limit of AOA trained residents going into ACGME fellowships, as programs had to prove that 80% of their grads were eligible to sit for the boards, and only an ACGME trained resident could do so.

I'm not sure about which year its happening specifically could even be in the 2020s but I too read (official notice) that they were planning to have all IMG institutions verified and only then could their students be eligible to join residency in the US.

Edit, found it: http://www.ecfmg.org/forms/9212010.press.release.pdf

 

[rokshana]

I'm not sure about which year its happening specifically could even be in the 2020s but I too read (official notice) that they were planning to have all IMG institutions verified and only then could their students be eligible to join residency in the US.

Edit, found it: http://www.ecfmg.org/forms/9212010.press.release.pdf

there is truth to this, but its not the ACGME, its ECFMG...for a foreign student to be eligible for ECFMG certification, the school they went has to be accredited by an accreditation body (it doesn't and in fact cannot, per LCME guidelines, be the LCME) that is the equivalent to the LCME (ie GMC, CAA-HP) otherwise they will not be able to apply for ECFMG certification...without ECFMG certification an applicant cannot do an ACGME residency or fellowship.

I want to say it is to be implemented in 2015, but i don't remember the exact date.

 

[NotAProgDirector]

I'm not sure about which year its happening specifically could even be in the 2020s but I too read (official notice) that they were planning to have all IMG institutions verified and only then could their students be eligible to join residency in the US.

Edit, found it: http://www.ecfmg.org/forms/9212010.press.release.pdf

Thanks for that.

The press release can be read in two ways. If you believe them, they are clear that they want nothing to do with accrediting medical schools. Rather, they want to force some international coalition to create standards and then enforce them across each country. Sadly, I think this is pretty ridiculous -- any country with a well established system probably polices itself reasonably well already, and any without is likely to create a sham/nepotistic system anyway. I doubt this will change much.

If you don't believe them, then they will get into the business of accrediting international schools. Rather than "enhancing the quality of education" as they suggest, it will instead "enchance their bottom line".

Either way, I doubt many international schools will fail this process. And they've left it to 2023 -- too far in the future to really worry about now (unless you run a school like this)

 

[IMPD]

Thanks for that.

The press release can be read in two ways. If you believe them, they are clear that they want nothing to do with accrediting medical schools. Rather, they want to force some international coalition to create standards and then enforce them across each country. Sadly, I think this is pretty ridiculous -- any country with a well established system probably polices itself reasonably well already, and any without is likely to create a sham/nepotistic system anyway. I doubt this will change much.

If you don't believe them, then they will get into the business of accrediting international schools. Rather than "enhancing the quality of education" as they suggest, it will instead "enchance their bottom line".

Either way, I doubt many international schools will fail this process. And they've left it to 2023 -- too far in the future to really worry about now (unless you run a school like this)

Overall I agree with your take on "most schools not failing" accreditation. Mostly, accreditation bodies want to continue to accredit their members, otherwise they risk losing political support.

And yet, I look at what the ACGME is doing with ACGME-I and think about how the NRMP actions with All-In dovetail with it's parent organization (AAMC's) decision to expand enrollement and then create a (possible) new accreditation barrier to IMG schools. It seems to be all of a piece.

Offering "enhanced" accreditation to programs that are able to funnel the best and brightest to the US while offering a non-discriminatory way to shut out schools that won't meet the standards.

Just an impression, not any kind of inside knowledge.

This comes from a couple years on the job at a primarily IMG program where it is vitally important to me to be aware of changes in the IMG applicant pool as this, of course, affects my recruitment.

 

[NotAProgDirector]

It certainly is interesting.

I actually see the NRMP and the AAMC somewhat at odds with each other. The NRMP created the all in rule mostly to ensure that the match doesn't collapse as the number of AMG's increases. Theoretically, it helps both AMG's and competitive IMG's since it takes some of the pre-matches out of the system. However, let's imagine that the number of AMG's really spikes and actually closes the gap -- so that the number of AMG's = number of slots (which may actually happen). The AAMC is going to want an "AMG first" type of rule. The NRMP may or may not do that, as they have two constituents -- medical schools and residency programs -- who may not agree.

Time will tell.

 

[CDI]

It certainly is interesting.

I actually see the NRMP and the AAMC somewhat at odds with each other. The NRMP created the all in rule mostly to ensure that the match doesn't collapse as the number of AMG's increases. Theoretically, it helps both AMG's and competitive IMG's since it takes some of the pre-matches out of the system. However, let's imagine that the number of AMG's really spikes and actually closes the gap -- so that the number of AMG's = number of slots (which may actually happen). The AAMC is going to want an "AMG first" type of rule. The NRMP may or may not do that, as they have two constituents -- medical schools and residency programs -- who may not agree.

Time will tell.

IMGs this year have, I think, 8 programs or so to choose from that are completely out of match (so no US seniors). That number is holding from last year I believe.

 

[doctr2be]

IMGs this year have, I think, 8 programs or so to choose from that are completely out of match (so no US seniors). That number is holding from last year I believe.

How do "out of Match" residencies work? Being an IMG this thread is a very interesting read.

 

[CDI]

How do "out of Match" residencies work? Being an IMG this thread is a very interesting read.

A couple (scutwork-heavy) programs try to dangle a Visa in front of high scoring IMGs early on in the season, to prevent them from seeing other residency programs. Usually these candidates have 250-260+. Or occasionally the US-IMGs with 230/230+ after a pimping session.

 

[doctr2be]

A couple (scutwork-heavy) programs try to dangle a Visa in front of high scoring IMGs early on in the season, to prevent them from seeing other residency programs. Usually these candidates have 250-260+. Or occasionally the US-IMGs with 230/230+ after a pimping session.

LOL I didn't know that. Thanks!

 

[CDI]

LOL I didn't know that. Thanks!

No prob.

 

[cee]

US-IMG here. Reapplying for the second time (didn't match last year).

How come no one in D.C. has ever thought of privatizing residencies? They are all funded through Medicare. Why can't they be like universities or medical schools, and either be private or public? In all honesty, I would be willing to pay tuition for 3 years of residency, and I am not ashamed to admit that. Let the free market solve the healthcare crisis and lack of providers in this country.

I believe that residents funding their education would lead to an explosion of residencies in underserved areas, which would create a surge of primary care physicians that would meet the country's demand for physicians. The current Medicare money allocated for resident salaries can be converted to "residency scholarships", which U.S. citizens who are medical school graduates can apply for-- and let's be honest, most of those scholarships will go to AMG's anyways, so not much will change in that regard. However, majority of IMG's looking for residencies will be able to obtain them if they are willing to pay for tuition. These new "privatized" residencies will still have to meet the criteria set forth by the ACGME that exists now, which will ensure quality physicians are put into the workforce.

Overall, it would create a supply for the demand.

 

[CDI]

Unfunded residency spots do exist, but are very rare. Hospitals may eventually go that route if Medicare can't pay for more spots.

Example: McLaren Macomb Radiology (DO only)

 

[Raryn]

Unfunded residency spots do exist, but are very rare. Hospitals may eventually go that route if Medicare can't pay for more spots.

Example: McLaren Macomb Radiology (DO only)

While there is a not insignificant number of unfunded spots in that there are plenty of spots that are not funded by medicare (though they are in the minority), there is no such thing as an ACGME accredited spot that doesn't pay you. A handful of DO programs notwithstanding, there is no MD residency in the country such as the one described by that poster.

 

[CDI]

While there is a not insignificant number of unfunded spots in that there are plenty of spots that are not funded by medicare (though they are in the minority), there is no such thing as an ACGME accredited spot that doesn't pay you. A handful of DO programs notwithstanding, there is no MD residency in the country such as the one described by that poster.

Yeah, I haven't come across any ACGME accredited positions, just DO. If Medicare doesn't keep up with increasing needs... wouldn't surprise me to see it at some point.

 

[NotAProgDirector]

It's an ACGME institutional rule that residents be paid:

II.D. Resident Salary and Benefits: The Sponsoring Institution, in collaboration with each of its ACGME-accredited programs and its participating sites, must provide all residents/fellows with financial support and benefits to ensure that they are able to fulfill the responsibilities of their ACGME-accredited programs. (Core)

 

[CDI]

It's an ACGME institutional rule that residents be paid:

So...pay minimum wage via "donations from family" which is what McLaren does. (And that's DO)

Where there is an America... there is a loophole.

 

[Attending1]

The number of IMG docs getting into US residency programs is going to decrease, no matter who thinks what, because the number of US AMGs is increasing, and matching up to the number of residency spots.
It sure is a good thing for AMGs.

But, the U.S. medical system was always also about "selection of the fittest" and "diversity".
It looks like these aspects are likely to take a back seat, and bread & butter issues (like AMG loan payments, local preference etc) are going to predominate.

As an IMG, I personally believe that IMGs come to US (for residencies/ settling down in US), not primarily for money, but because they believe that being a part of the US medical system is an achievement, and that the U.S. medical system is the greatest in the world - a meritocracy, where it's not about where you are from, but about how good you are.

What I'd like to stress is that most IMGs who come to US for higher training, come here believing themselves to be global citizens competing for the best that life has to offer - not to rob locals of their jobs
Most of the IMGs that I know of are monetarily well off/ middle class, and have come to US residency/ medical system for something higher and better, not for existence.

The US has one of the best systems in the world. The reason partly is because the U.S. system attracts and retains the best talent from all over the world, not just its own territory.

Especially brilliant doctors from developing countries (China, India, Africa) get opportunities that they would not have in their countries. I haven't seen too many IMGs from Western Europe interested in US residencies, as they get comparable opportunities there.

I agree that AMGs need to be given preference in selection, but also think that there should be adequate space for accommodating good IMG residents.

I think it would be good to have a cosmopolitan global mix in residency, besides giving the U.S. an edge ( in the talent pool) over comparable health systems.

 

[drk]

The current USA situation as far as I know is that we are or are soon going to experience a shortage of doctors. How does increasing U.S. medical schools solve this problem in any meaningful way. 99% of the residency positions are filled each year so it would appear the bottle neck is training positions and not medical student positions, even if AMG graduates=total residency spots you're still in the same position as your are today as far as physician shortages is concerned. Additonally, and I am asking a question here - given the decreased reimbursements and highly stressful lifestyle of a physician, is there still a demand for medical schools to the point that we will reach AMG graduates=total residency spots without compromising the rigorous standards for admission?

 

[rajhanda]

I agree that AMGs need to be given preference in selection, but also think that there should be adequate space for accommodating good IMG residents.

I think it would be good to have a cosmopolitan global mix in residency.

Are you saying there should be some kind of a set-aside quota for IMGs?

 

[rokshana]

The current USA situation as far as I know is that we are or are soon going to experience a shortage of doctors. How does increasing U.S. medical schools solve this problem in any meaningful way. 99% of the residency positions are filled each year so it would appear the bottle neck is training positions and not medical student positions, even if AMG graduates=total residency spots you're still in the same position as your are today as far as physician shortages is concerned. Additonally, and I am asking a question here - given the decreased reimbursements and highly stressful lifestyle of a physician, is there still a demand for medical schools to the point that we will reach AMG graduates=total residency spots without compromising the rigorous standards for admission?

there are plenty of applicant that meet the standards set today, just not enough spots.

but you are absolutely right in that the call for an increase in med students should've been accompanied by a call for an increase ni residency spots to meet the "shortage" (IMHO its a distribution problem not a numbers problem, but that's another discussion).

 

[Attending1]

Are you saying there should be some kind of a set-aside quota for IMGs?

No, rather there should be a set aside quota for AMGs, say 70%
The other 30% should be filled based on merit of the applicant ( scores/ skills etc) irrespective of AMG/ IMG status

 

[Obnoxious Dad]

No, rather there should be a set aside quota for AMGs, say 70%
The other 30% should be filled based on merit of the applicant ( scores/ skills etc) irrespective of AMG/ IMG status

Listen, chum, the U.S. faces a physician shortage. The residency slots the U.S. taxpayers underwrite at a cost of approximately $225,000 per resident per year need to be set aside for Americans. In the next five years we may have more medical school graduates than residency slots. Would you like to tell American medical school graduates who can't match about your scheme?

Americans already subsidize the rest of the world through $30,000,000,000 per year for basic research. Americans on a per capita basis spend approximately 4 times as much as Canadians on basic research. We also pay much higher prices to pharmaceutical companies to cover the cost of applied research and clinical trials.

There was a recent thread on this board from a young Swede who wants to train here as a resident and go back to Sweden. Why should American taxpayers cover that cost? What does that do for us?

What do we get in return from other countries?

 

[thehundredthone]

Listen, chum, the U.S. faces a physician shortage. The residency slots the U.S. taxpayers underwrite at a cost of approximately $225,000 per resident per year need to be set aside for Americans. In the next five years we may have more medical school graduates than residency slots. Would you like to tell American medical school graduates who can't match about your scheme?

I've always wondered about the politics of these changes, so some honest questions. What about the quality of physicians? Assuming that for a given residency spot, a foreign graduate (the FMG "superstars", so to speak) is better than an American graduate. Do you want a blanket embargo on hiring foreign trained physicians?

There are also some programs that for various reasons, American graduates don't apply to at all. Do you think that there would be an alternate way to fill those programs if there were no F/IMGs applying? Would American graduates apply to them if the residency slots continue to lag behind graduation rates?

 

[rokshana]

Listen, chum, the U.S. faces a physician shortage. The residency slots the U.S. taxpayers underwrite at a cost of approximately $225,000 per resident per year need to be set aside for Americans. In the next five years we may have more medical school graduates than residency slots. Would you like to tell American medical school graduates who can't match about your scheme?

Americans already subsidize the rest of the world through $30,000,000,000 per year for basic research. Americans on a per capita basis spend approximately 4 times as much as Canadians on basic research. We also pay much higher prices to pharmaceutical companies to cover the cost of applied research and clinical trials.

There was a recent thread on this board from a young Swede who wants to train here as a resident and go back to Sweden. Why should American taxpayers cover that cost? What does that do for us?

What do we get in return from other countries?

hey buddy…how do you think we got the reputation of having the best medical training?
and so if we "subsidize" so much research why is it that a prominent researcher has said that its better to go abroad since the US is no longer funding research as it did before (have you even tried to get money for research recently? its not that easy bub).

and it 125K, not 225k to train a resident these days….not sure where you got that number from…

and trust me….when the time comes that there is a 1:1 parity, qualified US grads will not go unmatched….and there are unqualified US citizens out there…they are not entitled to a spot just because of the happenstance of their birth...

 

[Attending1]

Listen, chum, the U.S. faces a physician shortage. The residency slots the U.S. taxpayers underwrite at a cost of approximately $225,000 per resident per year need to be set aside for Americans. In the next five years we may have more medical school graduates than residency slots. Would you like to tell American medical school graduates who can't match about your scheme?

Americans already subsidize the rest of the world through $30,000,000,000 per year for basic research. Americans on a per capita basis spend approximately 4 times as much as Canadians on basic research. We also pay much higher prices to pharmaceutical companies to cover the cost of applied research and clinical trials.

There was a recent thread on this board from a young Swede who wants to train here as a resident and go back to Sweden. Why should American taxpayers cover that cost? What does that do for us?

What do we get in return from other countries?

You say "Listen, chum, the U.S. faces a physician shortage"
You then contradict yourself by saying "In the next five years we may have more medical school graduates than residency slots."

You didn't understand the content of my post.

I said 70% of residency spots need to be reserved for AMGs, and the rest 30% need to be allocated on a "merit" basis irrespective of AMG/ IMG status. That should be fair.

Do you suggest a totally inbred system with 100% reservation in residency spots for AMGs ?

You talk about taxpayers and subsidies.
Well, you know what, medicine ain't just about bread & butter/ labour union stuff.
It ain't just about you getting a job either.

America is a free market and advocates a free market economy worldwide

Taxpayers are paying for the best care for themselves - be it from an AMG or from an IMG;

Those taxpayers want the best that they can buy, from wherever, for that 225000 - for an analogy, they'd prefer an American Corvette or an Imported Maserati - not a hyped up American Dodge Caravan

 

[Obnoxious Dad]

hey buddy…how do you think we got the reputation of having the best medical training?
and so if we "subsidize" so much research why is it that a prominent researcher has said that its better to go abroad since the US is no longer funding research as it did before (have you even tried to get money for research recently? its not that easy bub).

and it 125K, not 225k to train a resident these days….not sure where you got that number from…

and trust me….when the time comes that there is a 1:1 parity, qualified US grads will not go unmatched….and there are unqualified US citizens out there…they are not entitled to a spot just because of the happenstance of their birth...

The $125K figure is an understatement, usually made by financially incompetent physicians, because it simply divides all of the medical residents in the U.S. into a portion of federal funding and comes up with an erroneous dividend. The total funding, when these mistakes are made, ignores children's hospital GME, state financed GME and/or GME subsidized by insurance companies that have enough sense to understand that alleviating a shortage will drive physician wages to a lower level. Furthermore, even if the $125k figure was accurate that would mean that taxpayers are forking over at least $375,000 per board eligible residency graduate. Why should we do that for people from countries who spit at Americans?

The babbling of one researcher does not tell the whole story. U.S. citizens through the NIH alone pay approximately $30 billion per yer for basic medical science. This does not include all of the money Americans privately donate to charity for medical research.

Finally American medical schools merely scratch the surface of the American talent pool because adcoms are too lazy and stupid to normalize transcripts to account for the varying rigor of undergraduate colleges and majors. If you find the occasional dud among residents and students blame the adcoms not the country.

 

[Obnoxious Dad]

You say "Listen, chum, the U.S. faces a physician shortage"
You then contradict yourself by saying "In the next five years we may have more medical school graduates than residency slots."

You didn't understand the content of my post.

I said 70% of residency spots need to be reserved for AMGs, and the rest 30% need to be allocated on a "merit" basis irrespective of AMG/ IMG status. That should be fair.

Do you suggest a totally inbred system with 100% reservation in residency spots for AMGs ?

You talk about taxpayers and subsidies.
Well, you know what, medicine ain't just about bread & butter/ labour union stuff.
It ain't just about you getting a job either.

America is a free market and advocates a free market economy worldwide

Taxpayers are paying for the best care for themselves - be it from an AMG or from an IMG;

Those taxpayers want the best that they can buy, from wherever, for that 225000 - for an analogy, they'd prefer an American Corvette or an Imported Maserati - not a hyped up American Dodge Caravan

I have a law degree and two other graduate degrees. I understand your post perfectly. I've read dozens of posts like yours before. Let me be crystal clear: If there is one qualified American medical school graduate who can't match, we should not accept one foreign resident. I don't give a rat's kiester about inbreeding. We simply do not have the resources to finance graduate medical education for people who won't stay here. My wife works at a nationally renowned university hospital. Some foreign trainees stay and others leave. We can't afford to train foreigners who get home sick.

People from Europe, Africa, Asia, South America, and Canada don't help us with GME. We finance the lion's share of the world's basic medical research. We do enough for the world. Who's stepping up to find a vaccine and a cure for Ebola? Who else but the Yanks?

You think medicine isn't bread and butter stuff? According to the Center for Medicare and Medicaid Services in 2009 Americans spent $2.3 trillion on health care. That was approximately 17% of the US GDP.

I'm not a physician. My kid is and she has completed 40% of a great residency program and will graduate in 21 months. I'm not worried about a job for me or her. In fact, I'm arguing against her interests because training people here who will leave will just drive up her compensation and the price of care.

 

[DermViser]

In less than four years the number of US-trained medical students will be greater than the number of residency slots available. The question really boils down to whether an American medical student would rather be unemployed (and attempt to rematch) than accept a lower-tier residency. I bet the answer is yes, Americans would rather be unemployed. Of course the match gets more competitive each year so that might be a poor career decision.

And that's always another possibility I alluded to in last year's match thread... IMGs taking over the PD positions and simply not ranking AMGs no matter what their qualifications. Since apparently this is already the case, the number of US residency slots realistically available to US medical graduates will dry up even sooner than expected.

Seriously, if you're going to troll try harder.

 

[DermViser]

Right... so put them (us) in the boonies for 3 years and make em pay for it.

And once 3 years is done - then off they go never to come back again.

 

[thehundredthone]

Let me be crystal clear: If there is one qualified American medical school graduate who can't match, we should not accept one foreign resident.

Qualified, i.e. meeting minimum requirements or qualified as per the opinion of the program interviewing them?

And once 3 years is done - then off they go never to come back again.

From all the discussions it would seem that most American graduates don't even go there to begin with, so how does one address that problem? Right now IMGs taking what they can get seems to be a stop gap for these programs, and maybe the community in that region.

 

[DermViser]

From all the discussions it would seem that most American graduates don't even go there to begin with, so how does one address that problem? Right now IMGs taking what they can get seems to be a stop gap for these programs, and maybe the community in that region.

Let them be obligated to practice there for 10-20 years or for perpetuity.

 

[thehundredthone]

Let them be obligated to practice there for 10-20 years or for perpetuity.

And if it causes a lot them not to apply to those places any longer either/foreign medical graduates are no longer selected for residency training in the US?