THE SOAP 2013 Thread

[gutonc]

Yea, I'm not sure why a doctor who didn't match is prevented from taking the PA or NP licensing exams other than legal headache from IMGs that want to do the same. I do think they should take the licensing exams though.

I do think some people are vastly underestimating PA exams and what they need to go through though ( don't know about NP). There aren't many schools out there and the average PA probably did better than the average DO in terms of where they went for college and their college GPA (even the low tier PA schools average 3.3 gpa).

I was with you for the first paragraph, but then you lost me comparing a 2y PA degree to a 4y DO degree (and I'm an AMG MD/PhD who thinks most DOs went that route to avoid going Carib). Are you honestly comparing the education and training of a PA to a DO (whose education and training is more or less equivalent to the average AMG)?

But I do actually support some sort of IMG-->PA track. There are a metric f**kton of medico-legal issues to work out in that setting though so don't hold your breath for it.

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[tkim]

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[scott1981]

the goal would be to reduce the number of applications each institution must review before giving a final offer thus prioritizing a qualified AMG. is that so unfair?

a priority filter would maximize the number of qualified/zero red flag AMGs to secure spots. that alone would relieve a lot of stress. if you don't agree with it, you have to have a damn good reason. i know multiple sub surg specialty applicants who didn't even find a prelim.

now maybe im misunderstanding you. are you referring to soap or the match? if its for the match, its impossible to implement on many levels.

i do think something can be implemented in soap for people that matched to an advanced position, but not a prelim. i think they should get priority. they will get more out of the prelim position than anyone that simply did not match.

currently the way soap is set up, significant preference is already given to the AMG. trust me on this.

the problem is that there are too few residencies in general, especially surgical positions. there are just too few spots for highly qualified applicants. without altering the match/soap process, the problem can be alleviated by applying to backups. trust me, those AMGs will not be scrambling if they did that.

bottom line, in about 4 years when all the class size increases come on line and entered into the match......... the caribbean applicant will not be an issue.

 

[ravijaua]

Who would have thought a simple thread I started about the SOAP would end up getting 110,000 plus views and 1000 plus replies. I'm kind of happy about creating the most replied to and most viewed thread of the ERAS/NRMP folder. Woo Hoo, at least I can feel good about something this year.

 

[halekulani]

now maybe im misunderstanding you. are you referring to soap or the match?

i do think something can be implemented in soap for people that matched to an advanced position, but not a prelim. i think they should get priority. they will get more out of the prelim position than anyone that simply did not match.

this is a soap thread

EVERYTHING i've been talking about has been directly related to soap

 

[mozdef]

Thank you all in advance for any advice that may come my way. The thread has been up and down with getting down right nasty in some cases and though tensions run high and anger, sadness and being bitter is ok for the time being, please try to not get jaded. So here's my story;
Non traditional US senior in public state medical school; long story short, had to work EMS through medical school for financial reasons. Bad at managing both and ended up repeating 2nd year for a single course failure in which remediation was not an option. Tough coming back from it but I will finish my coursework with no other failures on my record. Passed all Steps first time with below average scores(1-221 2-208 CS - P). I was always passionate about EM, Honored all my EM aways, clerkships and continued to participate in research projects that will be submitted for publication this month and next. I applied early and widely on the eastern seaboard, knowing that EM is getting more and more competitive. My application was held up until late October for one letter of rec from an away program. I received 6 interviews, which I thought had gone well, and was counseled to apply to IM/prelim as a back-up. Only received one interview at my home institution and was told by the PD that my application was so EM heavy that it was no surprise that I did not receive more IV invites in my back ups.
NOW: No match, No SOAP and about 500k in debt and not sure about my future.
Plan: Try to scramble on Monday, keeping an eye out for any openings that might occur while in the meantime returning to work to live and try to participate in anypublishable research that might bolster my re application next cycle where I will try for EM even more widely and more IM programs as many as I can afford to apply to.
Any advice out there of anything more that I should do? Constructive comments would be greatly appreciated. Best of luck to all of you....

Keeping calm and carrying on...

500k whoaa that's like going to med school twice. How did you manage this?

 

[mozdef]

I just want to say how much I sympathise with everyone who didn't match but especially all the AMGs here. I find it incredible that a system exists which will allow you to rack up a quarter of a million dollars of debt without giving you the opportunity to pay it back? My heart truly goes out to all 800 of you that didn't match, joining the 800 from last year and the year before.... It's just wrong.

I applied as an IMG from the UK with my terrible scores (albeit with a Ph.D and a lot of publications). Applied broadly - no interviews. SOAPed - no interviews. I've got one LoR from a Sub-I I did in 2008 but all my other (actually great) references are from the UK. I was disappointed but at least I've a job (albeit a poor one) being a doctor. I can't imagine what you guys are going through with this SOAP/match nightmare.

Poor one? Are you working as a physician? If so, how much do they typically get paid over there? Just wondering.

 

[scott1981]

this is a soap thread

EVERYTHING i've been talking about has been directly related to soap

even for soap, AMGs already get preference. most places would rather offer to an AMG with no red flags.

but no worries.... in 4 years this is all going to be moot.

 

[halekulani]

even for soap, AMGs already get preference. most places would rather offer to an AMG with no red flags.

but no worries.... in 4 years this is all going to be moot.

again missing the point
programs are flooded w/ apps if everyone submits 30

there's a way to efficiently deliver quality AMGs to the schools making the soap easier for both sides

i dont know how many more ways i can skin this cat on why we should have priority applications for soap

 

[scott1981]

again missing the point
programs are flooded w/ apps if everyone submits 30

there's a way to efficiently deliver quality AMGs to the schools making the soap easier for both sides

i dont know how many more ways i can skin this cat on why we should have priority applications for soap

its beating a dead horse at this point. its not going to happen over the next 4 years.

a red flag for one program director may not be one for another. too hard to implement to satisfy everyone. i can honestly say that although you, as an american allo med student want this now (biased or not), most program directors would push back. they want freedom of choice.

but the horse is dead and i see there is no convincing you. we might as well end it there..... but like i said..... in four years, this argument is moot.

 

[Ogenki]

Are you honestly comparing the education and training of a PA to a DO (whose education and training is more or less equivalent to the average AMG)?

No, I was comparing AMG training (and I think DOs are AMG) to PA training. There's no argument from me that AMGs get more training in med school than a PA gets in PA school. But PAs learn pretty much the same subject matter, stuff gets condensed or cut out, but AMGs should have learned everything PAs did (and more). That's why MD/DOs should be able to license for them. I don't think its double the time because frankly I thought we wasted some of our time in med school but that's a different argument.

All the comparison I made from PAs to DOs is that their average college GPA is similar. It is. A top DO school's GPA is probably ~3.4-3.5 I'm not too sure because once you get towards 3.5, you start running into 'back-up' allopathics that take from across the country. PA schools in major states range from 3.3 to 3.4 average GPA.

I made the comparison because some people seem to be looking down on them as failed premeds. In fact the average PA probably did better in college/university than the average DO after the explosion of new DO med schools.

 

[halekulani]

its beating a dead horse at this point. its not going to happen over the next 4 years.

a red flag for one program director may not be one for another. too hard to implement to satisfy everyone. i can honestly say that although you, as an american allo med student want this now (biased or not), most program directors would push back. they want freedom of choice.

but the horse is dead and i see there is no convincing you. we might as well end it there..... but like i said..... in four years, this argument is moot.

no i completely understand from the POV of a program director that a 240 step 1 US or IMG are both basically on the same level and i would totally pick the IMG with the 240 if i were a PD myself

from the POV of someone running the AMA, you need to protect US grads. that simply has to be a priority.

again, i think your opinions are coming from a narrow view. i'm talking about fixing the system that would work in favor of the majority.

 

[dusselas]

again missing the point
programs are flooded w/ apps if everyone submits 30

there's a way to efficiently deliver quality AMGs to the schools making the soap easier for both sides

i dont know how many more ways i can skin this cat on why we should have priority applications for soap

If you believe AMGs are superior to IMGs as a rule, then you obviously believe in American exceptionalism. IMGs come from all over the world and cannot be neatly categorized as inferior to AMGs. Are AMGs from med schools in Alabama superior to IMGs from med schools in Germany? You have a serious lack of knowledge if you can't see why there is no correct answer to such a question. The only reason there is a preference for AMGs is because most PDs are AMGs and are familiar with requirements of American med schools. Some foreign med schools have tougher requirements, such as oral final exams, and oral and written licensing exams over several days. Still, that just indicates such schools are more stringent, maybe not superior. But it also indicates students who pass such stringent exams are also very smart, have worked very hard, and are well-qualified. Who would say these IMGs are inferior to AMGs?

 

[Noegrus]

no i completely understand from the POV of a program director that a 240 step 1 US or IMG are both basically on the same level and i would totally pick the IMG with the 240 if i were a PD myself

from the POV of someone running the AMA, you need to protect US grads. that simply has to be a priority.

again, i think your opinions are coming from a narrow view. i'm talking about fixing the system that would work in favor of the majority.

You seem to be new here. Take a look at the match statistics released today. There were ~1000 extra allopathic grads this year above and beyond last year's numbers and they got absorbed in the main match without a whimper. The unmatched rate for allos is less than that in 2009 and 2010. Some people will mess up. That is a given. No PD would pick the IMG if both the IMG and AMG have 240. No one in their sane mind does that and PDs are very smart people. What you are arguing is that the PDs should pick an AMG with 192 and two attempts on Step 1 over an IMG with 250. The PD needs to run the program and get acceptable board pass rates. They are running a business and picking the loser just turns a loss for them. The statement that they have loans to pay is irrelevant. The medical enterprise is not run as a charity, at least in this country.
The people who went unmatched in GS and subspecialty or derm - and I know some very bright ones who did in their time - ALWAYS go unmatched because of strategic blunders (i.e. ortho applicant was told that he was ranked very highly by home program, canceled all other interviews, went unmatched). GS applicants go unmatched. Meanwhile, Harlem hospital ctr is rumored to have 100% IMGs as its categorical GS residents. Same goes for Bronx Lebanon. There is no need for expansion of residency positions, there are 50% more positions than AMG candidates. There is a need to explain to people that ending up at Lincoln Medical Ctr or Jacobi is better than going unmatched.

 

[scott1981]

no i completely understand from the POV of a program director that a 240 step 1 US or IMG are both basically on the same level and i would totally pick the IMG with the 240

from the POV of someone running the AMA, you need to protect US grads. that simply has to be a priority.

nobody has the power to do that. frankly, the program director's desires will outweight any outside political organization. the AMA is the last lobbying organization that would step up to the plate since they have done such a superb job with everything else . there is a reason that they keep sending me a $450 dues notice which goes unpaid to try to hook me as a member. plus they dont want to pick a fight for a cause that is going to piss off a large portion of their members.....or should i say sources of income.....namely IMG's and FMG's

 

[scott1981]

You seem to be new here. Take a look at the match statistics released today. There were ~1000 extra allopathic grads this year above and beyond last year's numbers and they got absorbed in the main match without a whimper. The unmatched rate for allos is less than that in 2009 and 2010. Some people will mess up. That is a given. No PD would pick the IMG if both the IMG and AMG have 240. No one in their sane mind does that and PDs are very smart people. What you are arguing is that the PDs should pick an AMG with 192 and two attempts on Step 1 over an IMG with 250. The PD needs to run the program and get acceptable board pass rates. They are running a business and picking the loser just turns a loss for them. The statement that they have loans to pay is irrelevant. The medical enterprise is not run as a charity, at least in this country.
The people who went unmatched in GS and subspecialty or derm - and I know some very bright ones who did in their time - ALWAYS go unmatched because of strategic blunders (i.e. ortho applicant was told that he was ranked very highly by home program, canceled all other interviews, went unmatched). GS applicants go unmatched. Meanwhile, Harlem hospital ctr is rumored to have 100% IMGs as its categorical GS residents. Same goes for Bronx Lebanon. There is no need for expansion of residency positions, there are 50% more positions than AMG candidates. There is a need to explain to people that ending up at Lincoln Medical Ctr or Jacobi is better than going unmatched.

very nicely put!!!!!

 

[Jessipeds]

I fail to see why the US MD applicants (unmatched/match) are targeting solely American Caribbean students when there are far more NON-AMERICAN IMG's who need VISAs applying and possibly taking spots "away".

Also, in the slightest of defense, we the lucky American Caribbean ones who did get a spot, aren't being "handed" anything. We work our ass off, oh .. did we mention our tax dollars are also funding the positions that are benefiting us?

Blame the government I'd say. The current administration wanted to ensure that jobs stay in the country and that we don't go out looking for people to work for us. Heck if they readily hand out H1s and J1s etc. I don't see how they're going to accomplish the herculean task.

100% agree with this. American IMG's should be given preference over foreign IMG's. I think it is completely ridiculous how we are handing out visas like candy to all these non-English speaking, visa-needing people showing up here looking for American dollars. I met many of these people on the interview trail as well as on clinical rotations (they were observers), and all of them told me straight up that they are seeking a US residency because they can make more money in the US. Many of these third-world countries are full of impoverished people who need good, qualified doctors to treat them. There is a humanitarian crisis in your country, millions of people are suffering because they don't have adequate care, and you don't have the moral values to help these citizens of your own freakin' country? No, instead, the AMG should go and do a medical mission to help treat the underserved who are not being treated by their own countries' medical graduates.

 

[xrevision]

Instead of just circlejerking/beating a dead horse on an internet forum I've already written to my congressman to investigate if there are better ways to ensure that more US citizens (AMG and US-IMG alike) match. Such as limiting the amount of FMG's applying to the main match, and have 2 different matches. I suggest you other AMGs/US-IMG's do the same. This is in light of tying SGR to residency positions. If that were untied and more residency positions were created, I don't think special protections would be needed. I do like working with IMG's, but this is about protecting the interests of our citizens.

 

[Noegrus]

While we are distinguishing between groups, why not have a preference/first shot/separate match for Caucasian AMGs? I would really like to not bust my ***** to get into a top training program. I would really like to be able to use some quota because the color of my skin makes me superior IMO.

[YOUTUBE]http://www.youtube.com/watch?v=768h3Tz4Qik[/YOUTUBE]

 

[CDI]

You seem to be new here. Take a look at the match statistics released today. There were ~1000 extra allopathic grads this year above and beyond last year's numbers and they got absorbed in the main match without a whimper. The unmatched rate for allos is less than that in 2009 and 2010. Some people will mess up. That is a given. No PD would pick the IMG if both the IMG and AMG have 240. No one in their sane mind does that and PDs are very smart people. What you are arguing is that the PDs should pick an AMG with 192 and two attempts on Step 1 over an IMG with 250. The PD needs to run the program and get acceptable board pass rates. They are running a business and picking the loser just turns a loss for them. The statement that they have loans to pay is irrelevant. The medical enterprise is not run as a charity, at least in this country.
The people who went unmatched in GS and subspecialty or derm - and I know some very bright ones who did in their time - ALWAYS go unmatched because of strategic blunders (i.e. ortho applicant was told that he was ranked very highly by home program, canceled all other interviews, went unmatched). GS applicants go unmatched. Meanwhile, Harlem hospital ctr is rumored to have 100% IMGs as its categorical GS residents. Same goes for Bronx Lebanon. There is no need for expansion of residency positions, there are 50% more positions than AMG candidates. There is a need to explain to people that ending up at Lincoln Medical Ctr or Jacobi is better than going unmatched.

Aye, keep that on the DL...
Entitlement Match strategy FTW!

Also, many PDs & attendings are IMGs, 15-20% of doctors in the US are. They'll always look to snag some fellow-IMGs and lend a helping hand to someone who made it against the odds like they did. That wont change too much. Although in the next 3-4 years USMLE pass scores may get jacked higher, and minimum screening cutoffs may be raised further.

 

[CDI]

Well, this thread has officially gone full ****.

 

[rokshana]

no i completely understand from the POV of a program director that a 240 step 1 US or IMG are both basically on the same level and i would totally pick the IMG with the 240 if i were a PD myself

from the POV of someone running the AMA, you need to protect US grads. that simply has to be a priority.

again, i think your opinions are coming from a narrow view. i'm talking about fixing the system that would work in favor of the majority.

Actually there are just as many F/IMGs applying to the match so there really isn't an AMG majority per se.

And your 1st statement demonstrates that you don't get it... The 240 IMG and the 240 AMG are NOT seen in the same light or at the same level...the 240 IMG is being lumped in with the 200 AMGs and even then the 200 AMG is going to get interviews at places the 240 IMG could only dream of...

And whether you believe it or not... The AMG ( and I mean us seniors not DOs...they are still considered independent applicants) IS already getting preferential treatment... If the NRMP releases those numbers, I am pretty comfortable saying that most of the SOAP spots were filled by AMGs...the IMG does not fare well in the soap.

Again, this isn't an issue of the slacker AMG , but that AMGs probably didn't apply to enough programs or interview or rank enough places...AMGs had the luxury of being picky and it wasn't an issue of IF they would match but WHERE...now? Now you are competing with MORE AMGs and in the coming years what with the new schools opening, the AMG is going to now need to interview and rank in the double digits to assure themselves A spot...

 

[CDI]

Actually there are just as many F/IMGs applying to the match so there really isn't an AMG majority per se.

And your 1st statement demonstrates that you don't get it... The 240 IMG and the 240 AMG are NOT seen in the same light or at the same level...the 240 IMG is being lumped in with the 200 AMGs and even then the 200 AMG is going to get interviews at places the 240 IMG could only dream of...

And whether you believe it or not... The AMG ( and I mean us seniors not DOs...they are still considered independent applicants) IS already getting preferential treatment... If the NRMP releases those numbers, I am pretty comfortable saying that most of the SOAP spots were filled by AMGs...the IMG does not fare well in the soap.

Again, this isn't an issue of the slacker AMG , but that AMGs probably didn't apply to enough programs or interview or rank enough places...AMGs had the luxury of being picky and it wasn't an issue of IF they would match but WHERE...now? Now you are competing with MORE AMGs and in the coming years what with the new schools opening, the AMG is going to now need to interview and rank in the double digits to assure themselves A spot...

The difference in score 'leeway' is a completely fair one and adjusted appropriately. AMGs do not get to take dedicated years off for each USMLE exam. Some IMGs take one year to TWO years per exam, doing nothing but studying! That is seriously ridiculous to me and I'm an IMG myself. If the US becomes more strict on the 2-years from graduation (unspoken criteria) for IMGs it may really even the score "playing field" a bit.

 

[septoplasty]

The difference in score 'leeway' is a completely fair one and adjusted appropriately. AMGs do not get to take dedicated years off for each USMLE exam. Some IMGs take one year to TWO years per exam, doing nothing but studying! That is seriously ridiculous to me and I'm an IMG myself. If the US becomes more strict on the 2-years from graduation (unspoken criteria) for IMGs it may really even the score "playing field" a bit.

Not that i'm condoning this, but there are just too many variables behind this and you can't judge everyone in the same light.

One possible reason IMG's do this is because the USMLE is VERRRRRRRRRRRY different than the types of examinations they are used to (as one of the posters mentioned above, sometimes consisting of oral exams, essay type written exams etc.). I bet if you were an AMG and went to the UK or wherever, and sat for their exam.. you wouldn't be doing too well. Not because you don't have the knowledge, but because what's being asked is presented differently.

 

[CDI]

Not that i'm condoning this, but there are just too many variables behind this and you can't judge everyone in the same light.

One possible reason IMG's do this is because the USMLE is VERRRRRRRRRRRY different than the types of examinations they are used to (as one of the posters mentioned above, sometimes consisting of oral exams, essay type written exams etc.). I bet if you were an AMG and went to the UK or wherever, and sat for their exam.. you wouldn't be doing too well. Not because you don't have the knowledge, but because what's being asked is presented differently.

Um, I can judge this. I went to a non-Caribbean school overseas. Joined one of the most rigorous programs you could enter (one which is well known to have helped support the US system for decades now). I'm from the US system and I had to suddenly take all written essay exams, oral viva exams and live patient practicals...fail any one aspect and fall back 6 months. I survived, and finished on time. Here I am aiming to take my USMLEs in a reasonable amount of time. You don't need 3-4 years, nor should one take that long.

 

[NJDevilsFan]

Um, I can judge this. I went to a non-Caribbean school overseas. Joined one of the most rigorous programs you could enter (one which is well known to have helped support the US system for decades now). I'm from the US system and I had to suddenly take all written essay exams, oral viva exams and live patient practicals...fail any one aspect and fall back 6 months. I survived, and finished on time. Here I am aiming to take my USMLEs in a reasonable amount of time. You don't need 3-4 years, nor should one take that long.

I am a USIMG from the Carib system (AUA) and I agree with this statement. I took less than a month to prep for all of my step exams. My issue is that AMGs with the same score as me (mid 220s) should not be given preference. Since so many argue that they're entitled to residency seats because of their MCATs from college then maybe they should study harder for their exams. With all the change coming to the number of US med students coming up, maybe our AMG counterparts should get with the times and apply broadly just as we have been doing for years.

But right now in 2013, residency slots outnumber US IMGs so where do you expect those people to come from???

And those people with mediocre scores should be smarter about the way they apply. Just because you we're a cocky AMG with no contingency plan, you're entitled to NOTHING.

The MCAT works for US schools because a small number of seats need to be filled, and the MCAT is unfortunately the best way to screen. But after that you are NOT SPECIAL. The US schools just want people that won't screw up a standardized test.

The IMGs who take > 6months- a year for step prep deserve the scrutiny though, and they should be grilled about large study gaps in interviews

 

[CDI]

I am a USIMG from the Carib system (AUA) and I agree with this statement. I took less than a month to prep for all of my step exams. My issue is that AMGs with the same score as me (mid 220s) should not be given preference. Since so many argue that they're entitled to residency seats because of their MCATs from college then maybe they should study harder for their exams. With all the change coming to the number of US med students coming up, maybe our AMG counterparts should get with the times and apply broadly just as we have been doing for years.

But right now in 2013, residency slots outnumber US IMGs so where do you expect those people to come from???

And those people with mediocre scores should be smarter about the way they apply. Just because you we're a cocky AMG with no contingency plan, you're entitled to NOTHING.

The MCAT works for US schools because a small number of seats need to be filled, and the MCAT is unfortunately the best way to screen. But after that you are NOT SPECIAL. The US schools just want people that won't screw up a standardized test.

The IMGs who take > 6months- a year for step prep deserve the scrutiny though, and they should be grilled about large study gaps in interviews

Caribbean apps are deservingly scrutinized as well. Your 220 is not the same as a 220 from an AMG program and/or possibly even an overseas program where the students are the top 0.5% of their country's med applicants. Your day to day competition is much weaker. Thats where the difference lies. Also, many Caribbean programs have dedicated 4-6 month semesters for board prep alone, and people are also known to take much longer in those programs as well as required.

Problem is PDs don't seem to care too much about it.

If someone gets a 250 but took longer to do so, it doesn't matter much cause the person with the 250 clearly has a better grasp of the knowledge than the one with a 200 (just a slower learner maybe).

One method in place to prevent too many inflated IMG scores is by preventing exam re-taking once someone passes (unlike most other exams), maybe that could be relaxed for AMGs though, as alternate to their their dedicated time crunch. Maybe give them a second shot if they fall short of their goal.

We need to see a stricter 2 year post-grad criteria (or more scrutiny over the resume post-grad). This will help AMGs, & US-IMGs but limit non-US-IMGs from taking years and years per each exam creating that ridiculous divide in scores.

 

[AStark]

And whether you believe it or not... The AMG ( and I mean us seniors not DOs...they are still considered independent applicants) IS already getting preferential treatment... If the NRMP releases those numbers, I am pretty comfortable saying that most of the SOAP spots were filled by AMGs...the IMG does not fare well in the soap.

Just for the sake of comparison, the 2012 match rate for IMGs in the first iteration of the Canadian match was 18.2% (42.2% for 2012 grads), which is awful, but nowhere near as abysmal as the match rate in the second iteration of 5.5% (13.9% for 2012 grads). The match rates for CMGs were 94.0% and 62.7% in the first and second iterations respectively. I'm sure the numbers of IMGs in the US are better, but it's worth noting that the second iteration is open to everyone.

 

[NJDevilsFan]

Caribbean apps are deservingly scrutinized as well. Your 220 is not the same as a 220 from an AMG program and/or possibly even an overseas program where the students are the top 0.5% of their country's med applicants. Your day to day competition is much weaker. Thats where the difference lies. Also, many Caribbean programs have dedicated 4-6 month semesters for board prep alone, and people are also known to take much longer in those programs as well as required.

Problem is PDs don't seem to care too much about it.

If someone gets a 250 but took longer to do so, it doesn't matter much cause the person with the 250 clearly has a better grasp of the knowledge than the one with a 200 (just a slower learner maybe).

One method in place to prevent too many inflated IMG scores is by preventing exam re-taking once someone passes (unlike most other exams), maybe that could be relaxed for AMGs though, as alternate to their their dedicated time crunch. Maybe give them a second shot if they fall short of their goal.

We need to see a stricter 2 year post-grad criteria (or more scrutiny over the resume post-grad). This will help AMGs, & US-IMGs but limit non-US-IMGs from taking years and years per each exam creating that ridiculous divide in scores.

I agree with this paragraph, but I still don't see where my competition differs. I sat in front of a computer and took the same test as anyone else who applied this year. That 2year critera rule you're talking about is actually a pretty good idea.

 

[ActionFigure]

so...who's scrambling?

 

[CDI]

[/B]

I agree with this paragraph, but I still don't see where my competition differs. I sat in front of a computer and took the same test as anyone else who applied this year. That 2year critera rule you're talking about is actually a pretty good idea.

Your 220 (by itself) is the same as anyone else's 220. However, the rest of your app as a whole will not hold the same weight as an AMGs. So, if you want it to "even out" then your score would need to be higher to compensate since scores are only one of many filters. PDs have obviously taken that into account, appropriately so.

 

[Chicarito]

Poor one? Are you working as a physician? If so, how much do they typically get paid over there? Just wondering.

http://careers.bmj.com/careers/static/advice-salary-scales.html
An outstanding specialist in the field with a lot of private practice will earn £250K but that is the exception. The majority of consultants are on about £80-100k

There are a lot of non-training jobs in the NHS. However to be a registrar or a consultant you (believe it or not) need to be trained in something.

Its interesting having gone through both application processes. The US system relies so heavily on exam scores. In the UK they couldn't care less about your exam performance as long as you passed. What they do expect a LOT more of is that you take much more responsibility for your own development. If you haven't published a lot, given a presentation at a reasonable level and completed courses like ATLS, you can forget about a competitive specialty. So on my CV I've got a lot more evidence of having done things rather than outstanding scores. The problem with the UK system is that actually being good as a doctor counts for nothing so the "best" candidates in selection are what I call "CV technicians" i.e people who will do anything (including neglecting clinical duties) if they can put it on their CV. I like the US systems use of LoRs for this reason.

I agree with the earlier post about the discrepancy between test scores and physician ability. I can think of lots of doctors with great scores who I wouldn't let treat a relative of mine in a million years.

That said, there are a lot of overseas doctors in non training posts and the NHS is currently trying to create a culture where its OK to not be a consultant. I don't buy it though.

 

[Law2Doc]

Your 220 (by itself) is the same as anyone else's 220. However, the rest of your app as a whole will not hold the same weight as an AMGs. So, if you want it to "even out" then your score would need to be higher to compensate since scores are only one of many filters. PDs have obviously taken that into account, appropriately so.

I think this is the real point. The step 1 score isn't the whole equation PDs take into account here. Having seen some of the things that some of the supposedly better offshore schools are calling core third year rotations, I can assure you that without LCME oversight the education is often not remotely equivalent to the US med students clinical year, even if the step exam score is. If Caribbean students are going to various different community hospitals throughout the country, and doing makeshift "lite" rotations with insignificant didactics and no call and the attendings not particularly vested in teaching them because its not really a teaching hospital, they aren't going to come out of there as prepared to be an intern. PDs know this, and factor this in. So the equivalent step score isn't as important to them -- nobody calls them in the middle of the night about residents scoring low on an inservice exam, but they sure will if the intern is screwing up on call with things he should have learned on his IM sub-I rotation but didn't. So yeah, there are legit reasons FMG/IMG need to put up higher scores to get euivalent consideration -- they aren't coming with the LCME endorsement of a standardized clinical education. It's sort of like going to the store to buy a TV. If two TVs are the same price, but one has a brand behind it you have had a lot of good experience with, and the other not so much, that other one is going to have to have an awful lot of bells and whistles for you to consider it. You wouldnt consider same price to mean it's a coin flip.

 

[scott1981]

Your 220 (by itself) is the same as anyone else's 220. However, the rest of your app as a whole will not hold the same weight as an AMGs. So, if you want it to "even out" then your score would need to be higher to compensate since scores are only one of many filters. PDs have obviously taken that into account, appropriately so.

which when you think about it in the big picture, there really is no difference. the carib student that aced basic sciences, clinical sciences, and both usmle steps would have flourished in a US allo school. when you look at it from a distance, the only real difference was that the AMG scored better on a test about battery schematics, english literature, etc..... or simply had a connection to get in a med school or lived in the proper state. kind of seems trivial when you look at it that way, nevertheless, it doesnt matter. the caribbean student will always get more scrutiny.

bottom line, every one is making a big deal over this. if the AMG's apply broadly, all of this goes away. if they want to use their advantage, make sure that they apply broadly to backup places that IMG's tend to flock. almost guaranteed they would match at the minimum and there would never be a soap or scramble for them. at some point in med school, self responsibility needs to take hold for them. if they dont apply defensively and realistically to prevent going unmatched, they really shouldnt have anyone to cry to. outside of that, this conversation never happens and the 94-95% match rate jumps to 99%.

 

[Law2Doc]

which when you think about it in the big picture, there really is no difference. the carib student that aced basic sciences, clinical sciences, and both usmle steps would have flourished in a US allo school...

hard to know because many Caribbean programs don't have clinical rotations that compare favorably with those required of US students. This, to me, is one of the bigger hurdles they face with PDs. The LCME isn't involved, so it all comes down to how intent the money hungry community hospitals that agree to sporadically host offshore med students for a month or so throughout the year are to provide a solid clinical experience. The couple I've seen do not provide the equivalent rotation to what you'd get at a teaching hospital affiliated with a US med school. Most of the time, they do the bare minimum they need to to keep the cash flowing, often erring on the side if what the students like better (ie no call) rather than the best educational experience. And the clinical years are probably a pretty good indicator of whether one will struggle in residency. PDs know this, and it puts the Caribbean grad in a worse position, despite the step score. They go with the LCME endorsed brand.

 

[scott1981]

hard to know because many Caribbean programs don't have clinical rotations that compare favorably with those required of US students. This, to me, is one of the bigger hurdles they face with PDs. The LCME isn't involved, so it all comes down to how intent the money hungry community hospitals that agree to sporadically host offshore med students for a month or so throughout the year are to provide a solid clinical experience. The couple I've seen do not provide the equivalent rotation to what you'd get at a teaching hospital affiliated with a US med school. Most of the time, they do the bare minimum they need to to keep the cash flowing, often erring on the side if what the students like better (ie no call) rather than the best educational experience. And the clinical years are probably a pretty good indicator of whether one will struggle in residency. PDs know this, and it puts the Caribbean grad in a worse position, despite the step score. They go with the LCME endorsed brand.

that is true for quite a few places. usually the upper tier carib schools do a better job at it, but not always. most of the time, their students are in good hospitals rotating with US allo students. in some cases they create deals with the US allo school (dont know if money is/was involved) and the US allo school allows the carib students to go to the separate lectures with the AMG's at the medical school campus outside of the hospital rotation.

but i agree in that it is too much work to be able to separate what hospital provided a good rotation or not out of the thousands that exist. we cant expect a PD to dissect all this, so its easier to generalize and do what they currently do. however, the student who aced the boards, basic sciences and clinical sciences would probably do good regardless of the quality of the clinicals as they would thrive in any setting.

it is what it is.

 

[IamnotFreud]

Just to clarify, there are no advanced (PGY-2) EM programs. You would have to start as an intern if you want to transfer.

That's absolutely incorrect. There are some programs that are 3 year programs, and there are some programs that require internship and then are 3 additional years. So no you would not have to start as an intern if you transfer, you just have to find a program that is 4 vs. 3 years.


Also wanted to point out that the reason why this match seemed more competitive is because according to what I have recently read, there were 40,000 applicants for 29,000 positions!!! The # of AMGs stayed stable with about 16,000 and some odd number of AMGs graduating, about 7000+ or so DOs/US-IMGs, and then a whopping over 7,000 foreign grads!!!

There were I think 25,000 or so first year spots. So clearly, it's not that there aren't enough spots, there are currently almost twice as many spots as there are AMGs, and even accounting for DO/US-IMGs, there would be spots for everyone of those groups. The problem is that there is a huge amount of foreign grads who want to practice in the US because of financial reasons.

Because there was such a huge amount of foreign grads, that's why many of them can't find positions, which is reasonable. You can't expect to apply in a foreign country and get it. The problem is that the US has created an environment where people are used to being taken care of by the US, but that has limits. So while I feel terrible for AMGs, and US-IMGs as well since they are American citizens, I feel less bad for foreign people who are taking a chance, a shot at working here, and it's entirely for financial gain.

There is a hugeeeeeee shortage of doctors across the world-I"m sure they could be employed n their countries but I'm sure it does not pay as well.

I think we need to develop a system like Canada has, and Canada makes no excuses.

Heck one of the reasons I did not apply to the Canadian system was because I figured as an American grad I would have farrrr less chances than a Canadian grad, and I don't really see a problem with them giving preference to *gasp* their students!

Why can't we develop real expectations here? Problem-you have close to 8,000 foreign people applying, close to a 1/4 of all positions, and they are all expecting to get a spot. Not goign to happen. We should set up real expectations, with first iteration for AMGs, and second one for everyone else. That way, people still have a shot if they want, but they have real expectations at the same time, carefully weigh paying all that $$ before applying, and having a back up.

Honestly, this whole prematch thing was a sham, and unfair to AMGs, I know some programs particularly in IM that are almost all IMGs. I'm sure some of the AMGs who did not match would love getting a spot there. Finally I think the elimination of the prematch is precisely an attempt to raise AMG/DO/ match rates and decrease foreign grad match rates, which is exactly what's happened. Just saying.

 

[Noegrus]

that is true for quite a few places. usually the upper tier carib schools do a better job at it, but not always. most of the time, their students are in good hospitals rotating with US allo students. in some cases they create deals with the US allo school (dont know if money is/was involved) and the US allo school allows the carib students to go to the separate lectures with the AMG's at the medical school campus outside of the hospital rotation.

but i agree in that it is too much work to be able to separate what hospital provided a good rotation or not out of the thousands that exist. we cant expect a PD to dissect all this, so its easier to generalize and do what they currently do. however, the student who aced the boards, basic sciences and clinical sciences would probably do good regardless of the quality of the clinicals as they would thrive in any setting.

it is what it is.

Please pardon my ignorance, but what would you term as 'upper tier'? SGU? AUA? Ross? I met quite a few students from these places at community hospitals where I went to interview for prelim medicine. I can speak for about 5 hospitals. None of them were teaching hospitals where US med students rotate. All had 100% IMG categorical residents. The perceived quality of the hospitals ranged from truly awful (all prelims were IMGs except one depressed-looking AMG who didn't know how he ended up matching there), to excellent (all prelims were AMGs). I did not see any carribs at the NYC academic medical centers I interviewed at. I also have a distant friend at a carribean medical school. She is at SGU, I think. She asked me about housing for her scheduled rotations near the city I live in. I looked up the places and they are small clinics that I had never heard of (peds and psych). Just out of curiosity, which medical schools allow carribs to attend lectures with their own MS?

 

[CDI]

hard to know because many Caribbean programs don't have clinical rotations that compare favorably with those required of US students. This, to me, is one of the bigger hurdles they face with PDs. The LCME isn't involved, so it all comes down to how intent the money hungry community hospitals that agree to sporadically host offshore med students for a month or so throughout the year are to provide a solid clinical experience. The couple I've seen do not provide the equivalent rotation to what you'd get at a teaching hospital affiliated with a US med school. Most of the time, they do the bare minimum they need to to keep the cash flowing, often erring on the side if what the students like better (ie no call) rather than the best educational experience. And the clinical years are probably a pretty good indicator of whether one will struggle in residency. PDs know this, and it puts the Caribbean grad in a worse position, despite the step score. They go with the LCME endorsed brand.

Not really relevant to anyone in this thread, but just to point out that this is being taken into account at a higher level for the long term.

There has already been notice that eventually (~10 years?) non-US med schools with students wishing to enter US residency will have an on-site verification/accreditation procedure of their programs.

 

[scott1981]

Please pardon my ignorance, but what would you term as 'upper tier'? SGU? AUA? Ross? I met quite a few students from these places at community hospitals where I went to interview for prelim medicine. I can speak for about 5 hospitals. None of them were teaching hospitals where US med students rotate. All had 100% IMG categorical residents. The perceived quality of the hospitals ranged from truly awful (all prelims were IMGs except one depressed-looking AMG who didn't know how he ended up matching there), to excellent (all prelims were AMGs). I did not see any carribs at the NYC academic medical centers I interviewed at. I also have a distant friend at a carribean medical school. She is at SGU, I think. She asked me about housing for her scheduled rotations near the city I live in. I looked up the places and they are small clinics that I had never heard of (peds and psych). Just out of curiosity, which medical schools allow carribs to attend lectures with their own MS?

usually AUC, ROSS, and SGU. the NYC rotations tend to be of that quality. i noticed from your location being detroit, so you may be familiar with providence and st john hospital in the detroit area.

im actually an AUC alumnus and 7 years ago when I was a clinical student EVERY 3rd year rotation was with Wayne state students.... we were tied to the hips so to speak. for quite a few rotations, wayne state even sanctioned the AUC students to go to their lectures on campus out of the hospital. we even had michigan state students rotate with us as well. ultimately we became a tight group and we still keep in contact with one another. 4th year was done up there with a few away rotations in florida where I rotated with USF students. heck, Ive even done rotations within the neurology and GI programs in Cleveland clinic with the residents and fellows, fully sanctioned by the GME dept. Hardly a small "community" hospital.

i think your sample size was limited to NYC, and quite frankly those rotations exemplify what is wrong with some caribbean rotations. your ignorance is pardoned

ps- your attitude about some of those holes in NYC is why 5% of AMGs dont match since they never would dream to apply there as a backup. thank you for proving the theory.

 

[CDI]

usually AUC, ROSS, and SGU. the NYC rotations tend to be of that quality. i noticed from your location being detroit, so you may be familiar with providence and st john hospital in the detroit area.

im actually an AUC alumnus and 7 years ago when I was a clinical student EVERY 3rd year rotation was with Wayne state students.... we were tied to the hips so to speak. for quite a few rotations, wayne state even sanctioned the AUC students to go to their lectures on campus out of the hospital. we even has michigan state students rotate with us as well. ultimately we became a tight group and we still keep in contact with one another. 4th year was done up there with a few away rotations in florida where I rotated with USF students. heck, Ive even done rotations within the neurology and GI programs in Cleveland clinic with the residents and fellows, fully sanctioned by the GME dept. Hardly a small "community" hospital.

i think your sample size was limited to NYC, and quite frankly those rotations exemplify what is wrong with some caribbean rotations. your ignorance is pardoned

Doesn't one of the Caribbean programs actually own one of the NY hospitals? Could just be a rumor...

 

[scott1981]

Doesn't one of the Caribbean programs actually own one of the NY hospitals? Could just be a rumor...

yea.... this has caused quite a controversy in NY. SGU paid $100 million for exclusivity in a hospital group (i think it is 4-5 hospitals) for 10 years. they approached it as a business. the NY medical schools cant compete with that since they are usually non-profit and cant come up with cash like that. there were complaints within the new york legislature to prohibit future carib schools from doing that because the NY allo lobby was fearful that in the long run..... this would set a bad precedence by allowing other rich carib schools to buy up other hospitals thus limiting rotations for their own stateside students. since then, AUC bought out a few hospitals on further out on long island for $15-20 million.

http://www.nytimes.com/2008/08/05/nyregion/05grenada.html?pagewanted=all&_r=0

 

[Noegrus]

ps- your attitude about some of those holes in NYC is why 5% of AMGs dont match since they never would dream to apply their as a backup. thank you for proving he theory.

Thats 'cuz I am special.
Still, ranked all of them.
Also, I don't live in MI.

 

[CDI]

yea.... this has caused quite a controversy in NY. SGU paid $100 million for exclusivity in a hospital group (i think it is 4-5 hospitals) for 10 years. they approached it as a business. the NY medical schools cant compete with that since they are usually non-profit and cant come up with cash like that. there were complaints within the new york legislature to prohibit future carib schools from doing that because the NY allo lobby was fearful that in the long run..... this would set a bad precedence by allowing other rich carib schools to buy up other hospitals thus limiting rotations for their own stateside students. since then, AUC bought out a few hospitals on further out on long island for $15-20 million.

http://www.nytimes.com/2008/08/05/nyregion/05grenada.html?pagewanted=all&_r=0

Wow. Yeah, I guess its tough to say no since the hospitals do need the money too. I guess that $100 million gives them a lot to work with and helps support NY jobs though. Tough call...

 

[scott1981]

Thats 'cuz I am special.
Still, ranked all of them.
Also, I don't live in MI.

thats good. hopefully it didnt come to them

if everyone would rank them all.... even the hole in the walls....... there would never be an AMG with a clean academic record in the SOAP.

i just assumed you were from detroit since its listed as your location.... but didnt read the rest of it

 

[manolaMD]

All AMGs and USImgs, please, join our facebook group- residency ready physicians.. We need you!

 

[username456789]

Please pardon my ignorance, but what would you term as 'upper tier'? SGU? AUA? Ross? I met quite a few students from these places at community hospitals where I went to interview for prelim medicine. I can speak for about 5 hospitals. None of them were teaching hospitals where US med students rotate. All had 100% IMG categorical residents. The perceived quality of the hospitals ranged from truly awful (all prelims were IMGs except one depressed-looking AMG who didn't know how he ended up matching there), to excellent (all prelims were AMGs). I did not see any carribs at the NYC academic medical centers I interviewed at. I also have a distant friend at a carribean medical school. She is at SGU, I think. She asked me about housing for her scheduled rotations near the city I live in. I looked up the places and they are small clinics that I had never heard of (peds and psych). Just out of curiosity, which medical schools allow carribs to attend lectures with their own MS?

This was precisely my experience in a completely different area of the country when applying to IM prelims (n=7 for me). I concur with everything contained within your post.

 

[scott1981]

This was precisely my experience in a completely different area of the country when applying to IM prelims (n=7 for me). I concur with everything contained within your post.

maybe things changed since you all seem to be fairly fresh out of med school and my personal experience has been from 6-7 years ago? what area of the country were you in?

although back when i was in the match in 2008....... despite me being a IMG.... i had my pick of programs....... although i was a very strong applicant that was above the average of most AMG's stats....except the one big thing of being an IMG. i too was picky and didnt rank quite a few places because they were holes. after seeing the catastrophe in the SOAP thread, im beginning to see the changes that are occurring. match strategies need to change for everyone to succeed.

 

[Anon212]

That's absolutely incorrect. There are some programs that are 3 year programs, and there are some programs that require internship and then are 3 additional years. So no you would not have to start as an intern if you transfer, you just have to find a program that is 4 vs. 3 years.

Nope, sorry. I believe there are some programs that do require an intern year but that's for DO's and I think that's limited to a very few states (I remember Michigan being one of them). And I'm pretty sure you still start as a PGY1 after your traditional rotating internship year.
4 vs 3 year programs are a totally different thing. 4 year programs tend to be more academic and have more elective time, while 3 year programs are more concentrated. They all start PGY1. There used to be PGY2 advanced EM residencies but the last one switched to PGY1 a year or two ago. So no, you cannot start EM after an intern year without just doing the whole 3 or 4 year program from the beginning as an intern. I just applied in EM.

 

[rokshana]

Caribbean apps are deservingly scrutinized as well. Your 220 is not the same as a 220 from an AMG program and/or possibly even an overseas program where the students are the top 0.5% of their country's med applicants. Your day to day competition is much weaker. Thats where the difference lies. Also, many Caribbean programs have dedicated 4-6 month semesters for board prep alone, and people are also known to take much longer in those programs as well as required.

Problem is PDs don't seem to care too much about it.

If someone gets a 250 but took longer to do so, it doesn't matter much cause the person with the 250 clearly has a better grasp of the knowledge than the one with a 200 (just a slower learner maybe).

One method in place to prevent too many inflated IMG scores is by preventing exam re-taking once someone passes (unlike most other exams), maybe that could be relaxed for AMGs though, as alternate to their their dedicated time crunch. Maybe give them a second shot if they fall short of their goal.

We need to see a stricter 2 year post-grad criteria (or more scrutiny over the resume post-grad). This will help AMGs, & US-IMGs but limit non-US-IMGs from taking years and years per each exam creating that ridiculous divide in scores.

That makes no sense whatsoever... The steps are a standardized test...if a person studies the same amount of time and gets the same score how exactly can you justify that the US student's score is inherently better?

In fact I would argue that the US student should be scoring way better than an IMG or FMG... US med schools have a far more supportive system for their students and are teaching with emphasis on familiarizing their students with the steps from day one of medical school...heck many of these schools have professors that are writing questions for the steps...