Stigma Associated W/Foreign Medical School

[Roy7]

Hi, I was looking into foreign medical schools and was wondering what people have heard about IMG's experiences after graduation?

Did they face and open predjudice because of their attending a foreign medical school? Did it matter at all once they began practicing? Was there any stigma associated with having attended a foreign medical school later on in life?

Thanks.

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[Miklos]

Hi, I was looking into foreign medical schools and was wondering what people have heard about IMG's experiences after graduation?

Did they face and open predjudice because of their attending a foreign medical school? Did it matter at all once they began practicing? Was there any stigma associated with having attended a foreign medical school later on in life?

Thanks.

My opinion is that IMGs (whether true foreign grads or USIMGs) are simply viewed as undesired competition for US grads.

As a result, all kinds of barriers exist for IMGs.

Briefly, off the top of my head, these include:

• Entirely different (read: more difficult and complex) rules for licensure, which are set by individual state boards (e.g. most states require an additional year of postgraduate training for IMGs versus US grads-who can often gain licensure after their first postgraduate year)
• Foreign medical school diplomas are not universally accepted, unlike those by US schools (e.g. California)
• Access to U.S. clinical rotations can be problematic, especially outside foreign programs that aren't established in the U.S. This is key, because this is where IMGs have a chance to prove themselves and receive LoRs. (e.g. Many US med schools do not allow foreign students to do clinical rotations at their university hospitals.)
• Residency programs often overtly or covertly discriminate against IMGs, by putting up IMG barriers (e.g. require an ECFMG certificate prior to applying, while US students need only USMLE Step 1)

I'm sure that others will add their thoughts.

Miklos

 

[retroviridae]

Hi, I was looking into foreign medical schools and was wondering what people have heard about IMG's experiences after graduation?

Did they face and open predjudice because of their attending a foreign medical school? Did it matter at all once they began practicing? Was there any stigma associated with having attended a foreign medical school later on in life?

Thanks.

prejudice? yep. you limit yourself to residencies which US students don't want (ie the lower paying ones). Even after doing residency, you will almost always lose out to US grads when applying for Fellowships. lots of nasty comments about your abilities, even when you score much higher than the American competition.

once in private practice, nope. Doesn't really matter. Many many IMGs do very well in practice.

Stigma later in life only matters if you are say, running for office in a national medical association, or trying become chief of staff.

The fact is that the majority of IMGs enter IM FP or Peds, so there are predictions that we will be the majority of docs in these professions before too long. Some of those stigma may end then.

 

[lobelsteve]

prejudice? yep. you limit yourself to residencies which US students don't want (ie the lower paying ones). Even after doing residency, you will almost always lose out to US grads when applying for Fellowships. lots of nasty comments about your abilities, even when you score much higher than the American competition.

once in private practice, nope. Doesn't really matter. Many many IMGs do very well in practice.

Stigma later in life only matters if you are say, running for office in a national medical association, or trying become chief of staff.

The fact is that the majority of IMGs enter IM FP or Peds, so there are predictions that we will be the majority of docs in these professions before too long. Some of those stigma may end then.

Agreed.


SGU grad from 2000.
UVA for IM intership
EVMS (Norfolk VA) for PM&R residency
Emory University for Pain fellowship

Start private practice in 1 month-

All worth it. I found myself heads above most of the US MS3's and 4's in clinical rotations (NJ/NY/MD) and I had a great time all the way. I would have changed only 1 thing- less beer that one night at Colin and Sue's in 1997 as I may have had a subclinical alcoholic hepatitis- better now though.

 

[Miklos]

prejudice? yep. you limit yourself to residencies which US students don't want (ie the lower paying ones). Even after doing residency, you will almost always lose out to US grads when applying for Fellowships. lots of nasty comments about your abilities, even when you score much higher than the American competition.

once in private practice, nope. Doesn't really matter. Many many IMGs do very well in practice.

Stigma later in life only matters if you are say, running for office in a national medical association, or trying become chief of staff.

The fact is that the majority of IMGs enter IM FP or Peds, so there are predictions that we will be the majority of docs in these professions before too long. Some of those stigma may end then.

Good point, I left that out in my original reply.

So, you want to know how many IMGs make it into which specialties?

The AMA, thankfully, gives us a free insight.

The following was compiled from http://www.ama-assn.org/vapp/freida/spcindx/0,,TR,00.html the FREIDA Online Specialty Training Search.

Look at the percentage of IMGs in that field for a rough measure of competitiveness. Very roughly 25% of US physician residents are IMGs. If the value in a given field is greater than 25%, it is "relatively" less difficult to obtain. If it is less than 25%, it is more competitive.

I've done the work below for the following residencies.

• ENT 1.9%
• Ortho 2.0%
• Derm 3.6%
• EM 4.4%
• Urology 5.1%
• Plastics 5.8%
• Ophth. 6.9%
• Rad-Onc 8.0%
• Neurosurg 9.1%
• Transition 9.2%
• Rad-Diag 9.8%
• Ob/Gyn 21.0%
• Surg 21.5%
• Anesth. 26.7%
• Peds 29.5%
• FP 33.5%
• PM&R 34.90%
• Neuro 38.0%
• Psych 42.0%
• IM 48.9%

 

[Skip Intro]

Look at the percentage of IMGs in that field for a rough measure of competitiveness. Very roughly 25% of US physician residents are IMGs. If the value in a given field is greater than 25%, it is "relatively" less difficult to obtain. If it is less than 25%, it is more competitive.

Are your numbers for EM correct? I'm not aware that it's THAT competitive, based on your assessment. You can also look at the ranks/position ratio available on the NRMP website for each specialty. This looks at the number of individual ranks put into the Match for each position gained. For example, anesthesiology had a higher ranks/position ratio than EM this year, but far lower than the other specialties you list as "competitive" in your survey.

Also, I slightly disagree with retroviridae about IMGs taking positions that U.S. grads necessarily don't want. Many (if not most) of us, meaning U.S. citizens who went to foreign schools (myself included), will be in residency programs where the majority of fellow residents will be U.S. MD or osteo grads. (This may be different if you are a true IMG who needs a J-1, H-1b, or green card.) Some of us will even get very competitive spots (e.g., a Ross grad this year matched at Duke for EM) that I'm sure many U.S. grads would like to have.

-Skip

 

[RAD11]

....Entirely different (read: more difficult and complex) rules for licensure, which are set by individual state boards (e.g. most states require an additional year of postgraduate training for IMGs versus US grads-who can often gain licensure after their first postgraduate year)....
Miklos

Is this also true for Caribbean graduates (i.e. SGU or Ross) where students are able to do their clinical rotations (3rd and 4th year) back in the US?

 

[Skip Intro]

Is this also true for Caribbean graduates (i.e. SGU or Ross) where students are able to do their clinical rotations (3rd and 4th year) back in the US?

The short answer is "yes". An IMG is an IMG, whether or not you are a U.S. citizen.

-Skip

 

[RAD11]

The short answer is "yes". An IMG is an IMG, whether or not you are a U.S. citizen.

-Skip

Can you please tell me where I can find information regarding state licensures? I'm interested in applying to both SGU and Ross for 2006. Thanks!

-RAD

 

[Skip Intro]

Can you please tell me where I can find information regarding state licensures? I'm interested in applying to both SGU and Ross for 2006. Thanks!

-RAD

Ahhh... there's the rub. Unfortunately, this is not conveniently accessible anywhere. You have to look at the individual licensing requirements of each state separately (uggghh!!!! ).

The best place to start is the FSMB website, with the links to each licensure board.

http://www.fsmb.org/statehome.htm

Go to the "State Medical Board Info" link.

Typically, it's well understood that the most difficult states (i.e., the ones that have the most hoops to jump through) are Pennsylvania, California, Illinois, Texas, and Florida. Doesn't mean that you can't get a license there. Just means you have to do a lot of extra paperwork and, in most cases, make sure you do the correct clinical rotations at accredited programs so you get credit.

-Skip

 

[Miklos]

Are your numbers for EM correct? I'm not aware that it's THAT competitive, based on your assessment. You can also look at the ranks/position ratio available on the NRMP website for each specialty. This looks at the number of individual ranks put into the Match for each position gained. For example, anesthesiology had a higher ranks/position ratio than EM this year, but far lower than the other specialties you list as "competitive" in your survey.

The FREIDA info is a lagging indicator, based on 2003 data.

For EM: http://www.ama-assn.org/vapp/freida/spcstsc/0,1238,110,00.html

It lists 4.4% IMG residents.

The NRMP match data lists a 80% US seniors fill rate for the PGY1 programs last match (down from 82.4% in 2001) and a 83.3% US seniors fill rate for PGY2 programs.

The other explanation may well have to do with the fact that independent applicants (IMGs, DOs, Fifth Pathway, Canadians and Past US grads) account for the remainder who matched. As we don't have the breakdown, this means that we can't separate DOs and past US grads from IMGs. I suspect that EM is a popular choice for both DOs and past US grads looking for a career change.

 

[Miklos]

Ahhh... there's the rub. Unfortunately, this is not conveniently accessible anywhere. You have to look at the individual licensing requirements of each state separately (uggghh!!!! ).

The best place to start is the FSMB website, with the links to each licensure board.

http://www.fsmb.org/statehome.htm

Go to the "State Medical Board Info" link.

Typically, it's well understood that the most difficult states (i.e., the ones that have the most hoops to jump through) are Pennsylvania, California, Illinois, Texas, and Florida. Doesn't mean that you can't get a license there. Just means you have to do a lot of extra paperwork and, in most cases, make sure you do the correct clinical rotations at accredited programs so you get credit.

-Skip

Add New York for residency positions, unless you attended a New York approved school (see the Form 2CC listings). If one does more than 12 weeks of clinical rotations outside the home country of the medical school and the school is NOT approved, one is ineligible for residency, but potentially eligible for licensure.

 

[tkim]

Are your numbers for EM correct? I'm not aware that it's THAT competitive, based on your assessment. You can also look at the ranks/position ratio available on the NRMP website for each specialty. This looks at the number of individual ranks put into the Match for each position gained. For example, anesthesiology had a higher ranks/position ratio than EM this year, but far lower than the other specialties you list as "competitive" in your survey.

I've heard/read that EM was particularly competitive this year, with 4%-5% (~20) unfilled slots, of which about half were at Drew/King. If you've been following the controversy about Drew/King, it's been steadily losing accreditation of its various residencies. So, arguably the unfilled rate is really 2-3%.

 

[RAD11]

Ahhh... there's the rub. Unfortunately, this is not conveniently accessible anywhere. You have to look at the individual licensing requirements of each state separately (uggghh!!!! ).

The best place to start is the FSMB website, with the links to each licensure board.

http://www.fsmb.org/statehome.htm

Go to the "State Medical Board Info" link.

Typically, it's well understood that the most difficult states (i.e., the ones that have the most hoops to jump through) are Pennsylvania, California, Illinois, Texas, and Florida. Doesn't mean that you can't get a license there. Just means you have to do a lot of extra paperwork and, in most cases, make sure you do the correct clinical rotations at accredited programs so you get credit.

-Skip

Hey Skip,

Thanks for the link. I guess I'm gonna have fun searching !

 

[Miklos]

Hey Skip,

Thanks for the link. I guess I'm gonna have fun searching !

Here's a couple for free...

• New York
• California
• Texas

 

[retroviridae]

Also, I slightly disagree with retroviridae about IMGs taking positions that U.S. grads necessarily don't want.

true, i am generalizing

 

[Skip Intro]

The other explanation may well have to do with the fact that independent applicants (IMGs, DOs, Fifth Pathway, Canadians and Past US grads) account for the remainder who matched. As we don't have the breakdown, this means that we can't separate DOs and past US grads from IMGs. I suspect that EM is a popular choice for both DOs and past US grads looking for a career change.

Agreed. Good point. A limitation of the way the data is presented. However, one might be able to search for articles put out by the individual academies that might break this down. They perhaps have greater access to such data. For example, I know I was one of the 58 U.S. IMGs who got an anesthesiology spot this year:

http://www.asahq.org/Newsletters/2005/05-05/grogono05_05.html

-Skip

 

[Miklos]

Agreed. Good point. A limitation of the way the data is presented. However, one might be able to search for articles put out by the individual academies that might break this down. They perhaps have greater access to such data. For example, I know I was one of the 58 U.S. IMGs who got an anesthesiology spot this year:

http://www.asahq.org/Newsletters/2005/05-05/grogono05_05.html

-Skip

Good point. In Table 3 of the link, it lists 'sponsored graduates'.

Do you know what this means?

 

[Skip Intro]

Good point. In Table 3 of the link, it lists 'sponsored graduates'.

Do you know what this means?

I'm not really sure, but perhaps it has something to do with the military appointments?

-Skip

 

[whuds]

If you go IMG you may not get the residency in the place you want, you may not be able to practice in some states at first or ever, you may not get into the specialty you want. On the bright side if you want to be an MD and this is the only way then you settle for some of the roadblocks. Things are changing and we never know whats next so it may get better. I really want to practice as an FP or IM so that shouldn't be too hard to do as an IMG. I do not expect the best residency but a decent one. A lot of Docs I've known (I'm from GA) were IMGs and they did well.

 

[Skip Intro]

If you go IMG you may not get the residency in the place you want, you may not be able to practice in some states at first or ever, you may not get into the specialty you want.

While this is probably inherently true if you have your sights set very high, I can speak the strongest on this point from my own personally experience. After deciding on and applying for anesthesiology, I was offered a relatively large (and surprising) number of interviews from a variety of programs and ended-up matching at my #2 choice (out of fifteen ranks). It was never my intention to go to a Harvard or Hopkins type program, so I was far from disappointed (and actually, quite the opposite, ecstatic to get interviews where I did and would've been equally happy at any of my top four choices).

So, it all depends on what you want, within reason, when you enter the interview/match process. Sure, you're going to get your shot perhaps at programs that traditionally may not look at you first or give you a spot over a U.S. grad unless you are beyond stellar and stand out way above the crowd. There are a few of these in each Carib class, but they clearly aren't the norm.

However, at least on paper I was far from a stand out myself and I did quite well. And, once you complete your residency and get out in the real world, it's all up to you (for the most part) anyway. You get into a decent residency at a good program and excel, this will open doors and ladders to "climb" farther away from your Carib education roots. Some people have done quite well in residency and fellowship placements.

On the bright side if you want to be an MD and this is the only way then you settle for some of the roadblocks. Things are changing and we never know whats next so it may get better. I really want to practice as an FP or IM so that shouldn't be too hard to do as an IMG. I do not expect the best residency but a decent one. A lot of Docs I've known (I'm from GA) were IMGs and they did well.

It may get better indeed. I was pretty blown away by what's published on Ross' match list this year. Very pleasantly surprised. Still, if you want IM or FP, it's not going to matter TOO much where you go to medical school overall provided you don't have other issues (e.g., visa problems, failing board scores, major setbacks in school, etc.). Those fields are and will continue to be fairly wide open, FP more so than IM.

Good luck whatever you decided.

-Skip

 

[Miklos]

Skip,

What I find interesting about the table for the Anes. match results is the following:

2005 results

914 US Seniors
124 DOs
58 USIMGs
83 true FMGs
45 sponsored grads (still don't know what this means)
1 5th Pathway
3 Canadians
0 Past US grads

DOs appear to be outcompeting IMGs (combined US citizen and non-citizens), considering that there were only something on the order of 1,524 "active" (minus no ranking and withdrawals) applicants in the 2005 NRMP match. Compare this with 2,091 USIMGs and 5,554 true FMG "active" applicants.

Comments, anyone?

Miklos

 

[Skip Intro]

Comments, anyone?

I'm not sure how you're coming up with your numbers. I can only respond anecdotally with people I know at Ross who applied for gas this year. Out of about 30 (give or take a few) people I know personally who went for gas, 23-24 of us got spots. I personally know most of the people who got spots and can go down the list on the Ross website and put names with each program listed. There were a few who were pre-matched at various places. But, I still know a few who didn't get a spot and are going to re-try next year. In that regard, I'm pretty certain that Ross placed the more of those 58 U.S. IMGs referenced on that list into Gas residencies than any other school this year. But, we also have the most students. Likewise, there are 3-4 people who got Gas spots who aren't on that list (pre-match, post-match). I could also pretty much guarantee you that the rest of those U.S. IMG spots were made up of SGU and AUC students.

I don't know how this shakes out in the grand scheme of things, but school certainly matters. So, I'm not sure what kind of firm conclusions you can draw. Out of the graduating pool of students between the "big three", there are probably around roughly 1,200 students who were vying for spots across all specialties this year, Ross being the largest at 450+.

There are 19 osteopathic schools with a total enrollment of 11,432 students, the largest two being NYCOM and PCOM with over 1,000 students each. There are now about 2,700 osteopathic graduates per year.

Putting all other off-shore, international schools aside and comparing just the "big three" to osteopathic schools in the U.S., you can come up with a rough ratio based on my assumptions above. If you look at the placement ratio of osteopathic graduates into anesthesiology residencies, 124, over the rough number of graduates this year, 2700, you get a placement ratio of 4.5% into anesthesiology residencies. Taking the big three, let's say 45 of the 58 spots (which is probably pretty close to what actually happened), over the roughly 1200 graduates of the three schools, you come up with a placement ratio of 3.75%.

Using the overall numbers, you get 58/2,091 - or a placement ratio of 2.8% for all IMGs. And, you get 83/5,554 for 'true' IMGs - or a placement ratio of 1.5% for anesthesiology. Of course, this assumes a lot of things - namely that the same proportions of the applicant pool actually applied for anesthesiology. Who knows? We don't have a good way to collect the actual number of applicants for the field. Therefore, any investigation into this (at least at our level and access to the raw data) may be meaningless anyway.

However, it would superficially appear that there may be a slight advantage in going to an osteopathic school. I know for a fact that there are certain programs (Northwestern comes to mind) that won't even look at Caribbean applicants, but accept many DO's. So, I'm sure that plays in their favor as well.

This is, of course, based on a lot of assumptions - some of which may be incorrect. But, overall, I'd say that compartively you have a pretty good shot of getting anesthesiology if you are a solid applicant from a well-known Carib school, but may have a slight advantage if you stay in the U.S. and go to an osteopathy school.

Just my $0.02.

-Skip

 

[Miklos]

I'm not sure how you're coming up with your numbers.

The NRMP match data and the ASA Newsletter.

So, I'm not sure what kind of firm conclusions you can draw...but may have a slight advantage if you stay in the U.S. and go to an osteopathy school.

Neither am I. As DO schools are mushrooming and expanding like crazy, might this be a bellwehter for IMGs?

Thanks for your comments.

 

[Skip Intro]

As DO schools are mushrooming and expanding like crazy, might this be a bellwehter for IMGs?

Well, my general feeling that I've stated before on this forum (and it's just an opinion) is that there's going to continue to be a shake out in the "off-shore" route. So far, it appears that there are more and more schools, both DO and Caribbean, trying to "cash in" on the now-predicted huge shortage of doctors by the year 2020. There is a looming healthcare crisis as the baby-boomers continue to age, and I think both the primary care and peri-surgical fields are going to continue to rapidly grow, both at the physician and mid-level practitioner levels.

How this plays out for IMGs? Not sure. At the current rates, it's going to be hard to make up the 200,000 predicted physician deficit even given the expanding classes at osteopathy and allopathy schools in the U.S.

The most important thing to remember is that the individual is paramount. There are many "diamonds in the rough" out there who go through alternative routes to become a physician. The cream will still rise, even if it is at an offshore school. Likewise, many very highly qualified foreign doctors who want to come to the U.S. and can find a spot will always be welcome. Even today, about 25% of all practicing physicians in the U.S. are foreign-trained. I seriously doubt that this number will decrease substantially, and even if it does (say down to 20%, which would be a substantial decrease), there will still be a need for foreign-trained doctors.

What will happen in the short run is that the fly-by-night Caribbean schools will still spring up like mushrooms after a summer rain, and will almost as quickly go out of business either by not getting enough students to attend and/or the inability to secure licensure for their graduates. The long-running and well-established schools will remain, but they may get more selective. Conversely, they may have to get less selective as well if the number of U.S. spots continues to increase and the osteopathic and allopathic fields further merge philosophically with the distinctions becoming irrelevant.

Personally, I still like the French medical education model the best, with some clearly needed modifications and improvements, and I wish that we'd adopt a similar system here. It is the most equitable, and would select overall the most capable students - not just the ones with the highest GPAs and MCAT scores. Likewise, it is much easier to adjust the numbers on a rolling basis using this system. However, it is FAR more competitive and cutthroat even than the current U.S. system. Still, everyone who wants to become a doctor gets a chance to do so in their own country and is not forced to take seemingly spurious loophole routes to pursuing their dreams.

In contrast, the Dutch system is the worst. We should be at least be grateful we don't have that kind of system here.

-Skip

 

[Miklos]

Well, my general feeling that I've stated before on this forum (and it's just an opinion) is that there's going to continue to be a shake out in the "off-shore" route. So far, it appears that there are more and more schools, both DO and Caribbean, trying to "cash in" on the now-predicted huge shortage of doctors by the year 2020. There is a looming healthcare crisis as the baby-boomers continue to age, and I think both the primary care and peri-surgical fields are going to continue to rapidly grow, both at the physician and mid-level practitioner levels.

How this plays out for IMGs? Not sure. At the current rates, it's going to be hard to make up the 200,000 predicted physician deficit even given the expanding classes at osteopathy and allopathy schools in the U.S.

The most important thing to remember is that the individual is paramount. There are many "diamonds in the rough" out there who go through alternative routes to become a physician. The cream will still rise, even if it is at an offshore school. Likewise, many very highly qualified foreign doctors who want to come to the U.S. and can find a spot will always be welcome. Even today, about 25% of all practicing physicians in the U.S. are foreign-trained. I seriously doubt that this number will decrease substantially, and even if it does (say down to 20%, which would be a substantial decrease), there will still be a need for foreign-trained doctors.

What will happen in the short run is that the fly-by-night Caribbean schools will still spring up like mushrooms after a summer rain, and will almost as quickly go out of business either by not getting enough students to attend and/or the inability to secure licensure for their graduates. The long-running and well-established schools will remain, but they may get more selective. Conversely, they may have to get less selective as well if the number of U.S. spots continues to increase and the osteopathic and allopathic fields further merge philosophically with the distinctions becoming irrelevant.

All good points.

Personally, I still like the French medical education model the best, with some clearly needed modifications and improvements, and I wish that we'd adopt a similar system here. It is the most equitable, and would select overall the most capable students - not just the ones with the highest GPAs and MCAT scores. Likewise, it is much easier to adjust the numbers on a rolling basis using this system. However, it is FAR more competitive and cutthroat even than the current U.S. system. Still, everyone who wants to become a doctor gets a chance to do so in their own country and is not forced to take seemingly spurious loophole routes to pursuing their dreams.

In contrast, the Dutch system is the worst. We should be at least be grateful we don't have that kind of system here.

-Skip

However, unlike you, I'm not a fan of the French system. (It is not too different from the Hungarian one, except that there is no one formal exam at the end of the first year. Also, admission initially is competitive; nevertheless attrition rates are around 50%.)

 

[Skip Intro]

However, unlike you, I'm not a fan of the French system. (It is not too different from the Hungarian one, except that there is no one formal exam at the end of the first year. Also, admission initially is competitive; nevertheless attrition rates are around 50%.)

Well, the French system clearly has many problems, but I like the fact that everyone who wants to be a doctor has equal access to the opportunity to study medicine (or at least begin to study medicine) in their own country, provided they meet the minimum admission requirements.

What I envision as being most equitable and likely to pick the best candidates is a modified French system in the U.S. would be something like this:

• Following admission to college, the candidate would start on an approved two-year standardized medicine track. This would be open to everyone wanting to go into medicine, and colleges would not have to (necessarily) restrict the number of students going into this pre-med/med track. It would include the basics (biology, chemistry, math, english, organic, etc.).
• Next, there'd be an "admission test" at the end of those two years, and the student would be admitted depending on the score in the test. Based on the score, they'd be "assigned" to one of the medical schools in the U.S. You could probably develop a system that would give regional preference. Students not gaining and admission would be further stratified, and offered the choice whether to continue on in "regular" undergrad and finish with a four-year degree, or to remediate for a year if they achieved at least a set minimum score and re-take the test again a year later. If they then failed to get an admitting score, they could finish undergrad, pursue other options, etc.
• For those who pass the test and get a spot, the next two years would be spent studying the pre-clinical medical school curriculum. At the end of those two years, you'd offer Step 1 and students would then move onto a clinical track that would prepare them for a particular specialty that they had their mind set on.
• At the end of six years, they'd graduate with an M.D. degree and go onto to residency based on the track that they'd been on.

Why this system would be most equitable is that it would completely level the playing field. In essence, you'd start out in undergrad at an "approved" 2-year premedical curriculum program that guarantees that you will get into medical school if you pass the test. There'd really be no downside because, at the end of those two years if you bombed, you could still go on to finish your undergrad degree. One problem might be that, in essence, you'd have to meet the requirements for an admission into this program up front at the beginning of college. This may be disadvantageous for those who decide later to go to medical school (like myself), but they could always apply into this two-year program later (just like doing a post-bacc). So, overall, it would just necessitate that 18-year-olds already know that they want to be a doctor. Personally, I think more students would apply to such programs giving medicine a "shot" earlier in their life, especially if some approved programs had open admissions. Of course, you'd still have to pass your classes to be allowed to sit for the exam. Failing the pre-med work would limit your ability to sit for the test at the end of the two years.

The advantages are that it shortens essentially all medical schools to a single-degree, six-year program (like most European schools), but retains the graduate degree M.D. status. Furthermore, on any given year, you could easily adjust the number of students coming into programs based on the projected physician needs.

I'd run such as system like how the Caribbean and Osteopathic schools do it, with affiliated hospitals that students are assigned to. The difference is, you'd be "tracked" based on your score on the tests. Additionally, I would give students the opportunity to take the test a second time even if they passed because they didn't like their score, because more would be riding on the outcome of that test.

Sadly, I think we are way too politically correct in the U.S. to ever adopt such a system. People would try to claim that it favors test takers or that it's "socialistic" or some other such nonsense because you have no choice in where you might end up and due to the fact that you might end up in a field you don't want to be in. However, I think such a system would be much more equitable and would "track" students into the field that is best for them, in lieu of just having a sort of free-for-all residency application process that leaves many applicants confused and disappointed.

Likewise, I'd SEVERELY limit the number of residency spots to the number of students you have in the system based on the projections. For example, there are currently about 23,500 residency positions offered each year. I'd make sure that about 20,000 students were tracking to graduate in U.S. medical schools and that, based on how they were tracking, they would be filtered in the direction of primary care, surgical specialty, or medical specialty - and that there'd be enough U.S. students to fill those spots.

However, not to come across as xenophobic, I'd also allow a substantial number of foreign students to enroll into U.S. schools, again based on merit and ability up front.

This is just a rough sketch on how I think the system could be improved in the U.S. I'm not the first one who's thought of it. It certainly would save a lot of money (two less years of schooling) for both the student and the government. Of course there'd be kinks, but I think that there are already a LOT more kinks in the current system.

Anyway, just some ideas from my imagination on how things could be better...

-Skip

 

[JudoKing01]

Maybe I didn't understand you correctly, but you're saying that they should basically phase out FMGs from getting residency spots in the US unless they actually get a degree from a US med school, right? Didn't you graduate from a carib school? Just strikes me as odd that you'd want to eliminate foreign grads from getting residencies when you are one yourself.

Now if I'm totally misunderstanding you, I apologize, but that is what I got from what you just said. Please feel free to correct me if I'm mistaken.

 

[Skip Intro]

Maybe I didn't understand you correctly, but you're saying that they should basically phase out FMGs from getting residency spots in the US unless they actually get a degree from a US med school, right? Didn't you graduate from a carib school? Just strikes me as odd that you'd want to eliminate foreign grads from getting residencies when you are one yourself.

Now if I'm totally misunderstanding you, I apologize, but that is what I got from what you just said. Please feel free to correct me if I'm mistaken.

No, you're not mistaken. And, yes, I realize the irony that I might not otherwise be a doctor right now because of it. Still, I'd attempt to equalize things and limit the number of incoming foreign graduates. But, the upshot is that I'd also be increasing the number of spots annually by about 3,500 allowing many students who are forced to go Caribbean or to Osteopathic school, especially when most don't really want to, a 'fairer' shot at traditional "Doctor of Medicine" programs in the U.S. On the whole, I'd work simply to make the system much more equitable.

It would not completely eliminate osteopathic education (which wouldn't be affected anyway because it isn't regulated by the AAMC and accredited by the LCME) nor would there never be IMGs coming into the U.S., but this way it would make sure that people who truly wanted to go the osteopathy route because they chose it (and not as a default) and that the most competitive foreign grads would come to the U.S.

The system just seems so broken, on so many different levels, to me right now. It's financially unsound. So many problems.

-Skip

 

[JudoKing01]

Okay, I get you. I'd have to agree with you on that plan, and I'm an FMG myself.

 

[Miklos]

The system just seems so broken, on so many different levels, to me right now. It's financially unsound. So many problems.

-Skip

I think we can agree on this, but I'm still against a "French" solution.

 

[Skip Intro]

I think we can agree on this, but I'm still against a "French" solution.

Okay, but what do you think about my alternative?

-Skip

 

[Miklos]

Okay, but what do you think about my alternative?

-Skip

Outside of implementation (how many universities are willing to forgo 2 years of tuition?), I can see only one real downside. The end of college/university liberal education. That's not a huge problem if you come from a rigorous high school/college prep program, but if you don't I think that it has a significant downside.

One of the differences I've seen between Americans who've got a university degree and Europeans who directly go to med school is (very generally) the lack of perspective among the Europeans (sometimes, I find their knowledge, though high, to be strictly of a scientific/technical nature). This difference, I'm sure is due to the liberal education imparted during undergrad years in the U.S.

Miklos

 

[Skip Intro]

Outside of implementation (how many universities are willing to forgo 2 years of tuition?), I can see only one real downside. The end of college/university liberal education. That's not a huge problem if you come from a rigorous high school/college prep program, but if you don't I think that it has a significant downside.

I think a better question would be how many states would be willing to get out of paying an additional 2-year stipend to medical universities to fund this education. The savings across the country would be astronomical (on the order of $1.6B, yes billion, per graduating class in the U.S.).

One of the differences I've seen between Americans who've got a university degree and Europeans who directly go to med school is (very generally) the lack of perspective among the Europeans (sometimes, I find their knowledge, though high, to be strictly of a scientific/technical nature). This difference, I'm sure is due to the liberal education imparted during undergrad years in the U.S.

Fair criticism. And may explain why certain posters, such as f_w, think they know more than they actually do.

-Skip

 

[germanIMG]

this is...very general speaking, how do I put it, a rather unintelligent remark and kind of disqualifies the author immediatly...
how many european MDs have you met, from how many different countries that have very different educational systems?
Generalisations are usually not very helpful, lumping all of Europe in one pot does not help either...
trying to extrapolate from these generalisations and unprecise statements information regarding the educational system of US vs Europe is plain stupid.
I offer you just some other possible explanations for your perceived difference between US MDs and european MDs:

Different selection criterias for med schools.
Selection bias of those that you have met ( obviously coming to the US)
Language barrier....
etc, etc

 

[Miklos]

this is...very general speaking, how do I put it, a rather unintelligent remark and kind of disqualifies the author immediatly...
how many european MDs have you met, from how many different countries that have very different educational systems?
Generalisations are usually not very helpful, lumping all of Europe in one pot does not help either...
trying to extrapolate from these generalisations and unprecise statements information regarding the educational system of US vs Europe is plain stupid.
I offer you just some other possible explanations for your perceived difference between US MDs and european MDs:

Different selection criterias for med schools.
Selection bias of those that you have met ( obviously coming to the US)
Language barrier....
etc, etc

I stand by my opinion.

Generally speaking, European MDs do not have the same liberal education as US MDs (there are of course, as anywhere, exceptions).

 

[bulletproof]

Outside of implementation (how many universities are willing to forgo 2 years of tuition?), I can see only one real downside. The end of college/university liberal education. That's not a huge problem if you come from a rigorous high school/college prep program, but if you don't I think that it has a significant downside.

One of the differences I've seen between Americans who've got a university degree and Europeans who directly go to med school is (very generally) the lack of perspective among the Europeans (sometimes, I find their knowledge, though high, to be strictly of a scientific/technical nature). This difference, I'm sure is due to the liberal education imparted during undergrad years in the U.S.

Miklos

First , let me say that GermanIMG raises a valid point with reference to the diversity of education that falls under the umbrella term "european". Secondly, I believe the secondary education system of many if not most european states is superior in its breath and depth relative to the american public school system. For example, in Britain and Ireland, the exit exams alone are spread out over a two to three week period compared to the one day SAT or ACT. Furthermore these exams are heavily essay dependant, and require the students to make assertions, defend their arguments, and come to definitive conclusions on a wide variety of topics from socioecomic breakdowns of various countries to the implications of proteomics in medicine. I have been taking multiple choice exams since I arrived in the states seven years ago, and I have never encountered any that would rival these exit exams, including those in the first two years of medical school.I could go on to discuss the relative ignorance of many college educated americans on topics involving the world outside of the Fifty states...but my point here is not to start arguments. I agree with a liberal arts education as a basis for any educational model. However I believe that the europeans get alot more of it earlier on, doctors included.

 

[Miklos]

First , let me say that GermanIMG raises a valid point with reference to the diversity of education that falls under the umbrella term "european". Secondly, I believe the secondary education system of many if not most european states is superior in its breath and depth relative to the american public school system. For example, in Britain and Ireland, the exit exams alone are spread out over a two to three week period compared to the one day SAT or ACT. Furthermore these exams are heavily essay dependant, and require the students to make assertions, defend their arguments, and come to definitive conclusions on a wide variety of topics from socioecomic breakdowns of various countries to the implications of proteomics in medicine.

No question about it, most U.S. HS diplomas are not equivalent to European leaving certificates, maturity exams, etc... (I've expounded on this point in other posts)

However, European leaving certificates, maturity exams are equally not equivalent to a four-year U.S. Bachelor's degree with regard to liberal education.

I have been taking multiple choice exams since I arrived in the states seven years ago, and I have never encountered any that would rival these exit exams, including those in the first two years of medical school.

Thank you for making my point regarding technical knowledge.

I could go on to discuss the relative ignorance of many college educated americans on topics involving the world outside of the Fifty states...but my point here is not to start arguments.

Ditto for the busloads of monolingual (Germans, Italians, British etc.) package tourists that I run across on a daily basis. Just because someone is "European" (whatever that means), that does not imply worldliness.

I agree with a liberal arts education as a basis for any educational model. However I believe that the europeans get alot more of it earlier on, doctors included.

Oh, the Europeans get it early on. No question about it. They spend their time memorizing passages for examinations at the ages of 17 or 18. This, IMO, is far from the equivalent of a four year degree.

 

[bulletproof]

No question about it, most U.S. HS diplomas are not equivalent to European leaving certificates, maturity exams, etc... (I've expounded on this point in other posts)
Ok. Sorry, I have not had a chance to read through your other posts. I am in clinicals currently....not too much free time


However, European leaving certificates, maturity exams are equally not equivalent to a four-year U.S. Bachelor's degree with regard to liberal education.
Fine, if the U.S bachelors degree encompasses a generous scattering of social/political/humanities courses. However, a large proportion of american medical school applicants pursue biology or other science degrees. Yes they may have to take calculus, and commuications courses ( all of which I placed out of after coming from Ireland), which really impart nothing more than basic communication and analytical skills ( obtained in high school, at least in my country) In most european countries however, there is at least a threshold requisite level of politics/social issue awareness knowledge that I have found to be missing in many of my cohorts. You imply elsewhere in your post that the exit exams may essentially be reduced to a large degree of memorization. OK, you may have to remember the heads of states, and political protocols, UN resoloutions etc. , but if you cannot weave all of this into a coherent, rational, well executed 4 page essay in a matter of 40 minutes under exam conditions ( all at the age of ~17) discussing for example the ineptitude of the "oil for food program", then the memorisation is useless. Essentially, I am disagreeing with your contention that perspective is contingent upon completion of a liberal arts degree. The ultimate point of such a degree is to impart reason, open mindedness, and the ability to assess information from many angles. If you have gained such skills during secondary education then why spend another four years belaboring the point, particularly when you can spend the time teaching good clinical diagnostic skills ( ie. not dependent on imaging or lab data), or allowing the student to take relevant liberal education courses ( Philosophy of Health..... one course that comes to mind which is included in a couple of the Irish medical education programs).


Thank you for making my point regarding technical knowledge.
Yes, I agree , memorization is far easier than rationalisation and actually employing the circuitry God gave you. Don't make the mistake that European Docs cannot do this. Please see above.



Ditto for the busloads of monolingual (Germans, Italians, British etc.) package tourists that I run across on a daily basis. Just because someone is "European" (whatever that means), that does not imply worldliness.
I have to send some of my friends your way....none of whom are monoligual...I myself am proficient in three languages...and feel inadeqaute when conversing with some of my German friends...Leider, ist mein Deutsch kenntnische simlach schwach.These tourists may not speak english, but are you sure they are monolingual? I agree, "european" is not synonomous with "worldly". I do however feel that a Spaniard, for instance has a better understanding of american politics, than an american of spanish politics. Some americans would argue, that this is because America is more important. Extrapolate from that line of reasoning what you will.



Oh, the Europeans get it early on. No question about it. They spend their time memorizing passages for examinations at the ages of 17 or 18. This, IMO, is far from the equivalent of a four year degree.

Again, the four years spent in pre-medical education are typically not spent contemplating cartesian metaphysics, or grappling with the intricacies of the social divide. With regard to the memorisation, I believe I already addressed that. In any event I agree that liberal education is important no matter where or when you recieve it. Notably, many find travel and independent reading, to be the best educator of all in this regard. I believe the addage goes "sense is born of experience". Having completed a philosophy degree, and travelled quite a bit, I maintain that perhaps 1/100th of my perspective comes from the philosophy degree. You can only learn so much in the classroom.

 

[Miklos]

I think that we've covered everything except for this little bit below.

I do however feel that a Spaniard, for instance has a better understanding of american politics, than an american of spanish politics. Some americans would argue, that this is because America is more important. Extrapolate from that line of reasoning what you will.

I recently read a columnist's comments on the current EU dust-up. I cannot find the comments on-line, but I'll try to paraphrase them:

From an American (or rising Chinese perspective), the current disagreements about the EU constitution amount to little more than the irrelevant and incomprehensible arguments of warring tribes at the edge of Caesar's Empire.

Spain is no longer a major league player on the global political scene (probably since the Habsburgs) and the EU is quickly fading into the background. In the words of Mario Monti, former EU competition commissioner, Europe is on its way to turning into a "suburb of Shanghai."

In this context, who cares (besides me, because I'm a politics bluff) as to what government happens to run Madrid (note: not Spain)? On the other hand, decisions in Washington D.C. (as well as NYC and elsewhere in the U.S.) can have at least a perceived impact on the daily lives of Castilians, Catalans, Basques, etc.. That's why "Spaniards" care to know as to who occupies the White House.

 

[bulletproof]

You clearly enjoy your politics. I was merely using spain ( as a country, not as an amalgam of various regions/tribes/soverign entities) to illustrate a point. But to go along with your trail of thought...Insert China where I mentioned Spain. Indeed, insert most any country.The real issue here is that if the U.S. population were indeed as wholesomely educated as you might have us believe would they not be more concerned by or even enlightened as to the origins or intent of a rising chinese threat? Moreover, is this well educated society even cognizant of such a threat? I guess it is hard to figure out for yourself when Fox news is feeding you TERROR ALERTs , instead of focusing on outsourcing of jobs etc. But I digress. While it be convenient to talk of a broadminded, educated ,society in terms of the number participating in liberal arts education , the real barometer for gauging intelligent perspective is far more pragmatic...Take a look at elected officials. I find it hard to believe that a society comprised of so many liberal arts educated folk could elect such a patently competent, eloquent, honest, intelligent leader, .....TWICE. Perhaps I "misunderestimate" the value of the behemoth which is american liberal education.

 

[Miklos]

You clearly enjoy your politics. I was merely using spain ( as a country, not as an amalgam of various regions/tribes/soverign entities) to illustrate a point. But to go along with your trail of thought...Insert China where I mentioned Spain. Indeed, insert most any country.The real issue here is that if the U.S. population were indeed as wholesomely educated as you might have us believe would they not be more concerned by or even enlightened as to the origins or intent of a rising chinese threat? Moreover, is this well educated society even cognizant of such a threat? I guess it is hard to figure out for yourself when Fox news is feeding you TERROR ALERTs , instead of focusing on outsourcing of jobs etc. But I digress. While it be convenient to talk of a broadminded, educated ,society in terms of the number participating in liberal arts education , the real barometer for gauging intelligent perspective is far more pragmatic...Take a look at elected officials. I find it hard to believe that a society comprised of so many liberal arts educated folk could elect such a patently competent, eloquent, honest, intelligent leader, .....TWICE. Perhaps I "misunderestimate" the value of the behemoth which is american liberal education.

Despite having lived in the U.S. for seven years, you still do not understand the American polity.

What most Europeans don't understand (unless they've read and understood Tocqueville) is that Americans have no desire to be ruled by an elite.

Despite not kowtowing down to an elite (a la most of Europe), the U.S. seems to be doing okay. Compare this to Europe and Europe's future prospects.

I'll take an elected George W. Bush over a never-elected elitist like Dominique de Villepin any day and twice on Sunday.

The problem is that Europeans won't.

BTW, where are you going practice when you are done? Are you one of those dime-a-dozen Europeans who proclaim European superiority while working in the U.S.?

 

[bulletproof]

Despite having lived in the U.S. for seven years, you still do not understand the American polity.

What most Europeans don't understand (unless they've read and understood Tocqueville) is that Americans have no desire to be ruled by an elite.

Despite not kowtowing down to an elite (a la most of Europe), the U.S. seems to be doing okay. Compare this to Europe and Europe's future prospects.

I'll take an elected George W. Bush over a never-elected elitist like Dominique de Villepin any day and twice on Sunday.

The problem is that Europeans won't.

BTW, where are you going practice when you are done? Are you one of those dime-a-dozen Europeans who proclaim European superiority while working in the U.S.?

.....as I am sure you can appreciate, the beauty inherent to a democracy or indeed a republic,perhaps even a theocracy is the abilty to objectively criticise its weaker points in order to first understand it, and hopefully see it overcome its ( as I see it )less attractive attributes. As an AMERICAN CITIZEN since birth I feel this is my birthright. It does not make me any less patriotic. It does not mean I do not love the US, its people, or any of the liberties she offers. When a father scolds his child for writing on the wall, can you argue that he loves the child any less? I am equally willing to point out the flaws of Ireland, or indeed Europe as a whole, of which there are quite a few. I never claimed Europe was superior....in fact who was it that claimed that European Docs lacked perspective?So rest easy my son. By the way I have no plans as yet as to where I am going to practice....wherever the road may take me. Australia perhaps. Good luck...and thanks for the enjoyable banter. I believe the OP got their question answered, although we did tend to veer a little off course. Take care

 

[Menateach Rosh]

Well, my general feeling that I've stated before on this forum (and it's just an opinion) is that there's going to continue to be a shake out in the "off-shore" route. So far, it appears that there are more and more schools, both DO and Caribbean, trying to "cash in" on the now-predicted huge shortage of doctors by the year 2020. There is a looming healthcare crisis as the baby-boomers continue to age, and I think both the primary care and peri-surgical fields are going to continue to rapidly grow, both at the physician and mid-level practitioner levels.

How this plays out for IMGs? Not sure. At the current rates, it's going to be hard to make up the 200,000 predicted physician deficit even given the expanding classes at osteopathy and allopathy schools in the U.S.

The most important thing to remember is that the individual is paramount. There are many "diamonds in the rough" out there who go through alternative routes to become a physician. The cream will still rise, even if it is at an offshore school. Likewise, many very highly qualified foreign doctors who want to come to the U.S. and can find a spot will always be welcome. Even today, about 25% of all practicing physicians in the U.S. are foreign-trained. I seriously doubt that this number will decrease substantially, and even if it does (say down to 20%, which would be a substantial decrease), there will still be a need for foreign-trained doctors.

What will happen in the short run is that the fly-by-night Caribbean schools will still spring up like mushrooms after a summer rain, and will almost as quickly go out of business either by not getting enough students to attend and/or the inability to secure licensure for their graduates. The long-running and well-established schools will remain, but they may get more selective. Conversely, they may have to get less selective as well if the number of U.S. spots continues to increase and the osteopathic and allopathic fields further merge philosophically with the distinctions becoming irrelevant.

Personally, I still like the French medical education model the best, with some clearly needed modifications and improvements, and I wish that we'd adopt a similar system here. It is the most equitable, and would select overall the most capable students - not just the ones with the highest GPAs and MCAT scores. Likewise, it is much easier to adjust the numbers on a rolling basis using this system. However, it is FAR more competitive and cutthroat even than the current U.S. system. Still, everyone who wants to become a doctor gets a chance to do so in their own country and is not forced to take seemingly spurious loophole routes to pursuing their dreams.

In contrast, the Dutch system is the worst. We should be at least be grateful we don't have that kind of system here.

-Skip

In contrast, the Dutch system is the worst. We should be at least be grateful we don't have that kind of system here.

Whats wrong with the Dutch system??? I personally know a few Dutch surgeons and they all are extraordinary in the OR.

 

[Miklos]

Whats wrong with the Dutch system??? I personally know a few Dutch surgeons and they all are extraordinary in the OR.

I doubt that you'll get a response from Skip, as he's "retired".

However, I'm pretty sure he was referring to the selection process for medical school, not the quality of the medical education.