# of FMG/IMG in a residency program

[sam1999]

What are the pros or cons of having FMG/IMG in a residency program? Is it good or bad or cultural issues?

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[sam1999]

What about DO? I have seen DO and FMG goes hand in hand. Programs where you don't see FMG, there will be no DO as well.

Is there any threshold above which one should be cautious? e.g. If more than half are FMG, is it considered bad?


Reason for asking this question is: If you see lots of FMGs, is it because program wants lots of trained doctors esp. if program does not have lots of teaching faculty etc or program's first choice is still US grads but it has difficulty finding US graduates so they have to fill it FMGs. I have seen few programs where you see just one or 2 US grads in all 3 internal medicine years.

 

[sam1999]

I can't find a single US grad here, not even DO.


http://www.rochestergeneral.org/roc...nternal-medicine-residency/current-residents/

 

[mig26x]

I can't find a single US grad here, not even DO.


http://www.rochestergeneral.org/roc...nternal-medicine-residency/current-residents/

there's one. From Ponce school of medicine in Puerto Rico. Puerto Rico schools are LCME schools.

 

[bjackrian]

I can't find a single US grad here, not even DO.


http://www.rochestergeneral.org/roc...nternal-medicine-residency/current-residents/

Also one from Western U of Health Sciences which is an accredited DO school in California.

 

[Winged Scapula]

I can't find a single US grad here, not even DO.


http://www.rochestergeneral.org/roc...nternal-medicine-residency/current-residents/

Fascinating list. Such cultural and ethnic diversity.

 

[sam1999]

FMG's can provide significant amount to a program. Often times, they have trained in their country of origin and were attendings before coming over so they can come with a large knowledge base. They sometimes struggle with the culture change but from my experience adapt fairly quickly over a few months. FMG's tend to be seen as a sign that a program is lower tier for US med graduates but this is not always the case.

IMG's on the other hand are often U.S born who couldn't get into medical school in the United States so they went to the Caribbean or elsewhere. They don't add much value to a program in the way FMG's can with their previous experience and a program with a significant number of them usually speaks to a lower ranked program.

Lets say someone born outside of USA and did go to medical school outside of USA so they are FMG. But he/she came to USA got GC/Citizenship, lived here long time now would he be IMG? Does it really matters if someone is IMG/FMG in the residency application?

 

[gutonc]

FMG = Foreign born person who went to med school (usually) in their home country. Regardless of citizenship status. They tend to have some amount of clinical experience (ranging from a year of internship to 15-20 years practicing in their home country).

IMG = US citizen who goes overseas to go to med school (usually Carib but can be Mexico, Europe, Middle East or the Indian subcontinent) for whatever reason.

Different programs may have different biases against the 2 groups. Some places will not interview anyone who did not go to med school in the US/Canada. Others will interview FMGs but not IMGs and still others don't care where you went to school. I can speak only for my IM residency program in that they don't interview IMGs and have 1-2 FMGs per class (out of 30-35 interns), usually from big name places.

 

[EXPD]

It is difficult to judge the quality of a residency program based on the origin of the residents in that program. In general program directors try to get the best residents they can. There are many factors that go into evaluating the resident applicants to figure out who is the best for that program. International graduates/foreign medical graduates (used interchangeably and refer to the same group of people) may be the most qualified candidates. Over the last several years international applicants increasingly have scores of 99/99 and have a few years postgrad experience and an MPH. Having done the MPH in the US they have had time to adapt to the culture and develop fluency with the language. As a former program director I would much rather have that applicant than take a borderline US graduate with an attitude just because he/she went to a US medical school.

Osteopathic training is viewed differently in different parts of the country. Where I grew up in the East only those who couldn't go to allopathic schools went to osteopathic schools. In the Midwest applicants frequently turn down allopathic positions to accept an osteopathic position. My experience has been that on average the osteopathic pool is a little weaker than the allopathic pool. Having said that there are many osteopathic residents who are among the best residents we have ever had. When they are good, they can be very good.

So we take these IMG and DO candidates in addition to our US allopathic grads and probably have among the best residents in the country. In spite of this, an absolutely solid program with no citations from the RRC and outstanding hospitals that year after year have been recognized nationally as being among the highest quality in the country, we continue to have problems recruiting qualified US students. I believe this is in part because US students use the presence of IMGs as markers of "second tier" programs. I have no doubt that our program trains residents far better and more humanely than some more famous university programs but they have the fame, the football team, NIH grants etc and their program is filled with US grads. The command from their administration is that they are not allowed to interview IMG's or so I am told. Residents at some of these places are overworked and have egregious work hour violations which they tell me about verbally but turn in nice clean written reports for the ACGME to review. All the while they are thinking they must be in some great residency program, after all it is full of US grads and it was tough to get into. Maybe that has served the big university programs well because apparently students still think the presence of IMG's has something to do with quality and maybe in accepting internationals and osteopaths we have eliminated half of our applicant pool simply by considering the other half. I still have to have faith that US students will come to recognize that programs whose the primary objective is to recruit the best and help the resident become the best doctor they can be are really the places to train. I could be wrong.

 

[sam1999]

It is difficult to judge the quality of a residency program based on the origin of the residents in that program. In general program directors try to get the best residents they can. There are many factors that go into evaluating the resident applicants to figure out who is the best for that program. International graduates/foreign medical graduates (used interchangeably and refer to the same group of people) may be the most qualified candidates. Over the last several years international applicants increasingly have scores of 99/99 and have a few years postgrad experience and an MPH. Having done the MPH in the US they have had time to adapt to the culture and develop fluency with the language. As a former program director I would much rather have that applicant than take a borderline US graduate with an attitude just because he/she went to a US medical school.

Osteopathic training is viewed differently in different parts of the country. Where I grew up in the East only those who couldn't go to allopathic schools went to osteopathic schools. In the Midwest applicants frequently turn down allopathic positions to accept an osteopathic position. My experience has been that on average the osteopathic pool is a little weaker than the allopathic pool. Having said that there are many osteopathic residents who are among the best residents we have ever had. When they are good, they can be very good.

So we take these IMG and DO candidates in addition to our US allopathic grads and probably have among the best residents in the country. In spite of this, an absolutely solid program with no citations from the RRC and outstanding hospitals that year after year have been recognized nationally as being among the highest quality in the country, we continue to have problems recruiting qualified US students. I believe this is in part because US students use the presence of IMGs as markers of "second tier" programs. I have no doubt that our program trains residents far better and more humanely than the more famous university program an hour down the interstate from us but they have the fame, the football team, NIH grants etc and their program is filled with US grads. The command from their administration is that they are not allowed to interview IMG's or so I am told. Residents at the U are overworked and have egregious work hour violations which they tell me about verbally but turn in nice clean written reports for the ACGME. All the while they are thinking they must be in some great residency program, after all it is full of US grads. Maybe that has served the big U well because apparently students still think the presence of IMG's has something to do with quality and maybe we have eliminated half of our applicant pool simply by considering the other half. I still have to have faith that US students will come to recognize that programs whose the primary objective is to recruit the best and help the resident become the best doctor they can be are really the places to train. I could be wrong.

Thanks EXPD for a detailed reply and very nice explanation.

How do you view FMGs who have done reserach, first author publications at US institution with Phd/MPH degrees vs FMG with post graduation in clinical work in their home countries? Any preferences or bias etc.

I guess some number of FMGs should not be a problem even top gun IVY league schools have FMGs. My concern was when almost all of them are FMG/IMGs/DO as in the above mentioned example. I have seen several hospital (those who choose to mention their residents and their origin on their websites) with such examples. By looking at website I can't tell what kind of experience these FMGs have?


Does central administration play a role in selection of residents? I thought it was primarily up to program director to be a central player in selection of house staff.

 

[mdthisyear]

Thanks for the observations, expd.

Some of the IMGs are the best in their countries of origin. A program that takes them actually benefits from having them, I guess.