The coming residency bloodbath

[Slack3r]

I've too notcied that people think they can make a lot of money doing other things, but that they tend to simplify things. You can make a lot of money doing something else, but you need a nack for that something. So I agree with you to a great extent.

I will add that while the average salaries for a lot of jobs are lower than physicians, anyone can do most of those jobs. What I mean is that anyone on these forms could get an MBA or a JD (and try to pass the bar ). No just anyone with an MBA or JD could get an MD or a DO. So, yeah they have to get into top programs. If law schools and business schools were more scrupulous we wouldn't have a surplus of these parasites. We'd only have the useful ones (sort of like medicinal leeches ).

I dunno about this statement. People seem to oversimplify the facts of other careers and have the misguided view that a doctor must be smart in medicine, so they must be smart at everything else. Looking at most MCAT takers (both on this forum and nationally), most pre-meds seem to struggle with verbal, a core component of scoring well on the LSAT and in law school. Can anyone on this forum get a 120 on the LSAT and go to Devry University College of Law? Of course. But can anyone on this forum get into a top 14 law school and perform well there (a near prerequisite to becoming a successful lawyer nowadays)? Maybe, but I doubt it. I think both MBAs and JDs suffer from a surplus of less-than-stellar schools pumping out imbeciles and devaluing their degrees. But to lump those people in with the strong business/law programs and their graduates and devalue the whole profession saying ANY pre-med could do it is a fallacy.

Not only that, but I'd say medicine and law/business require much different "intangible" skillsets. While present in some facets of academic medicine, the "climb to the top of the corporate ladder" is one of the main challenges that differentiates between a mediocre lawyer and a successful one (at least monetarily), something you will not find differentiating most physicians.

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[howelljolly]

I dunno about this statement. People seem to oversimplify the facts of other careers and have the misguided view that a doctor must be smart in medicine, so they must be smart at everything else. Looking at most MCAT takers (both on this forum and nationally), most pre-meds seem to struggle with verbal, a core component of scoring well on the LSAT and in law school. Can anyone on this forum get a 120 on the LSAT and go to Devry University College of Law? Of course. But can anyone on this forum get into a top 14 law school and perform well there (a near prerequisite to becoming a successful lawyer nowadays)? Maybe, but I doubt it. I think both MBAs and JDs suffer from a surplus of less-than-stellar schools pumping out imbeciles and devaluing their degrees. But to lump those people in with the strong business/law programs and their graduates and devalue the whole profession saying ANY pre-med could do it is a fallacy.

Not only that, but I'd say medicine and law/business require much different "intangible" skillsets. While present in some facets of academic medicine, the "climb to the top of the corporate ladder" is one of the main challenges that differentiates between a mediocre lawyer and a successful one (at least monetarily), something you will not find differentiating most physicians.

Again, strongly agree.

Any physician can not get an MBA or a JD, and thinking so is simply arrogant and myopic. It's like saying that any physician can be a football player.

It takes a completely different knowledge base and way of thinking to complete an MBA or a JD. Just because you can learn learn physio and pharm and apply it to medicine, doesnt mean that you can learn finance, finance and economics and apply it to business administration. It doesnt mean that you can learn how to conduct legal research, and to pick apart semantics and understand the meaning of laws. It doesnt mean that you can be any good at legal writing, and argumentation.

Jeepers, the SDN is full of examples of how doctors can't put together a logical argument.

 

[NRAI2001]

I agree with you when it says it's harder to get a residency, and it should be. But when you look at the quality of the education and the average stats of a matriculant it is easier in a Caribbean med school so I still consider it the easy way out because instead of going to the first tier of medical education in the US (i.e a US MD/DO school), Caribbean students are willing to lower their standards to go to whatever med school is out there.

As for other US nationals going to med schools In Australia, Ireland, Poland, etc they have to be weighed on a case by case basis. Some of these international schools are excellent and deserve to be considered as such. But many are simply money factories that exploit young people's desires to become physicians at the cost of a proper education and those should not be treated equally.

Someone stated that DO schools avgs are around 3.3 and 27 mcat.. thats pretty comparable to the BIG 4 carribean schools. SGU has higher averages than this..

Someone else stated that carrib grads have extra time for boards and are less deserving than true IMGs.. At my school the august class has 6 weeks to study and the january class has a maximum of 12 weeks (3 months; not the 6 months someone stated). Most of the true IMGs that I know studied for close to 6 months for each of the steps and did this after clinical rotations (which IMHO would help someone tremendously on the boards).

Also I know many true IMGs from India and Africa and have heard all sorts of stories from them...from bribing people to getting into med school, to having a dad that was a police chief basically threatening school administrators to let you in...to cheating and paying you re way through med school.. key word is CORRUPTION big time in India and African med schools. A few of my friends went to India for med schools and they all brag about how much they cheated to get through med school and it was pretty much the norm... there would be times the entire class would be in on it. They would pay secretaries to change their grades...anything you can imagine happened.

The carribean doesnt have this cheating problem.. infact the carribbean schools look for reasons to hold you back or kick you out. Forget about paying teacher off for grades..

Point is i think AMGs dont have to worry at all about any residency shortages; the people who are really worried tend to be below average AMGs who feel threatened by above averages DOs and IMGs.

If undergrad performance is your argument against carribbean schools then DOs have very similar stats and many DO schools have stats even lower than some of the carrib schools.

Overall I think my school offers a good basic science education overall and from what I hear a good clinical education as well; its just the other aspects of the school that are sometimes bad (even though for the most part I ve been lucky enough to avoid them) like random tuition raises, people getting kicked out randomly, profs holding "profesionalism" against students to do whatever they feel like .. not the norm, but happens more often than it should or would in the US.

In the end dont forget we re all students.. and we all have a tremendous amount of loan on our shoulders. . I ve seen students get kicked out of medical school in their last semester of basic science and once/twice even after basic science...these are people too and most of them didnt deserve it. Imagine if you had 200K + in loans and couldnt find a residency or another medical school to take you; it would drive you to the brink of suicide. You cant completely blame someone for choosing to go abroad for their education. The US gov should really set stricter regulations and requirements for the carrib and other foreign schools taking US students. Its like how the gov sets regulations for car builders; one could argue it was the responsibility of the buyer to research the car and make sure it was safe. Its like saying to someone who bought a dangerous car and then got in an accident and was severly burned that its their own fault and the car company who created the car or the agency that allowed the unsafe car to be built have no responsibility at all.

 

[howelljolly]

You cant completely blame someone for choosing to go abroad for their education. The US gov should really set stricter regulations and requirements for the carrib and other foreign schools taking US students. Its like how the gov sets regulations for car builders; one could argue it was the responsibility of the buyer to research the car and make sure it was safe. Its like saying to someone who bought a dangerous car and then got in an accident and was burned that its their own fault

I agree that something should be done to keep people out of this sinking ship. People may not realize the immense numbers of Americans that are going to the Caribbean for med school. There are somewhere around 40 med schools in the Caribbean now, and we only hear of about 8 of them. Imagine the numbers of people that are in a mess that they dont know about.

I think the government has done what they can to keep Americans away from these schools. Theyve taken away federal loans to these schools, and denied any new loans. Theyve made it so that you can not get a private student loan for the school. States have restricted licensure and banned Caribbean students from doing residency. Still, people are bent on beating the odds, taking out private personal loans, and refinancing their house to do this, and promising to live "anywhere". The US government has washed their hands of the Carib med school situation in effort to keep people away, and therefore, cant DO anything more. The Carib med schools are only held responsible to the World Health Org.

The only way that students can be warned of this situation is from other individuals. Thats why I write these overly dramatic posts. So maybe somebody will listen.

Over the past ~25, there have been many successful graduates of Carib schools. NOW, right now, the tide is turning. As of 4 years ago, he number of AMGs and DOs is increasing, and the extra spots in the Match are no longer extra. The gap between American grads and residency seats will close within the next few years, and that will be the end of the story.

 

[Law2Doc]

I dunno about this statement. People seem to oversimplify the facts of other careers and have the misguided view that a doctor must be smart in medicine, so they must be smart at everything else. Looking at most MCAT takers (both on this forum and nationally), most pre-meds seem to struggle with verbal, a core component of scoring well on the LSAT and in law school. Can anyone on this forum get a 120 on the LSAT and go to Devry University College of Law? Of course. But can anyone on this forum get into a top 14 law school and perform well there (a near prerequisite to becoming a successful lawyer nowadays)? Maybe, but I doubt it. I think both MBAs and JDs suffer from a surplus of less-than-stellar schools pumping out imbeciles and devaluing their degrees. But to lump those people in with the strong business/law programs and their graduates and devalue the whole profession saying ANY pre-med could do it is a fallacy.

Not only that, but I'd say medicine and law/business require much different "intangible" skillsets. While present in some facets of academic medicine, the "climb to the top of the corporate ladder" is one of the main challenges that differentiates between a mediocre lawyer and a successful one (at least monetarily), something you will not find differentiating most physicians.

I actually disagree with this, speaking from personal experience. The premed path and med school and training are significantly more difficult and time and effort intensive than the pre-law path. Anyone who can jump through all the hoops and score well on the MCAT and boards could have used that same effort to get into a decent law school (no, it doesn't have to be top 14 to set you up for success, but it is certainly a smaller circle of pedigrees you need compared to med school), and would do well there. Law is primarily a field of common sense and elbow grease. That's often-times what separates the law student or firm associate who succeeds from the one who does poorly. You need to have a good head on your shoulders, and not be work averse and you can go far. For the most part, if someone put the same kind of effort into a law career that they do into a medical career, they will go far, no question. Being in the upper echelon of smarts and willing to work a lot harder than the average pre-professional are simply good recipes for doing well in law. I know of no one who met these criteria who didn't do quite well for themselves.

 

[howelljolly]

You comment that the only people who worry about Caribbean grads are below average MD candidates. I worry about them and am already in a top tier residency. I think they are representative of the problems with this country. Can't do the hard work and get the scores needed to be a doctor, well lets find a shortcut that we can pay ourselves into.

rs.

You're wrong on that point. Students who can do hard work, and get great scores are rejected from US med schools, and end up doing hard work and getting great scores from Caribbean schools.

I went to a Carib school with three guys who had PhDs in medically-related basic science, and I met about 3 more in clinicals. Why did they go to the Caribbean? Because no American med school would want them. I know another guy who was a non-physician instructor at a US medical school. He applied 3 times, and was rejected on all 3 rounds. You think these guys were not willing to work hard and couldn't get good scores? Among them are regular students who were willing to work hard and get good scores... but randomly not given a chance.

HALF of qualified applicants get rejected from US med schools each year... and that's probably not accounting for the applicants who are deemed unqualified because they are 36 years old, spent time doing a PhD +2 post-docs, or have their Bachelors in a field (like physics, math, or engineering) where a GPA of 3.2 is phenomenal. What about the "qualified rejected" applicants? They were just as qualified as you were. You were just in the lucky half.

Before you tell me that the American medical system loves MD/PhDs..... No. They're happy to make their own MD/PhDs and have NIH funded MSTPs. Come to the admissions committee already having PhD? Forget it. Getting into a US med school is a 50/50 crap shoot. To make it easier on the ad-coms, anything "non-traditional" including having done bona fide basic science, is simply filed under "rejection" How can you blame these guys for bucking the system?

Yes, you know some guys in your med school class who were non-trads. Well I know more. It's simply playing the odds. Smart, qualified, hard working non-trads are more likely to get into the Match on an ECFMG certificate, than they are just getting into a US med school. And Im using them as an example because they've proved that they are willing to work hard and do well. Again, among them are the qualified rejected folks.

Yes, half of Carib students fail the Step1. Of the half that pass, a very large proportion of them break a 240 on Step1 and 2. So saying that Carib students aren't willing to work hard and get good scores is just nonsense. They're willing to do just that. US schools are just not willing to accept them. And they prove with their scores that the US ad-coms did a lousy job if predicting that they would do poorly in med school and the USMLE.

As for taking 6 or whatever weeks to study for the USMLE. That period is imposed on the Carib students by the US medical education system (some big-shot in Fla. came up with it, and it stuck)... its called the 5th Semester. It's a four month period where they waste our time with hospital observerships, lectures, USMLE review courses, and roughly a 6 week chunk of study time. I suppose that one could study for less time, and take the post-test free time to travel. But who wants to go on vacation after living on a Caribbean island for 2 years???

So, you're worried about them and you are already a resident in your top-tier program? The only thing you should be worried about is educated individuals who question the American med school's definition of "qualified" and "top-tier", and are willing to work hard, and rock the boards.

Im done.

 

[Slack3r]

I actually disagree with this, speaking from personal experience. The premed path and med school and training are significantly more difficult and time and effort intensive than the pre-law path. Anyone who can jump through all the hoops and score well on the MCAT and boards could have used that same effort to get into a decent law school (no, it doesn't have to be top 14 to set you up for success, but it is certainly a smaller circle of pedigrees you need compared to med school), and would do well there. Law is primarily a field of common sense and elbow grease. That's often-times what separates the law student or firm associate who succeeds from the one who does poorly. You need to have a good head on your shoulders, and not be work averse and you can go far. For the most part, if someone put the same kind of effort into a law career that they do into a medical career, they will go far, no question. Being in the upper echelon of smarts and willing to work a lot harder than the average pre-professional are simply good recipes for doing well in law. I know of no one who met these criteria who didn't do quite well for themselves.

Longer, yes. More difficult? Maybe, it's hard to quantify. My main argument was that the two skillsets are very different, and while you (and I'm sure many others) have transitioned between the two, I still think it's a false argument to say that ANYONE can successfully transition. n=1 remember?

 

[howelljolly]

Seems to me you just want to justify you going to the Caribbean by blaming the system for not taking you rather than taking responsibility.

Incidentally, I only respond to a bit of your posts because I mostly agree with you.

Sure, older applicants are less useful overall... but when you are the older applicant, and by "you", I mean "me".... I'm not going to sit around for the next 45-55 years. Im going to get into the game ASAP. My being 3-4 years less useful isn't a big deal when I'm going to stick it out in clinical medicine, while some US grad will give it up to go make money or become the next Dr 90210... but whatever.

Maybe my evidence is anecdotal, but based on my anecdotes, I never had any reason to believe that my luck would be any better than theirs had I built up my application and gone for a US school. I've never anecdotally met someone who made it.

Just to give you an idea... the guy I was talking about... instructor in a med school, BS in engineering (GPA 3.2)... became an instructor, wanted in on medicine, did a post-bacc (GPA 4.0), MCAT 32ish... 3 rounds of apps... nothing. Talked to admissions people at his own institution, and advised that a post-bacc just doesnt look good, and that he should go get a MS in biochem or something. I lost touch when he went to go do that. My thoughts? - thats crap.

Now about that statement above, I'm sorta with you until the last "than".

I'm OK with having gone to the Caribbean because I dont have much faith in the system, and I dont expect it to have gotten me to this point at this time.... kinda what you said, with a different spin.

However, I take full responsibility for being in a position where the system would not have taken me. Whether I agreed with it or not, I knew what I "should have" done. Like you said, in choosing an easy vs. and interesting major... I chose the interesting one. I never did anything (big) as a means to an end, and I never intend to.

Do I regret that I put myself in that position? Not at all. Because what I did in the three years prior to med school, and the intangibles I learned in my first two years at the Clown College if Medicine have altered the course of my life. Had I gone to a US med school straight out of undergrad, I'd be the one on the SDN writing "I'm a PGY-2, is it too late for me to start a new residency in a totally unrelated field?"

Anyway... enough about me.

 

[tony montana]

I think that there enough applicants in their 20s that want in to med school so why waste a spot on someone who will not be able to contribute to the medical field for as long

Since when is lenght of service all that should matter in patient care?

If I was a patient and had a say on things I would want both lenght and quality...

If I had to choose only one (that is, a 20 year old vs. a "better" 30-40 yr old aplicant) I would choose quality (the older) over lenght (20 yr old) hands down...

 

[howelljolly]

Since when is lenght of service all that should matter in patient care?

If I was a patient and had a say on things I would want both lenght and quality...

If I had to choose only one (that is, a 20 year old vs. a "better" 30-40 yr old aplicant) I would choose quality (the older) over lenght (20 yr old) hands down...

Nobody cares about better, they care about more.

 

[Coastie]

Nobody cares about better, they care about more.

Oh please.

Getting into med school is tough, but not that tough anymore, especially with the new schools coming online like hotcakes. We've had a 30% increase in slots since early 2000's, right? (MD/DO)

Carib schools are going to be squeezed out of the match very soon even moreso than they already are...Buyer beware!

Their lack of decent clinical rotations combined with poor reputation has been a killing point for years on their graduates cv's...I'm glad that the US gov't is considering putting an end to the loans for these private-corporation based institutions...

Long story short, not everyone who wants to be a doctor, should or can become one..

 

[NRAI2001]

While I understand your need to defend the Caribbean education model, it rings hollow from a guy who is going to SGU and has to worry about matching in his future. Sure you would like the playing field to be more level.

As for your discussion about board study time, the med school I went to gave 3- 4 weeks so the 6-12 weeks you speak of is 2-3 times longer than what I consider standard for Step I. For step II, no time was given where I went to school as is the case at many US med schools.

You quoted my post about foreign med schools in Australia, Ireland, Poland, etc. and tangentially jumped to India/Africa. I simply stated, “Some of these international schools are excellent and deserve to be considered as such. But many are simply money factories that exploit young people's desires to become physicians at the cost of a proper education and those should not be treated equally.” Which I think still is true.

You comment that the only people who worry about Caribbean grads are below average MD candidates. I worry about them and am already in a top tier residency. I think they are representative of the problems with this country. Can’t do the hard work and get the scores needed to be a doctor, well lets find a shortcut that we can pay ourselves into.

You say we shouldn't blame the students, why shouldn't we? If you choose to go the Caribbean you should know the pitfalls and be responsible. If you are chasing a pipe dream thats your fault. As for regulation, im all for more regulation but I think the government has limited ability to regulate further. My hope is that all US tax dollars for student loans are taken away from students matriculating to any Caribbean schools. Seems like the return there is limited when you compare the matriculation rates- i.e. those that start on day 1 to those that graduate 4 years later. Funny how no Caribbean school wants to put those numbers up.

Does it really matter…hopefully the increase in US MD/DO spots will eliminate the Caribbean as an option in the next 3-5 years.

If you are in residency (which i seriously seriously do not believe; troll) then the only reason you would oppose carribbean grads entering residency is bc of fear of competition later on and not the proposed "danger" they pose.

Using the argument of undergrad grades is so flawed its stupid and precisely the argument a pre med would use (again TROLL).

-DO schools have the same entering grads/mcats
-Many US students have grades/mcats close to the 3.3 and 27 avg of the carribeans
-Many URMs have below the stats DO and carribean schools

Truth is even if you shut down all carribbean schools today there will be many many still circulating through residency/fellowships and working in private practices for the next 20 to 30 years.. its better to appreciate peoples differences and similarities..

 

[howelljolly]

Oh please.

Getting into med school is tough, but not that tough anymore, especially with the new schools coming online like hotcakes. We've had a 30% increase in slots since early 2000's, right? (MD/DO)

Carib schools are going to be squeezed out of the match very soon even moreso than they already are...Buyer beware!

Their lack of decent clinical rotations combined with poor reputation has been a killing point for years on their graduates cv's...I'm glad that the US gov't is considering putting an end to the loans for these private-corporation based institutions...

Long story short, not everyone who wants to be a doctor, should or can become one..

I'm just saying thats why the age vs. experience issue comes up in any employment situation, not just medicine. People want productivity over quality.

They put an end to the loans a while ago. Only the most heavily grandfathered 3 or so schools might possibly still have them. Even then it hasn't stopped people from taking out a second mortgage and going.

 

[sugardad]

You should probably check people's previous posts before trying to call them out. I have been posting for a few years, and it's identifiable what residency I am at. I post about Caribbean grads, not because of fear but because I think the system is flawed as it stands now. As for fear of competition, I am currently in radiation oncology where the number of FMG/IMG's combined in training in the United States is less than 5 so i dont think you're right there.

While you talk about all the things that Caribbean students have like similar MCAT'S/GPA to DO schools think about what they are lacking whether it be research, extra-curriculars, etc. Schools use some factor to split these groups up. Numbers are important but it's the individual application that tells the whole story. My arguement has always been that going to the Caribbean is the easy way out because people are unwilling to correct the deficiencies in their application whether it be a numbers thing or something else on their CV and jump off to whatever school will take them.

The fact is that there are many more qualified applicants than there are spots and schools are forced to use absolutely ridiculous criteria to differentiate applicants. Do you really think some BS extracurriculars are a good indicator of your fitness to be a physician. There really is no "individual application that tells the whole story". The fact is you and 45,000 other people want to get into med school and some qualified people will get left out, which makes it really hard to condemn a person as lazy if they pursue alternate paths to achieve their dreams.

 

[McGillGrad]

As for fear of competition, I am currently in radiation oncology where the number of FMG/IMG's combined in training in the United States is less than 5 so i dont think you're right there.

You forgot to mention that only 15 positions are matched per year in total. That is up from only 9 positions offered in 2005. Soooooo, 5 positions is 11% in training right now. That is in line with other competitive specialities such as urology.

Context is important.

 

[McGillGrad]

Actually per year there are 100-120 spots per year. If you are looking at the charting the outcomes, the reason there is 15 as a PGY-1 is because those are rad onc programs with transitional/prelim spots attached. So in reality the percentage is 5/500-600 throughout the 5 years of rad onc or a rate of 1%.

You are correct. Sloppy research on my part. ON further reading, 129 spots were filled and 121 by US seniors. That is only 6% and still low.

 

[QofQuimica]

Before you tell me that the American medical system loves MD/PhDs..... No. They're happy to make their own MD/PhDs and have NIH funded MSTPs. Come to the admissions committee already having PhD? Forget it. Getting into a US med school is a 50/50 crap shoot. To make it easier on the ad-coms, anything "non-traditional" including having done bona fide basic science, is simply filed under "rejection" How can you blame these guys for bucking the system?

I went to a Carib school with three guys who had PhDs in medically-related basic science, and I met about 3 more in clinicals. Why did they go to the Caribbean? Because no American med school would want them. I know another guy who was a non-physician instructor at a US medical school. He applied 3 times, and was rejected on all 3 rounds. You think these guys were not willing to work hard and couldn't get good scores? Among them are regular students who were willing to work hard and get good scores... but randomly not given a chance.

HALF of qualified applicants get rejected from US med schools each year... and that's probably not accounting for the applicants who are deemed unqualified because they are 36 years old, spent time doing a PhD +2 post-docs, or have their Bachelors in a field (like physics, math, or engineering) where a GPA of 3.2 is phenomenal. What about the "qualified rejected" applicants? They were just as qualified as you were. You were just in the lucky half.

This contention that adcoms automatically reject most applicants who have PhDs is ridiculous. I am speaking both from my own experience of having been a 30-year-old physical science PhD-to-MD applicant, as well as from having served on my med school's adcom for the past three years. In my case, I applied to 22 schools, got 19 interview invites, attended 17 of them, got 12 acceptances, and was offered six full scholarships. To claim that this was due to "luck" would go beyond cynicism to the point of being insulting, although I doubt that was your intention.

It's true that PhD-to-MD applicants don't get a free pass into med school just for having a PhD, but we're not discriminated against, either. If the rest of the app is strong (good UG GPA, good MCAT, good ECs including clinical experience and/or volunteering, good letters, and an honest ability to explain the change from science to medicine), a PhD-to-MD applicant has just as good of a chance as a college applicant does. Maybe even a better chance, because a successful PhD nontrad with rock star credentials adds an appealing diversity to the class that most other applicants can't. At my school, most classes have at least one or two PhDs, and if all the PhDs we accepted actually matriculated here, there would be even more.

I know you are trying to defend your classmates as being smart and hardworking, and I believe you that they are both of these things. However, you should consider that you don't really know the whole story of how competitive their apps actually were. As a matter of fact, neither do they, since they've never seen their own LORs and interview evaluations. I can tell you that many people don't interview nearly as well as they think they do. Regardless, if someone has competitive credentials in every way and doesn't get in *anywhere* after three tries, then there is something seriously wrong beyond them having "bad luck," even if it's just that they used an inappropriate application strategy.

Although there is a significant degree of subjectivity in the medical school admissions process, that doesn't mean it's a "crapshoot" or that some people just get "lucky" while others don't. It's not like we put all the applicants' names in a hat and pick some out randomly. We want to matriculate the most academically and nonacademically qualified students that we can, and that goal guides our admissions decisions. Even though the way that decisions are reached may not always be as transparent to the applicants as it could be, there *is* a rhyme and reason to why and how med school adcoms make the decisions they do.

 

[Eta Carinae]

There is still an advantage to distributing some of the student filtering to post-medschool rather than pre-medschool. Undergrads come from very diverse backgrounds and their performance in one subject or another says very little about what sort of doctors they will be. You also have variations of rigor among schools and large variations from one professor to the next in the same school. As such, regardless of methods employed, it is almost impossible to determine if one undergrad will be a better doctor than another undegrad. Academic performance is just not standardized enough to make any precise comparisons and it is not related to medicine to make the judgments accurate. Therefore, the quality of doctors should increase when more students are let in and then are evaluated specifically by their performance in the medical schools which teach almost the same material and test the students in the same clinical environments. It is not uncommon for academically weaker undergrads to outperform their peers in medical school. Thus, displacing at least some of the bottlenecking to PGY is not a bad step. Now "forcing" students into primary care is not great, but what would you rather have? No primary care spots either and let those unmatched be unable to become doctors? I view the primary care spots not necessarily as forcing students into it, but as a fall-back mechanism for those not qualified for other specialties to not be left out on the street. Even some of the most competitive specialties seem to have spots that go unfilled every year. So I am not sure if there are already enough well qualified and willing applicants for most specialties available.

 

[gutonc]

You are correct. Sloppy research on my part. ON further reading, 129 spots were filled and 121 by US seniors. That is only 6% and still low.

And that 6% includes DOs, IMG/FMGs and other independent applicants (any US grad not currently an MS4) so the actual # of foreign grads is likely even lower than that.

 

[Excelsius]

Non sequitur. Braccae tuae aperiuntur.

 

[howelljolly]

What about the alternative path of taking the time to improve one's GPA/MCAT, do extracurriculars, do research, get an MPH, do the 1 year pre-med school programs, etc. If you really want to be a physician and you can't get in on the 1st pass, shouldn't that be the next thought?

Certainly that should be your next thought. But dont you think that after a while CV padding starts looking like nothing more than CV padding?

 

[NRAI2001]

You should probably check people's previous posts before trying to call them out. I have been posting for a few years, and it's identifiable what residency I am at. I post about Caribbean grads, not because of fear but because I think the system is flawed as it stands now. As for fear of competition, I am currently in radiation oncology where the number of FMG/IMG's combined in training in the United States is less than 5 so i dont think you're right there.

While you talk about all the things that Caribbean students have like similar MCAT'S/GPA to DO schools think about what they are lacking whether it be research, extra-curriculars, etc. Schools use some factor to split these groups up. Numbers are important but it's the individual application that tells the whole story. My arguement has always been that going to the Caribbean is the easy way out because people are unwilling to correct the deficiencies in their application whether it be a numbers thing or something else on their CV and jump off to whatever school will take them.

My problem is that people here spout off about equal treatment for Caribbean grads or getting a fair shake and I just don't agree with that line of thinking. If you can't get into a LCME accredited school than you should be at the back of the line when it comes to residencies and further you shouldn't be getting US taxpayer money to fund your education.

I still highly doubt you ve even started med school yet.. working well with others and respectfully arguing ones views are traits that are central to practicing medicine in a hospital setting.... you have not demonstrated this in your posts on this thread as well as other discussions.

Your comment regarding ECs and research is dumb to the point that its laughable..

1) everyone knows that ECs, research (unless if you have 1st or 2nd authored publications), volunteering...etc is total BS and can be totally fabricated

2) About 1/3 of my entering class had some sort of a graduate degree (mostly M.S.'s and MPHs).. = good "CV boosters" as you argued

3) Your assuming that all the people that go to the carribean schools were those that applied to DO schools and were not accepted; the truth is that DO and Carribbean students probably applied to and were accepted to both DO and Carribean schools.. but for whatever their reasons were they chose the routes that they did.

I myself was accepted to CCOM and debated long and hard for many weeks whether I wanted to go to CCOM or SGU; most of the people at my school shared similar experiences with deciding on DO vs. SGU.

 

[Winged Scapula]

I still highly doubt you ve even started med school yet.. working well with others and respectfully arguing ones views are traits that are central to practicing medicine in a hospital setting.... you have not demonstrated this in your posts on this thread as well as other discussions.

FYI: This user is an SDN Mentor and as such, their identity has been verified in the vetting process.

Users are reminded to please stay on topic and refrain from personal insults when disagreeing with each other.

 

[Coastie]

3) Your assuming that all the people that go to the carribean schools were those that applied to DO schools and were not accepted; the truth is that DO and Carribbean students probably applied to and were accepted to both DO and Carribean schools.. but for whatever their reasons were they chose the routes that they did.

Dude, that is doubtful. You may have been accepted to both, but why would anyone take a foreign, for-profit school with poor prospects over an established American D.O. school?

If the choice was Rocky Vista/Lincoln/Pikesville/PCOM-Atlanta/Touro-NV/LECOM-Seton Hill/fill-in-the-blank versus SGU, I could see the argument, but NYCOM/CCOM/PCOM/TCOM versus SGU? That's a really, really tough sell.

What was the reason you chose your route? I believe that carib schools will be shut out of the residency process in the next 4-6 years, if not sooner, so anyone who goes carib versus D.O. at this point (read: starting fall 2010), is just asking for poor residency prospects and 300k in debt.

 

[howelljolly]

Dude, that is doubtful. You may have been accepted to both, but why would anyone take a foreign, for-profit school with poor prospects over an established American D.O. school?

If the choice was Rocky Vista/Lincoln/Pikesville/PCOM-Atlanta/Touro-NV/LECOM-Seton Hill/fill-in-the-blank versus SGU, I could see the argument, but NYCOM/CCOM/PCOM/TCOM versus SGU? That's a really, really tough sell.

What was the reason you chose your route? I believe that carib schools will be shut out of the residency process in the next 4-6 years, if not sooner, so anyone who goes carib versus D.O. at this point (read: starting fall 2010), is just asking for poor residency prospects and 300k in debt.

Dude, the answer is all over the SDN and probably somewhere on this thread itself. Many med students are convinced that DOs are not real doctors, and/or want to have an MD after their name. Theyre convinced that Carib MDs are more respected than DOs.

I think its the stupidest choice ever.... but many people are more interested in what the name plate on their office door will look like, than in what city, and practice setting their office will be in.

 

[NRAI2001]

Dude, that is doubtful. You may have been accepted to both, but why would anyone take a foreign, for-profit school with poor prospects over an established American D.O. school?

If the choice was Rocky Vista/Lincoln/Pikesville/PCOM-Atlanta/Touro-NV/LECOM-Seton Hill/fill-in-the-blank versus SGU, I could see the argument, but NYCOM/CCOM/PCOM/TCOM versus SGU? That's a really, really tough sell.

What was the reason you chose your route? I believe that carib schools will be shut out of the residency process in the next 4-6 years, if not sooner, so anyone who goes carib versus D.O. at this point (read: starting fall 2010), is just asking for poor residency prospects and 300k in debt.

I think its true that carib students will have more difficulties in the next 3 or 4 years as will DO students... mainly bc of the expansion of US MD school spots. They will never be shut out of residencies, but may experience more difficulty...

I had my reasons for choosing SGU over a DO school and I m pretty happy with my choice. I believe that the education I ve gotten here at SGU has been very good (just finished MS2) and from what I hear will continue to be good into clinicals... my main issues with SGU would revolve around tuition, administration type of issues, and the inconvience of living in another country.

 

[howelljolly]

I think its true that carib students will have more difficulties in the next 3 or 4 years as will DO students... mainly bc of the expansion of US MD school spots. They will never be shut out of residencies, but may experience more difficulty...

I had my reasons for choosing SGU over a DO school and I m pretty happy with my choice. I believe that the education I ve gotten here at SGU has been very good (just finished MS2) and from what I hear will continue to be good into clinicals... my main issues with SGU would revolve around tuition, administration type of issues, and the inconvience of living in another country.

No, they won't. The Allopathic match, which is what Carib students are restricted to, is where the crunch is. DO students have an Osteopathic match which is reserved for them. They have their own residency programs in Emergency, Ortho, Neurosurgery, Rads, Gas, ENT..., as well as hundreds in Family Practice. Only Caribs will have difficulty in the next few years. DOs may have less success with the Allopathic match, but they'll certainly get into a residency.

 

[NRAI2001]

No, they won't. The Allopathic match, which is what Carib students are restricted to, is where the crunch is. DO students have an Osteopathic match which is reserved for them. They have their own residency programs in Emergency, Ortho, Neurosurgery, Rads, Gas, ENT..., as well as hundreds in Family Practice. Only Caribs will have difficulty in the next few years. DOs may have less success with the Allopathic match, but they'll certainly get into a residency.

I think you re right about that... IMHO this is the biggest advantage of going to a DO school = the DO match. DO and carib will both have a more difficult time when it comes to the allo match, I m glad I ll be done applying to residencies by then.

 

[Law2Doc]

Longer, yes. More difficult? Maybe, it's hard to quantify. My main argument was that the two skillsets are very different, and while you (and I'm sure many others) have transitioned between the two, I still think it's a false argument to say that ANYONE can successfully transition. n=1 remember?

I'm actually making the argument that the skillsets are near identical. You do well in either path, for the most part, if you are (A) smart, and (B) willing to work incredibly hard. Those of us who went from one path to the other were able to do so precisely because we had transferable skillsets -- the skills that made us strong players in one career were prized by the other. I think you are kidding yourself if you think that you need a science/math skillset to be a good doctor and a strong reading/writing skillset to be a good lawyer. It doesn't really work that way. Having a good head on your shoulders and strong work ethic are the thing that makes the difference in either field and most folks in med school fit this bill, whether or not they are willing to admit it. Sure, you may not "like" to read a ton of legalese and may not like essay tests, but I'm certain if you are smart enough to get into med school you can master those basics -- it's really the same kind of issue spotting that is expected on the Step exams, whether or not you like to see it that way.

So I would suggest (from my own experience and knowing what is involved in both paths in intimate detail) that someone with the grades and work ethic to get into med school would generally get into a decent law school and would probably do above average. Which means looking to stats of how the "average" person does are moot. The typical high flyer coming out of law school into a large law firm in a large city starts his career at a $140k salary, which at 24 is an awesome salary. And currently, even in this recession, law schools are able to place about 60% of their graduates (down from 95% in non-recession years). Which is a bad percentage, but very decent for those in the top 20-30% at the above average law schools. Which I suggest would encompass most of the folks who worked as hard to get into med school had they chosen the law path. You aren't average, so why look to averages for comparison. I'm just saying.

 

[mercaptovizadeh]

I'm actually making the argument that the skillsets are near identical. You do well in either path, for the most part, if you are (A) smart, and (B) willing to work incredibly hard. Those of us who went from one path to the other were able to do so precisely because we had transferable skillsets -- the skills that made us strong players in one career were prized by the other. I think you are kidding yourself if you think that you need a science/math skillset to be a good doctor and a strong reading/writing skillset to be a good lawyer. It doesn't really work that way. Having a good head on your shoulders and strong work ethic are the thing that makes the difference in either field and most folks in med school fit this bill, whether or not they are willing to admit it. Sure, you may not "like" to read a ton of legalese and may not like essay tests, but I'm certain if you are smart enough to get into med school you can master those basics -- it's really the same kind of issue spotting that is expected on the Step exams, whether or not you like to see it that way.

So I would suggest (from my own experience and knowing what is involved in both paths in intimate detail) that someone with the grades and work ethic to get into med school would generally get into a decent law school and would probably do above average. Which means looking to stats of how the "average" person does are moot. The typical high flyer coming out of law school into a large law firm in a large city starts his career at a $140k salary, which at 24 is an awesome salary. And currently, even in this recession, law schools are able to place about 60% of their graduates (down from 95% in non-recession years). Which is a bad percentage, but very decent for those in the top 20-30% at the above average law schools. Which I suggest would encompass most of the folks who worked as hard to get into med school had they chosen the law path. You aren't average, so why look to averages for comparison. I'm just saying.

Law schools admit too many people. Nowadays, nearly half are not getting decent jobs (heck, even temping in some cases).

I agree that if you can do well in med school you can do well in law school. The skillsets are not that different.

 

[thedrjojo]

As for taking 6 or whatever weeks to study for the USMLE. That period is imposed on the Carib students by the US medical education system (some big-shot in Fla. came up with it, and it stuck)... its called the 5th Semester. It's a four month period where they waste our time with hospital observerships, lectures, USMLE review courses, and roughly a 6 week chunk of study time. I suppose that one could study for less time, and take the post-test free time to travel. But who wants to go on vacation after living on a Caribbean island for 2 years???

This 5th semester is exactly what anti-caribbean school folks are talking about. Most US Med schools have no build in time where no new information is given and instead an intense, specific for USMLE review course is given, then on top of that 6 more weeks for study time! My medical school gave us 6 weeks from the end of courses until the start of 3rd year clerkships. So while we had the same amount of "study time" we did so coming fresh off of learning stuff and thus had no "review everything in class" before. And even with that, you say 50% fail it?!? And of those that take it, how many of the class that started sit for the step 1? 50%? 75%? That means, if you are looking at a Caribbean school, even the top ones, from day one of starting, you are looking at 25-37.5% chance of even passing step 1, and the 50% match rate is of those who make it that far, which is probably 50% at best, so at best, 1 of every 4 people who start at the top carribbean school ends up with a residency. US Med schools, probably something like 90% of those who start finish, and of those 95% match, so you are looking at an 85% likelyhood of residency after starting medical school? And this will get more skewed.

One thing that isn't mentioned through all of this primary care discussion is that one reason it is not as sought after as some of the other fields is that it just isn't that interesting? Internal Med, Family Med, Peds, they are all incredibly dull to me, and even if they paid 5x what they currently offer, I wouldn't give a second thought about going into them. While I find some areas of gen surgery dull, the overall field is much more interesting, the combination of technical skills, faster paced decision trees, and the intellectual requirements (as one PD on an interview put it, Surgeons are Internists who finish the training). But I also find most in the ROAD dull as well... I do appreciate and applaud those of you who enjoy primary care, you are better people than I am, and probably deserve 5x what ROAD makes (still not necessarily more than gen surg, but what can I say?)

 

[Winged Scapula]

One thing that isn't mentioned through all of this primary care discussion is that one reason it is not as sought after as some of the other fields is that it just isn't that interesting? Internal Med, Family Med, Peds, they are all incredibly dull to me, and even if they paid 5x what they currently offer, I wouldn't give a second thought about going into them.

While you may not find it interesting, there are dozens more who find surgery uninteresting. To assume that these fields are uninteresting to the majority of students is a rather bold statement.

While I find some areas of gen surgery dull, the overall field is much more interesting, the combination of technical skills, faster paced decision trees, and the intellectual requirements (as one PD on an interview put it, Surgeons are Internists who finish the training). But I also find most in the ROAD dull as well... I do appreciate and applaud those of you who enjoy primary care, you are better people than I am, and probably deserve 5x what ROAD makes (still not necessarily more than gen surg, but what can I say?)

Ughh...please don't repeat that ridiculous statement. It makes you and other surgeons look bad to assume they know as much as internists. We know a lot about general medicine, but that arrogance that we know as much as IM is what gives us a bad rap.

 

[Saga1]

And even with that, you say 50% fail it?!? And of those that take it, how many of the class that started sit for the step 1? 50%? 75%? That means, if you are looking at a Caribbean school, even the top ones, from day one of starting, you are looking at 25-37.5% chance of even passing step 1, and the 50% match rate is of those who make it that far, which is probably 50% at best, so at best, 1 of every 4 people who start at the top carribbean school ends up with a residency. US Med schools, probably something like 90% of those who start finish, and of those 95% match, so you are looking at an 85% likelyhood of residency after starting medical school? And this will get more skewed.

50% from the poorer schools fail it. Depending on the school and pass rates, the Big 4 state that their Step 1 pass rates are in the 90s. And the 50% match rate is the average match rate for all caribbean schools, some have around 90% match rate (SGU) while others can be as low as 10%. So if you were to go to SGU which has the lowest attrition (around 10% I believe) you would have around an 80% chance of matching from the get go. If you went to Ross which has a higher attrition rate (I think 30%) and a match rate of 80%, a student statistically speaking would have around a 60% chance of matching. But this just looking at statistics without taking other factors into consideration such as how well the student studies, reasons for attrition etc. A lot of people drop out in the first couple of weeks because of the island environment. However it will definitely get more skewed in the coming years.

 

[thedrjojo]

While you may not find it interesting, there are dozens more who find surgery uninteresting. To assume that these fields are uninteresting to the majority of students is a rather bold statement.

I was over simplifying, I do appologize, and I do realize that everyone has their own motivations and desire... I was more pointing out that simply by increasing compensation for primary care will not sway everyone, because there are plenty like me who don't find it as interesting or stimulating... my last line

Ughh...please don't repeat that ridiculous statement. It makes you and other surgeons look bad to assume they know as much as internists. We know a lot about general medicine, but that arrogance that we know as much as IM is what gives us a bad rap.

and yeah, the quote is in poor taste... I don't assume to think that we know as much as IM about most topics in IM (just like IM shouldn't claim to know as much about surgical topics... both sides are at fault)... I was more look at it from the point of diversion when treatment and solutions come into it, ie, Surgery is more of a fixer up specialty and IM is more of a manage the situation specialty... but surgeons also need to manage, and IM also can fixer up...

 

[thedrjojo]

50% from the poorer schools fail it. Depending on the school and pass rates, the Big 4 state that their Step 1 pass rates are in the 90s. And the 50% match rate is the average match rate for all caribbean schools, some have around 90% match rate (SGU) while others can be as low as 10%. So if you were to go to SGU which has the lowest attrition (around 10% I believe) you would have around an 80% chance of matching from the get go. If you went to Ross which has a higher attrition rate (I think 30%) and a match rate of 80%, a student statistically speaking would have around a 60% chance of matching. But this just looking at statistics without taking other factors into consideration such as how well the student studies, reasons for attrition etc. A lot of people drop out in the first couple of weeks because of the island environment. However it will definitely get more skewed in the coming years.

I would have to see the numbers to believe you, because there is no way I believe SGU has a 90% match rate. I also find the attrition rates hard to swallow, but that I have less knowledge of. If match rate really was 90%, then no SGUer should consider a prematch at not their top place, because they would have just as good as almost all US Med schools (some dropped below 90% match rate themselves last year)... I have talked and rotated with several SGU students, and never have I heard 90%, or even 80% for ross...

 

[latinman]

I am a Senior Medical Resident, and I can tell you that the effects of the recession have already caused a lot of VERY COMPETITIVE applicants to apply to all kinds of different specialties which 5 years ago were thought as NON-Competitive. My specialty is not primary care, but it wasn't this competitive in the past. Some of the guyz I am interviewing have test scores over the 95th %tile. They could do Radiology or ENT, but instead they choose to do another field!! This is crazy!!!

It is gonna suck to be a Carib Grad or Foreign grad !! If you don't crush your USMLE's all of your doors will get closed.

 

[NRAI2001]

I would have to see the numbers to believe you, because there is no way I believe SGU has a 90% match rate. I also find the attrition rates hard to swallow, but that I have less knowledge of. If match rate really was 90%, then no SGUer should consider a prematch at not their top place, because they would have just as good as almost all US Med schools (some dropped below 90% match rate themselves last year)... I have talked and rotated with several SGU students, and never have I heard 90%, or even 80% for ross...

https://baysgu35.sgu.edu/ERD/2008/ResidPost.nsf/BYPGY?OpenView&RestrictToCategory=PGY2&Count=-1

http://books.google.com/books?id=NU...resnum=3&ved=0CBsQ6AEwAg#v=onepage&q=&f=false

Where do you keep coming up with your ridiculous stats jojo??

 

[thedrjojo]

I am not arguing the SGU students never match... and nothing you show me again states 90% of students match... the first link says 30% get placement via prematch, and then the rest lists a bunch of names of people in residency...

the second is a book that, of the 5 reviews, almost all of them mention that it has erroneous information and that each description "The information about each school sounds like marketing directly from the school." as one person quotes it. Just browsing through to see what it says about my school, I stumbled across the fact that NYU is apparrently Mt. Sinai School of Medicine in this book... Even looking at the front page, it states up to date information about the 162 schools accrediated by the AAMC... funny, since according to the AAMC, it recognizes 131 US Medical Schools, and 17 Canadian, St. George's doesn't seem to be one (granted, on the back cover it breaks it down to 128 US, 3 PR, 15 Canadian, and 16 Osteopathic, but again, St. George's doesn't fit into any of those numbers, and no where in the book does it state otherwise)... even reading the academics intro to st. georges, it says "have conducted site visits of our medical program" further providing proof that information was either lifted from websites or written by the places themselves, and not independently written... this book proves or shows me nothing, and neither does your web link... I appologize if I underestimated how well St. Georges does, I was pulling numbers mostly out of the air from hearsay, but again, if you want to tell me 90% of St. Georges students match (when US seniors had about a 94% match rate last year) and all IMG's (again, not listing St. Georges or even carribbean alone) was around 40%... and both of those numbers come from the NRMP website and data tables

 

[Coastie]

One thing that isn't mentioned through all of this primary care discussion is that one reason it is not as sought after as some of the other fields is that it just isn't that interesting? Internal Med, Family Med, Peds, they are all incredibly dull to me, and even if they paid 5x what they currently offer, I wouldn't give a second thought about going into them. While I find some areas of gen surgery dull, the overall field is much more interesting, the combination of technical skills, faster paced decision trees, and the intellectual requirements (as one PD on an interview put it, Surgeons are Internists who finish the training). But I also find most in the ROAD dull as well... I do appreciate and applaud those of you who enjoy primary care, you are better people than I am, and probably deserve 5x what ROAD makes (still not necessarily more than gen surg, but what can I say?)

Deserve 5x what ROAD makes....Why is that again?

Yeah, you know, those anesthesia guys are just tube jockeys, right? Radiologists are lazy nerds, derm people only play with skin, and people don't really care about having excellent eye surgeons, because hey, vision isn't that important!

Have fun in gen surg where you'll make 1/2 of ROAD...and know 1/10th the medicine of an internist. Come to think of it, why don't internists deserve to make more than gen surg?

 

[NRAI2001]

I am not arguing the SGU students never match... and nothing you show me again states 90% of students match... the first link says 30% get placement via prematch, and then the rest lists a bunch of names of people in residency...

the second is a book that, of the 5 reviews, almost all of them mention that it has erroneous information and that each description "The information about each school sounds like marketing directly from the school." as one person quotes it. Just browsing through to see what it says about my school, I stumbled across the fact that NYU is apparrently Mt. Sinai School of Medicine in this book... Even looking at the front page, it states up to date information about the 162 schools accrediated by the AAMC... funny, since according to the AAMC, it recognizes 131 US Medical Schools, and 17 Canadian, St. George's doesn't seem to be one (granted, on the back cover it breaks it down to 128 US, 3 PR, 15 Canadian, and 16 Osteopathic, but again, St. George's doesn't fit into any of those numbers, and no where in the book does it state otherwise)... even reading the academics intro to st. georges, it says "have conducted site visits of our medical program" further providing proof that information was either lifted from websites or written by the places themselves, and not independently written... this book proves or shows me nothing, and neither does your web link... I appologize if I underestimated how well St. Georges does, I was pulling numbers mostly out of the air from hearsay, but again, if you want to tell me 90% of St. Georges students match (when US seniors had about a 94% match rate last year) and all IMG's (again, not listing St. Georges or even carribbean alone) was around 40%... and both of those numbers come from the NRMP website and data tables

90% SGU match vs. 94% US seniors match is not a real comparison. A lot of SGU matches do go to IM, Peds, FP, ER, OBGYN, Neuro...etc the lesser competitive specialties and even with in these specialties most appear to be mid tier; of the 94% of US Seniors that match I m sure a greater percentage will match into the more competitive specialties and probably more at upper tier programs..h

Going to SGU expecting to become a neurosurgeon, dermatologist, plastics, ortho.... is exteremly niave. But going to SGU with the intention of becoming IM, Peds, OBGYN, ER, FP...etc (i.e. the avg competitive specialties) + if your a hardworking and above avg student you can have a reasonable shot at anesth, rads, general surgery (again mainly at lower tier and mid tier programs) is a reasonable goal.

Again its common sense, don't go to SGU (or any of the other big 4s) expecting a very competitive specialty at an upper tier program... but if your ok with getting into an average specialty at a midtier or lower tier program then the big 4 will give you a 90% shot of getting it on your first attempt.

Remember an avg medical specialty is still 10Xs better when it comes to salary and security compared to the avg americans job..

 

[PacificBlue2012]

I really doubt IMG/FMGs will really be shut out any time soon but harder residencies that some IMG/FMGs currently get will be closed out. I myself am an IMG but I am working in another rich country, so I see no incentive to go to the US for residency.


The average doctor 10x more secure than the average American worker? That makes me wonder if I really would want to live in such a society.

 

[PlutoBoy]

I really doubt IMG/FMGs will really be shut out any time soon but harder residencies that some IMG/FMGs currently get will be closed out. I myself am an IMG but I am working in another rich country, so I see no incentive to go to the US for residency.


The average doctor 10x more secure than the average American worker? That makes me wonder if I really would want to live in such a society.

I heard Australia is really good

 

[Giemsa]

i heard australia is really good

lol