THE SOAP 2013 Thread

[CDI]

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...

Like I said in my other post, the app as a whole has less weight. Most Caribbean students take their sweet dedicated time with the Steps as well. The one month prep is an exception, not the rule. However its difficult to determine how much dedicated prep a student really took anyways, unless theres a multi-year gap.

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[rokshana]

The problem is that there is a huge amount of foreign grads who want to practice in the US because of financial reasons.

I feel less bad for foreign people who are taking a chance, a shot at working here, and it's entirely for financial gain.


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.

You make it sound like all the AMG are in it for altruistic reasons....I would believe it if it wasn't for the fact that only 2% of US grads go into (the lower paying) primary care (per JAMA)...I would imagine if medicine paid less, there would be a lot less people in US med schools...

And while I agree that the pre match went against the spirit of the match and the closure of the pre match is an attempt to fix that loophole ( though you do know that DOs, as independent applicants were able to pre match as well- it was only the US senior that couldn't pre match), there was a reason those programs were FMG heavy....most AMGSs would never have thought to apply to those programs, much less actually do their residencies there...what? Did you really think that those programs were actively taking FMGs OVER the AMG that applied? Really???!!

 

[rokshana]

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?

NYMC... Their Peds students rotate alongside the SGU Peds students....
UMDNJ... Their Medicine students rotate alongside the SGU medicine students

And upper tier, well it's more of a separation of those school that are older, are federally funded, and have the ability to be licensed in all 50 states.... Generally sgu,AUC,Ross,in no particular order.

And your friend is not at sgu if she is rotating at a clinic... all of sgu's 3rd yr rotations are done at places with a residency in place in the specialty....some are AOA residency programs, but they are done within the structure of a teaching program.

 

[rokshana]

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

You forget however, that that agreement made sgu the only FOREIGN school tho rotate in the HHC hospitals...it pointedly stated that US students would always be able to rotate.... Interestingly enough these are usually places that the US schools did not want to put their students since prior to the agreement very few of these hospitals had US med students rotating...

 

[rokshana]

Like I said in my other post, the app as a whole has less weight. Most Caribbean students take their sweet dedicated time with the Steps as well. The one month prep is an exception, not the rule. However its difficult to determine how much dedicated prep a student really took anyways, unless theres a multi-year gap.

I agree that the application as a whole will be viewed differently, but your 1st post did not say that... You clearly said that an IMGs 220 is not the same as an AMGs same 220... A score is a score is a score...

 

[Dral]

I agree that the application as a whole will be viewed differently, but your 1st post did not say that... You clearly said that an IMGs 220 is not the same as an AMGs same 220... A score is a score is a score...

A score IS a score, but an IMG 220 doesn't equal an AMG 220. The preceding labels alone tell about the past of a person prior to medical school.

You're welcome to your opinion, but I unfortunately don't think it is an opinion shared by the majority.

 

[CDI]

A score IS a score, but an IMG 220 doesn't equal an AMG 220. The preceding labels alone tell about the past of a person prior to medical school.

You're welcome to your opinion, but I unfortunately don't think it is an opinion shared by the majority.

I don't think they understand there's a difference between AMGs and DMGs.

 

[deathmerchant]

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.

Well I don know abt carribean schools , but schools in most other countries are atleast 5and half yrs long ..and u would be surprised to know , the kind of exposure some colleges get is more than many residents might get here in america. Hell I know people who had done appendectomy and caesareans in their final year med school .Leave alone managing complicated medical and other conditions independently ..
So ...If thats the thing PDs start considering, then probably U would have had more unmatched AMGs here AND hence more Drama and may be an action might have been taken then ... So instead of hoping more AMGs match , hope very few match next time so that the govt realises the seriousness of the situation and find a way ...

Win some Lose some.

 

[Anon212]

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...

I'm gonna disagree on this. I go to a top 10ish US allo school and if anything, they're proud of how much they don't teach to the boards. I can make an argument that maybe they're wrong in this attitude, but basically they feel that we'll do well if we understand the material, not if they feed it to us. I never took an NBME until my step 1 practice tests. No subject-specific NBME's, no "comps" like what they have in the Caribbean. I finished my last class and a month later I had to show up to my first rotation, the rest was up to me. There was no review course, no hints, and the professors (even those who wrote questions for the steps) were not at all involved in making sure we were "ready". It's assumed that we are. I have a cousin at caribbean school and he's currently studying for step 1- he's got an entire semester to do it which includes a long and intensive review course, all his classes so far have had NBME subject tests, he has a school-specific "comp" exam to see if he's ready...don't get me wrong, I'd still rather be me than him, but I don't think I'd ever argue I had more focused prep for Step 1. I had far, far less.

 

[Dral]

Well I don know abt carribean schools , but schools in most other countries are atleast 5and half yrs long ..and u would be surprised to know , the kind of exposure some colleges get is more than many residents might get here in america. Hell I know people who had done appendectomy and caesareans in their final year med school .Leave alone managing complicated medical and other conditions independently ..
So ...If thats the thing PDs start considering, then probably U would have had more unmatched AMGs here AND hence more Drama and may be an action might have been taken then ... So instead of hoping more AMGs match , hope very few match next time so that the govt realises the seriousness of the situation and find a way ...

Win some Lose some.

Yes, and in many other countries people go to med school directly from high school, essentially skipping the equivalent US undergrad.

 

[topscorer]

keep in mind, DO students just need to call anybody DO in the country and shadow them in the clinic, have them sign a form and that meets the requirment for family rotation for the new DO school in FL

SGU/ROSS kids CANNOT graduate without 12 weeks internal core, 8 weeks interal electives, 12 weeks surgery, plus 4 weeks surgery elective, plus peds subi (SGU). so at the end, DO kid needs 8 weeks versus 16 of Carib (just to graduate). I rotated with DO kids in all my hospitals and our psych department was divided into 2 departments of 3 weeks each for the 6 week core. but the DO kids left after 4 weeks, like in the middle of rotation, just stopped coming. I dont know, maybe I'm bitter because I had chance to do DO many years ago but was advised against it, and now I'm paying for that bad advice. I told all my cousins to do it. I've even heard straight out of mouth of USC chairman of radio oncology say DOs are equivalent of AMG. wouldnt of heard that 8 years ago. not in cali anyway. things are different

 

[scott1981]

keep in mind, DO students just need to call anybody DO in the country and shadow them in the clinic, have them sign a form and that meets the requirment for family rotation for the new DO school in FL

SGU/ROSS kids CANNOT graduate without 12 weeks internal core, 8 weeks interal electives, 12 weeks surgery, plus 4 weeks surgery elective, plus peds subi (SGU). so at the end, DO kid needs 8 weeks versus 16 of Carib (just to graduate). I rotated with DO kids in all my hospitals and our psych department was divided into 2 departments of 3 weeks each for the 6 week core. but the DO kids left after 4 weeks, like in the middle of rotation, just stopped coming. I dont know, maybe I'm bitter because I had chance to do DO many years ago but was advised against it, and now I'm paying for that bad advice. I told all my cousins to do it. I've even heard straight out of mouth of USC chairman of radio oncology say DOs are equivalent of AMG. wouldnt of heard that 8 years ago. not in cali anyway. things are different

it was already heated with it being AMG vs IMG, now you just threw DO's into the mix

 

[topscorer]

the carib schools, especially lower tier more unestablished ones, MUST MUST MUST do everything your saying. they have no choice in the matter. THE NUMBER ONE thing that ANY applicant to carib schools considers is the board pass rate of that school. you would fail as a carib school if you did not realize the importance of step 1 pass rates, because that determines overall residency obtainment, and your school's reputation. you will often see new carib schools hide or not publish step score pass rates until it has improved. USMLE is incredibly weighted, so I guess they are responding to the system, especially when your fighting the stereotype, you have to go above and beyond the norm. if a student fails step 1 at your top tier US school, it is relatively painless compared to carib student failing step 1

 

[topscorer]

it was already heated with it being AMG vs IMG, now you just threw DO's into the mix

lol. i didnt mean to. more elective time just means more letters and stronger experience. more power to them. i mean all my friends and family are DO now because of rotations and I advised the younger ones to avoid the mistakes I made. It is best route you can take, especially with two residencies

but apparently they are combining residency now? I thought this would hurt them because now AMGs could apply for former DO residencies, but this is not going to be the case?

 

[NJDevilsFan]

An IMG's study gap is always questioned by PDs and rightfully so. But I am 100% with Rokshana, AMGs have everything handed to them. A US-IMG with a 220 and no visa issue should not have to compete with an AMG with a 192. We're all Americans that have worked hard and want to practice medicine.

 

[Law2Doc]

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.

Ditto. And these were mostly students from the "big four".

 

[Law2Doc]

An IMG's study gap is always questioned by PDs and rightfully so. But I am 100% with Rokshana, AMGs have everything handed to them. A US-IMG with a 220 and no visa issue should not have to compete with an AMG with a 192. We're all Americans that have worked hard and want to practice medicine.

It's not about working hard. It's about crossing the Ts and dotting the i's. Without LCME oversight, there is no way for a PD to know that is the case. With a US grad you know what hoops he has jumped through because there is a trusted certifying body giving it's seal if approval. You know he had a pretty standardized clinical experience. With the offshore programs where schools throw money at community hospitals in exchange for rotations, but don't do a great deal of auditing with respect to what they are getting for that money, it's a crapshoot. Again it's like the TV example. If you have two that are the same price, one thats a known brand and the other not, you go with the name brand unless the other offers extras that blow you away. In this case the extras would perhaps be at a minimum a significantly higher board score. That's pretty reasonable in the consumer setting as well as the PD setting. That's part of what you are signing on for when you go offshore. It shouldn't be a surprise, even if you think it's unwarranted. You are brand X competing against Sony.

 

[CDI]

An IMG's study gap is always questioned by PDs and rightfully so. But I am 100% with Rokshana, AMGs have everything handed to them. A US-IMG with a 220 and no visa issue should not have to compete with an AMG with a 192. We're all Americans that have worked hard and want to practice medicine.

We have two branches of US-IMGs as well. I'm glad that PDs seem to acknowledge this distinction as well.

IMGs, who made it through another nations rigorous curriculum and became licensed while in competition with top tier students.

DMGs, Americans who joined a two year long Step 1 prep course in the islands. These students think Steps are the be all, end all - as witnessed in this thread.

 

[NJDevilsFan]

I don't take issue with AMGs getting preference if the competing IMG scores are SIMILAR. I think a lot of them are brilliant to have even gotten into a US school. However in the case of the exceptional IMG vs a mediocre AMG, there are some that will side with mediocrity. I also take issue with the US medical students who are still hamming up the fact that they did well on their MCAT. I was able to prematch into a great residency and still live it up in college, I also think that the Carib experience made me a well rounded person and not a standardized test-taking robot.

 

[NJDevilsFan]

Just because you we're the biggest nerd in college....

1. Doesn't speak to your ability to be a physican.
2. Doesn't make you better than people who got their act together later on.
3. An MCAT score and an A+ in Orgo doesn't mean squat to the sick and scared.

There are more residency slots than AMGs (currently) so maybe some of you guys should eat some humble pie and apply broadly.
Clinical rotations have educational value if there are attendings willing to teach and patients willing to let you learn.

 

[NJDevilsFan]

We have two branches of US-IMGs as well. I'm glad that PDs seem to acknowledge this distinction as well.

IMGs, who made it through another nations rigorous curriculum and became licensed while in competition with top tier students.

DMGs, Americans who joined a two year long Step 1 prep course in the islands. These students think Steps are the be all, end all - as witnessed in this thread.

I agree with you, the people that take over a year to study do give a lot of us a bad reputation but a lot of US IMGs (myself included) don't believe in long study gaps.

 

[CDI]

There are several issues with that. The medical education and residency systems are essentially a combined national system. US med schools feed US residencies just like Canada, Europe, etc. As such, the system was designed to ensure that all those that are qualified (meet graduation/licensing standards) in the US med school system go on to the residency portion and should go ahead of FMGs/IMGs. FMGs/IMGs were only included because there weren't enough US grads for several decades .When we have parity or approach parity betwen the number of US grads and positions, we don't need IMGs/FMGs.

US-IMGs (Caribbean students in particular) go to non-LCME accredited schools which are accredited by the islands the schools are on; sorry, I don't see much value in St. Maarten or some other islands accreditation standard. As such, this is a huge issue which combined with IMGs push for education based on step scores rather than fundamental knowledge, makes comparison of step scores less valuable.

Finally, its time for the US medical education system to take a look around. For decades, we were the open and mobile system but limtied reciprocation was given to our students wishing to move outside the country. we readily accepted IMGs/FMGs because it benefited our country as we didn't have enough US grads to meet residency spots. Now the situation has changed and its time to protect our graduate sthe same way Canada, the EU, etc do. Anything thats leftover after US grads is fair game but protect our own country's graduates who went to a school accredited by our country's accrediting body.

We will have enough grads, but the shortage persists.

Only true solution for all parties, a truly fair one at that, is to increase the number of residency slots overall, but implement a a residency tuition system for IMGs. Just stop paying them, this is a part of training! (Hint: They have minimal loans as it stands!)

Hospitals need the money, the country needs the doctors and the doctors need the training.

 

[NJDevilsFan]

There are several issues with that. The medical education and residency systems are essentially a combined national system. US med schools feed US residencies just like Canada, Europe, etc. As such, the system was designed to ensure that all those that are qualified (meet graduation/licensing standards) in the US med school system go on to the residency portion and should go ahead of FMGs/IMGs. FMGs/IMGs were only included because there weren't enough US grads for several decades .When we have parity or approach parity betwen the number of US grads and positions, we don't need IMGs/FMGs.

US-IMGs (Caribbean students in particular) go to non-LCME accredited schools which are accredited by the islands the schools are on; sorry, I don't see much value in St. Maarten or some other islands accreditation standard. As such, this is a huge issue which combined with IMGs push for education based on step scores rather than fundamental knowledge, makes comparison of step scores less valuable.

Finally, its time for the US medical education system to take a look around. For decades, we were the open and mobile system but limtied reciprocation was given to our students wishing to move outside the country. we readily accepted IMGs/FMGs because it benefited our country as we didn't have enough US grads to meet residency spots. Now the situation has changed and its time to protect our graduate sthe same way Canada, the EU, etc do. Anything thats leftover after US grads is fair game but protect our own country's graduates who went to a school accredited by our country's accrediting body.

Fair enough, and the US medical school expansion will likely phase out IMGs. But with that expansion, more students will be admitted. The best of the US IMGs will probably have gained admission had they applied to med school in 2017 and beyond. Which is fine with me but it irks me when many US students think of themselves as elite/superior to all IMGs.

 

[NuckingFuts]

WOW has this thread derailed and taken on a life of its own.

Many of you folks need to check your professionalism. I mean, "DMG"? Really??

Instead of demonstrating your keyboard warrior prowess behind the veil of the interweb, do something constructive with your time.

Many of you posters- posers perhaps- clearly bring with you a significant, and to a degree disturbing, amount of preconditioned prejudice- and by extension, arrogance- to this thread, and perhaps to other SDN threads. I don't know what your end game is, but understand this- putting fellow physicians down in the manner and degree to which they are on this forum is simply appalling, and would never be tolerated in real life, and certainly not in the upper echelons of academia, from where some of you imply to be.

To all you unmatched physicians, if you're still reading this thread, I sincerely hope you've the acumen to channel out the negativity defecated throughout this thread, and perhaps learn positive tips from the helpful posts that were shared. Best wishes and good fortune to you.

To you naysayers, and you know damn well who you are, I wish you too good fortune, with a side of humble pie.

 

[CDI]

WOW has this thread derailed and taken on a life of its own.

Many of you folks need to check your professionalism. I mean, "DMG"? Really??

Instead of demonstrating your keyboard warrior prowess behind the veil of the interweb, do something constructive with your time.

Many of you posters- posers perhaps- clearly bring with you a significant, and to a degree disturbing, amount of preconditioned prejudice- and by extension, arrogance- to this thread, and perhaps to other SDN threads. I don't know what your end game is, but understand this- putting fellow physicians down in the manner and degree to which they are on this forum is simply appalling, and would never be tolerated in real life, and certainly not in the upper echelons of academia, from where some of you imply to be.

To all you unmatched physicians, if you're still reading this thread, I sincerely hope you've the acumen to channel out the negativity defecated throughout this thread, and perhaps learn positive tips from the helpful posts that were shared. Best wishes and good fortune to you.

To you naysayers, and you know damn well who you are, I wish you too good fortune, with a side of humble pie.

Coming from someone with the username of "NuckingFuts" I can't take this comment seriously.

 

[NuckingFuts]

Coming from someone with the username of "NuckingFuts" I can't take this comment seriously.

Sad, the contents of the comment didn't take.

Carry on.

 

[NuckingFuts]

...increase the number of residency slots overall, but implement a a residency tuition system for IMGs.

I understand that this idea, interestingly, was floated by a handful of influential hospital administrators in the state of New York roughly 5 years ago. I am unaware of any proposed legislation that may have come about since then.

 

[NuckingFuts]

I would assert there's a big difference in slamming physicians because of their academic pedigree and questioning the rationale for continuing to accept foreign physicians when we have enough supplied by US schools particularly in light of the lack of standardized accredtiation for schools in other countries paritcularly the Caribbean. A certain degree of nationalized protection makes sense in light of the currrent situation; if this was a truly free system US grads could train in other nations, doesn't work that way. As such, I would argue we are obligated to protect our own graduates just as other nations do. Might not be a problem for Harvard med school grads but this has become a challenge at some state med schools having talked to a few friends involved with med ed.

Agree.

 

[CDI]

I understand that this idea, interestingly, was floated by a handful of influential hospital administrators in the state of New York roughly 5 years ago. I am unaware of any proposed legislation that may have come about since then.

This is what other countries have in place, and it works amazingly well. They do it to their OWN grads!

Example: If you are doing your mandatory intern year in the same state but choose to train at a better hospital, you forego your stipend and PAY the new hospital. Then you shut up and work your tail off and be grateful you had that opportunity to learn and train.

Implement this and everyone wins.

IMGs will take their 'residency loans' out, further helping the economy, Medicare and hospitals save money, reduce the work burden on current residents...and our national healthcare still prospers.

 

[CDI]

The idea of a physicians shortage is controversial, many feel we have a far bigger maldistribution problem rather than shortage. Training more will not change this problem only incentivizing living in less ideal locales.

I disagree.

The unintentional (or maybe it should be intentional) saturation itself would drive doctors seeking higher pay into the less ideal locales. More doctors = less pay...something will have to give.

 

[scott1981]

This is what other countries have in place, and it works amazingly well. They do it to their OWN grads!

Example: If you are doing your mandatory intern year in the same state but choose to train at a better hospital, you forego your stipend and PAY the new hospital. Then you shut up and work your tail off and be grateful you had that opportunity to learn and train.

Implement this and everyone wins.

IMGs will take their 'residency loans' out, further helping the economy, Medicare and hospitals save money, reduce the work burden on current residents...and our national healthcare still prospers.

be careful what you wish for. we live in a free market society. we may see an increase in IMG enrollment due to the money making aspect of it for hospitals

 

[CDI]

be careful what you wish for. we live in a free market society. we may see an increase in IMG enrollment due to the money making aspect of it for hospitals

I'm an IMG. No worries here! ;-)

 

[CDI]

Having residents pay for their training devalues the training itself in my opinion regardless of whether its IMGs/FMGs/AMGs paying. Residents provide enough labor to the hospital to generate revenue that more than compensates for their salaries and benefits. As a profession, we are better off having the powers that be fine tune the system together such that each specialty college (ABIM, ABR, etc.) set the number of graduates their specialty needs based on supply/demand, retirement patterns, etc every 3-5 years; the ACGME can then ensure that their are enough accredited spots in each specialty to match the colleges needs. Finally, the LCME and AAMC can work together to match the number of students to the number of residency spots. Obviously some wiggle room will be needed as students take research years, MD/PhD's, drop outs, etc. but the number of wiggle spots would be relatively small.

I highly doubt it would 'devalue' anything. Residents are practically paying already. What does a $47k salary even get you these days? I'm a US-IMG, and I'd be all for this if it helps everyone in the long run. $150k in loans is nothing compared to the $250-500k that AMGs have. Even after 3 years from possibly the same residency...I'd STILL be coming out with $100k less debt than them!

 

[jackets5]

I highly doubt it would 'devalue' anything. Residents are practically paying already. What does a $47k salary even get you these days? I'm a US-IMG, and I'd be all for this if it helps everyone in the long run. $150k in loans is nothing compared to the $250-500k that AMGs have. Even after 3 years from possibly the same residency...I'd STILL be coming out with $100k less debt than them!

Where in the name of sweet jesus do you get your numbers from to assume USIMG's have that much less debt than AMG's. The Caribbean schools are just as expensive as the most expensive US private schools. St. George is close to 20k a semester, Ross is like 17k a semester etc. and thats for 10 semesters at a Caribbean school without living expenses.

I have plenty of friends who STARTED school in the Caribbean at 150k+ from UG.

 

[NuckingFuts]

To my knowledge, one example of an IMG not being a "financial burden" on the system is when she/he is sponsored by their country of origin, with the understanding that the skillset they acquire in the States will be utilized back home. I have heard of such arrangements at university programs. I imagine the country of origin not only pays the resident salary, but additional training-related costs.

 

[CDI]

Where in the name of sweet jesus do you get your numbers from to assume USIMG's have that much less debt than AMG's. The Caribbean schools are just as expensive as the most expensive US private schools. St. George is close to 20k a semester, Ross is like 17k a semester etc. and thats for 10 semesters at a Caribbean school without living expenses.

I have plenty of friends who STARTED school in the Caribbean at 150k+ from UG.

This is just sad.

Non-US-IMGs may in fact have paid nothing from Day 1. Their government covered their entire medical school tuition, and now they get into residency, yet this time they are living off the US taxpayers (Medicare).

I'm a US-IMG as well, and myself and many others I know have minimal loans - tuition rates are just much lower in other countries. (Then again, so are all healthcare costs...)

 

[CDI]

To my knowledge, one example of an IMG not being a "financial burden" on the system is when she/he is sponsored by their country of origin, with the understanding that the skillset they acquire in the States will be utilized back home. I have heard of such arrangements at university programs. I imagine the country of origin not only pays the resident salary, but additional training-related costs.

That's true. Some Middle East countries I believe have such arrangements.

Many others just get visas to stay in the US. They aren't paying anything at all, never paid any US taxes to date, but they got a residency spot and are still getting Medicare to cover their salary. Although unlikely, they could just as easily take their training & salary and go back to their own country for good - and the US is out a residency trained physician.

 

[p30doc]

Well I failed to SOAP into an intern year but managed to land a DO TRI this morning. I had to hustle last night at 5 pm with phone calls and emails to essentially every possible open spot in the country but it was well worth it. Congrats to all of us who have a spot! My sincere best wishes to all of those still looking, keep at it and don't give up.

 

[NuckingFuts]

Well I failed to SOAP into an intern year but managed to land a DO TRI this morning. I had to hustle last night at 5 pm with phone calls and emails to essentially every possible open spot in the country but it was well worth it. Congrats to all of us who have a spot! My sincere best wishes to all of those still looking, keep at it and don't give up.

Congrats and best wishes, welcome to the rest of your life

 

[foley12]

Well I failed to SOAP into an intern year but managed to land a DO TRI this morning. I had to hustle last night at 5 pm with phone calls and emails to essentially every possible open spot in the country but it was well worth it. Congrats to all of us who have a spot! My sincere best wishes to all of those still looking, keep at it and don't give up.

Awesome! Much better than a prelim surg year anyways. Enjoy your year and congrats on anesthesia.

 

[bambi]

This is just sad.

Non-US-IMGs may in fact have paid nothing from Day 1.

And they may have paid hundreds of thousands.

It's odd the way you all talk about IMGs. You can't lump them all in together, an IMG from the caribbean is very different to one from India who is very different to one from the UK etc Very little, if any, of what any of you say applies to all of them.

Admission to med school and residency are easier than in the US in some countries and harder in others. I don't think anywhere is quite as expensive as the US in terms of med school but a lot of places aren't exactly cheap and are getting significantly more expensive.

I think financially punishing people for wanting to come to the US to care for your citizens is a little harsh. A few of your residencies are pretty long too. Also, most IMGs would likely be unable to get loans for this sort of thing and you would only get the extremely wealthy coming over. I don't know about the US but we're quite into diversity among physicians over here in the UK. I think perhaps if people intend to do residency and go back home right after then maybe it's fair enough that they pay.

 

[CDI]

And they may have paid hundreds of thousands.

It's odd the way you all talk about IMGs. You can't lump them all in together, an IMG from the caribbean is very different to one from India who is very different to one from the UK etc Very little, if any, of what any of you say applies to all of them.

Admission to med school and residency are easier than in the US in some countries and harder in others. I don't think anywhere is quite as expensive as the US in terms of med school but a lot of places aren't exactly cheap and are getting significantly more expensive.

I think financially punishing people for wanting to come to the US to care for your citizens is a little harsh. A few of your residencies are pretty long too. Also, most IMGs would likely be unable to get loans for this sort of thing and you would only get the extremely wealthy coming over. I don't know about the US but we're quite into diversity among physicians over here in the UK. I think perhaps if people intend to do residency and go back home right after then maybe it's fair enough that they pay.

You can't be serious. Financially punishing?!

How is being asked to forego 3x$50k for 3 years of higher education & TRAINING any sort of punishment? You are being given an opportunity to earn millions over the course of your career as a future licensed physician. Quit thinking so small. What happens if they say, "Sorry, no money. Only 1 IMG per residency program." You have a better solution?

If that's the case let's stop 'financially punishing' IMGs an extra $100-200+ per USMLEs exam while we're at it.

Also, they are all lumped together because thats how it is. Do you see UK-IMG, Caribb-IMG, or Indian-IMG stats published separately?

 

[bambi]

You can't be serious. Financially punishing?!

How is being asked to forego 3x$50k for 3 years of higher education & TRAINING any sort of punishment? You are being given an opportunity to earn millions over the course of your career as a future licensed physician. Quit thinking so small. What happens if they say, "Sorry, no money. Only 1 IMG per residency program." You have a better solution?

If that's the case let's stop 'financially punishing' IMGs an extra $100-200+ per USMLEs exam while we're at it.

Also, they are all lumped together because thats how it is. Do you see UK-IMG, Caribb-IMG, or Indian-IMG stats published separately?

Not every residency is 3 years. What I would consider a surprisingly high number of IMGs matched into neurosurgery last year which is 7 years and I'm sure it happens in a lot of the other longer residencies too. If they can't get loans or aren't independently wealthy it's not possible. Most countries do not hand out loans the way the US does, scholarships are also practically non-existent in most countries. They have to eat! It is not their fault they were born in a country they either don't want to live in or would be limited by living in. If you were in their shoes you would be singing a very different tune. None of this in any way affects me so I can be more objective I guess but when it is clear that very few people on these boards know anything about the way medicine or any kind of education works in any other country in the world some of what you say seems rather closed minded.

For match stats etc yes all IMGs are grouped together but the statements people make on these boards about IMGs cannot be generalised to all IMGs which is what I was saying.

 

[Noegrus]

.

 

[CDI]

Not every residency is 3 years. What I would consider a surprisingly high number of IMGs matched into neurosurgery last year which is 7 years and I'm sure it happens in a lot of the other longer residencies too. If they can't get loans or aren't independently wealthy it's not possible. Most countries do not hand out loans the way the US does, scholarships are also practically non-existent in most countries. They have to eat! It is not their fault they were born in a country they either don't want to live in or would be limited by living in. If you were in their shoes you would be singing a very different tune. None of this in any way affects me so I can be more objective I guess but when it is clear that very few people on these boards know anything about the way medicine or any kind of education works in any other country in the world some of what you say seems rather closed minded.

For match stats etc yes all IMGs are grouped together but the statements people make on these boards about IMGs cannot be generalised to all IMGs which is what I was saying.

You're not thinking long-term, big picture. What do you think is going to happen when the majority IMGs are squeezed out in a few years?

Medicine is already for the more 'affluent' IMGs as it stands. If someone is able to make it to the US and pay thousands for all the prep materials, exams, and support themselves through observerships chances are they have money to work with (financial backing), more often than not. Some join MPH programs or do unpaid research. So, you think they don't eat until residency?

It's already not possible financially for many IMGs. In a few years, it won't be possible regardless of their personal finances because Medicare won't be paying for anyone but all the AMGs anyways.

I asked you already, do you have a better solution?

 

[IamnotFreud]

You're not thinking long-term, big picture. What do you think is going to happen when the majority IMGs are squeezed out in a few years?

Medicine is already for the more 'affluent' IMGs as it stands. If someone is able to make it to the US and pay thousands for all the prep materials, exams, and support themselves through observerships chances are they have money to work with (financial backing), more often than not. Some join MPH programs or do unpaid research. So, you think they don't eat until residency?

It's already not possible financially for many IMGs. In a few years, it won't be possible regardless of their personal finances because Medicare won't be paying for anyone but all the AMGs anyways.

I asked you already, do you have a better solution?

I just actually looked at the NRMP's #'s and it seems that match rates has held steady for most groups and even went up slightly for IMGs. I think 55% matched this time around vs. 47%. There were about 1097 unmatched AMGs compared to 815 last year, but there were close to 1000 more AMGs overall compared to last match. Look at 2010/2009 and those years were blood baths when it comes to unmatched AMGS-both over 1000, so it looks like AMGs are still matching quite well. The difference is that there was a huge increase in IMGs applying this year. Overall though you are right, more and more it will be difficult for foreign grads to match sadly. No way around it. It's better to know in advance than to waste money and hope.

 

[Y3M]

Better solutions:

1) Don't leave the US to train in light of the situation. Those students just starting med school are in peril but any US citizen who would think of going abroad for training now is foolish.

2) Accept that US residencies are designed for US grads and that you can't buy your way into a seat. If your foreign training is so great, why not pursue a residency in the country you went to school in. Oh wait....

Your idea is not novel and has been tried in the past. That being said, it doesn't work. Paying for residency (short term cost to the resident, long term gain) fails because it creates two standards of residents in the same program. Does not work, I know I am in academic medicine. I have seen physicians come over and do a paid fellowship (with their country/institution footing the bill) but this is a relatively rare situation compared with opening up new residency spots to IMG/FMGs with the funds to pay for it. The other question is whether we even need the spots; personally, I dont want to see any more spots in my specialty. Supply and demand; as a profession, we are better off keeping our numbers low enough that we can still have demand. No need to dilute the pool.

i noticed you are an attending- im not sure whats ur field.
im an AMG who didnt match this year. what do u recommend to increase my chances of matching next year? any advice?

 

[Y3M]

Yup. I wish you no ill will but yours is a perfect cautionary tale that will be ignored by others in the future...but I can pretend people will read this in the future.

Your stats aren't really that decent. Your Step scores are at or below the median. You failed classes and you applied to a small number of programs in a fairly competitively specialty. And honestly, the worst thing you did was ignoring the advice of a wise advisor by not applying - or interviewing - broadly.

Hopefully you'll recover next year but you need to adjust your expectations.

Hello Gut Onc,
Do you have any constructive advice for AMG who didnt match this year in medicine? what can we do better next yr? any advice on getting a spot of-cycle? thank you!

 

[IamnotFreud]

Hello Gut Onc,
Do you have any constructive advice for AMG who didnt match this year in medicine? what can we do better next yr? any advice on getting a spot of-cycle? thank you!

While I am not the mighty Gutonc, I would suggest you look at RS, which currently has 5 spots in IM. Maybe you can score one.

 

[Y3M]

i already contacted those programs... waiting to hear