Wondering what SDNers think of this?

[JelloBrain]

I just read this article published in the June issue of Journal of the American College of Surgeons: http://www.physorg.com/news197739311.html

It talks about poor patient access to quality surgical care due to declining number of IMGs practicing general surgery.

I would like to know what general surgery practitioners on SDN think about this. If AMGs are truly unable to fill the general surgery residency slots in terms of numbers, then why are IMGs held to higher standards in the match process and why do most places only offer preliminary positions to most IMGs?

I would like some insights and thoughts on the issues raised in this article please.

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[SocialistMD]

I would like to know what general surgery practitioners on SDN think about this. If AMGs are truly unable to fill the general surgery residency slots in terms of numbers, then why are IMGs held to higher standards in the match process and why do most places only offer preliminary positions to most IMGs?

As has been stated multiple times before on this topic in this forum and others on SDN, the quality of medical education from overseas medical schools is relatively unknown to program directors in the United States. Also, language and cultural barriers must be overcome, and programs are either (a) unwilling to deal with those problems or (b) set a higher academic standard so they know that while the IMG is acclimating to the system and culture in the United States, they have a knowledge reservoir on which to fall back so their overall performance won't suffer that much and patient care won't be as jeopardized.

 

[Dr.LeoSpaceman]

I just read this article published in the June issue of Journal of the American College of Surgeons: http://www.physorg.com/news197739311.html

It talks about poor patient access to quality surgical care due to declining number of IMGs practicing general surgery.

I would like to know what general surgery practitioners on SDN think about this. If AMGs are truly unable to fill the general surgery residency slots in terms of numbers, then why are IMGs held to higher standards in the match process and why do most places only offer preliminary positions to most IMGs?

I would like some insights and thoughts on the issues raised in this article please.

Well, the underlying point of the article is less about IMGs specifically and much more about the issue of a general surgeon shortage in general (which is addressed more broadly in a separate article in that issue). In that sense, your cause and effect statement is incorrect--access is being affected by the number of general surgeons, not the number of IMGs that become surgeons. The issue is where to find people to fill this demand, whether they be AMGs or IMGs. And, as SocialistMD says, the preference to fill that demand with AMGs, which is why the standards for IMGs aren't going to change.

 

[JackADeli]

I just read this article published in the June issue of Journal of the American College of Surgeons:

...If AMGs are truly unable to fill the general surgery residency slots in terms of numbers, then why are IMGs held to higher standards in the match process and why do most places only offer preliminary positions to most IMGs?...

I'm not sure your assertion is accurate, i.e. "higher standards". PDs have difficulty just comparing domestic MDs to DOs. IMG education systems are often vastly different. Numerous countries "fast track" education. The last two years of high school may be the first two years of college. Part of undergrad can be doing double duty as part of medical school, etc.... There have been numerous "medical schools" opened and closed abroad. There are plenty of ~"socialized" education systems that literally allow anyone into their school. It is not simply enough to hold up a diploma that says you are a doctor. As alluded to, it is not so much a higher standard as there are often limited comparative standards. Thus, for licensing and patient safety issues, programs look for minimum criteria to assure a minimum standard of basic medical education has been met prior to admitting someone to a residency.

On a positive note, there is recent evidence that this year more seniors are interested in general surgery; even so, this country remains dependent on a dwindling pool of IMGs...

I find this final line to be interesting. I don't view the overall tone of the article, especially with this closing remark to be suggesting it is a good thing to be "dependent" on IMG. I read the article as being supportive of increasing domestic grads entry into surgery residency.

 

[Winged Scapula]

Has it ever occured to any of *them* that there is a reason why US students don't want to go into surgery?

How about they get off their arses and work to increase the reimbursement for general surgery, reduce the work hours, have loan repayment programs, etc. and make the field more attractive? Plenty of students love the OR and surgery. Plenty of students love general surgery and want to have a broad based practice. But the *practice* of general surgery is nowhere near as financially, physically and psychologically sound as other fields or surgical subspecialties.

The general surgery shortage will continue as long as students realize they are going to work hard and not be financially compensated for it.

 

[JackADeli]

Has it ever occured to any of *them* that there is a reason why US students don't want to go into surgery?

How about they get off their arses and work to increase the reimbursement for general surgery, reduce the work hours, have loan repayment programs, etc. and make the field more attractive? Plenty of students love the OR and surgery. Plenty of students love general surgery and want to have a broad based practice. But the *practice* of general surgery is nowhere near as financially, physically and psychologically sound as other fields or surgical subspecialties.

The general surgery shortage will continue as long as students realize they are going to work hard and not be financially compensated for it.

Must agree with that assessment

 

[JelloBrain]

I agree with WS's statement in terms of reimbursement-who wouldn't want to be paid based on what you contribute to society?

However I might be one of the few crazy ones who would rather work longer hours and get "done" sooner based on how quickly one progresses with their surgical learning and overall training, than plod through 60-80 hours a week for long term! I, however, don't want to devote these longer hours to scut/paperwork, rather to developing surgical skills and patient management in terms of decision making.

JAD-the main reason I posted this article was due to the fact that I could not gauge the article's direction either. One the one hand it seemed to state USA needs more IMGs in general surgery, on the other hand general surgery has become more "desirable" to AMGs, hence quite competitive. On top of it, the bar is set higher for us than AMGs for a variety of reasons, not all having to do with verifying our medical education or lack thereof. Once an IMG has successfully jumped through all the ECFMG licensing/certifying hoops, they should be given a fair chance to be judged based on their overall application.

You never know what hidden gems of IMGs you might then find,

 

[opr8n]

I didnt read the article, but let me add a little personal commentary
In med school and residency I have had the opportunity to work with many IMGs.

I can say the skills and knowledge base are vastly varying with most not being very competative against AMGs, though there are some diamonds in the rough.

The language and culture barrier is huge. Communication is a big downfall. But hey, im not saying I would be any good in their country though.

I have seen IMGs applying to residency trying to pass step 1&2 trying 3, 4, 5, ect times and not passing

From my observations and looking at this years amtch numbers, it appears there are always a growing number of IMGs applying for surgery and the rate of eacceptance is much lower than for AMGs but as more AMGs dont go into the field, the slots will have to be filled by IMGs.

(deep thought) ... hmmm

 

[ESU_MD]

Once an IMG has successfully jumped through all the ECFMG licensing/certifying hoops, they should be given a fair chance to be judged based on their overall application.

For the most part, an IMG DOES have a chance to apply to programs via ERAS just like everyone elese.

The issue that not many will say is that surgery, at least at the program director level, still has an "old boys club" feel. If you dont fit the mold, they aint gonna interview you, or if they do its just a waste of your time/money.

As an img, you have to know someone, have a good mentor who knows someone AT the program you want to join, and/or be lucky.

having a comprehensive speaking knowledge of sports, especially regional collegiate sports helps too. nobody really cares about the usmle or what you did in some lab. the only person who ever remembers your usmle score is the program secretarial assistant who screens the applications.
Having knowledge of at least one form of gambling (poker, blackjack, etc..) helps too.

 

[JelloBrain]

ESU_MD-You have given me food for thought. Hmm.... I am against gambling in principle, , however I guess I could learn the theory behind some of them. And brush up on American sports.

I do agree about surgery being an old boys' club-that's the same everywhere, whichever continent you are on-something I have gotten used to.

Luck is everything in this game.