Anything outside of primary care is relatively challenging for an IMG to match. The very most competitive specialties (derm, ophthal, almost any surgery subspecialty, etc.) are generally not accessible to IMGs unless you are an absolute rockstar. There was one UQ-O grad who did match ortho this year though, so it is possible. As an IMG you have to ask yourself earnestly if you are really a rockstar student. Usually IMGs are IMGs because they were not good enough to get into a domestic school. Yes, there are exceptions to this for sure and I personally know of a number of IMGs who are just as brilliant as the top domestic students. But the reality is that the vast majority of the time if you are an IMG you aren't rockstar material and your chances of matching something like derm or ophthalmology is pretty close to zero. Before deciding to accept a spot in med school as an IMG, I think its important to recognize and come to terms with the fact that statistically you will more than likely end up in primary care.
I only disagree a little with you in degree, but not in kind.
For example, internal medicine and its subspecialties are not inaccessible. One person in my class also matched in categorical gensurg (and I can assure you this person was not a rockstar). Surgical subspecialty will be a fellowship after and I don't know the data on it (or even if there is) but typically coming from a US gensurg residency will obviate a fair bit of the IMG stigma. Direct entry surg subspec, just like derm, opthal, and ortho I agree with you though. Extremely difficult and not something one should bank on. That said, I will put $100 on the line that one person in the next class matches in Ortho as well (he is a good friend of mine and a serious rockstar). We also had one guy in my class match in rads and another in gas and two in ED.
So yes, it is undeniably more difficult as an IMG. But I do think it is an incorrect characterization to say that
anything outside of primary care is challenging to match in. At least, not appreciably more challenging than it is for a US grad to match.
You are correct that
usually IMG's couldn't hack it in the states. But that is just because it is a bit of a self selecting group - there are a huge number of people that can't hack it and of those most will go IMG. But the real point is that I believe that the sentiment in the US is turning. Slowly and so far small, but I think that programs are starting to care less about IMG status and more about whether you are qualified and a good fit. That said, some programs (particularly really top end like MGH or UCSF or UCSD) are going to be nigh impossible for an IMG. But they are also stupidly competitive for US grads. I also would say to any US grad that if they wanted to get into those programs they better be freakin' rockstars as well.
Additionally, part of the point of UQ-O is to generate a different perception of it than other IMG programs. The Caribs are pigeon holed as the place where "good but not good enough" kids go, with the knowledge that a lot of them are crap. UQ and Ochsner are actively making it a point to "win the beauty pageant" as we've said from time to time. Programs realize that while
most IMGs went elsewhere because they couldn't hack it, some of them couldn't hack it not because they weren't just as good but because the competition is so fierce. In other words, it is common knowledge that perfectly qualified candidates get turned away from US schools and go outside the country. The problem is that from a program's perspective they don't have a reliable means by which to differentiate those. The active goal of UQ-O and its PR dept is to position the program as that reliable means by which to differentiate. It isn't there yet, no question. But it is getting there. Pinsky, head of Ochsner, is on the ACGME and obviously talks up the program. The Cali Medical Board unanimously voted to approve the program and during the meetings said that this was one of the best and most innovative programs for allowing precisely those well qualified students who get turned away in the US an opportunity to become excellent physicians back in the US. And so on. And obviously, as we interview, get residency spots around the country, and show our stuff, that image we are intentionally trying to project (from the top all the way down) will become more noticed, more respected, and more acknowledged.
For example, end of last year there was a two-day meeting of which I was a part that invited ~50 undergrad pre-med advisors from universities around the country (incl places like Yale and Stanford) to come talk to us and get our perspective and see what the program was all about. Their response was uniformly positive.
Point being, there are active attempts on multiple fronts and at multiple levels to create a different image for UQ-O than the "standard" IMG program. No doubt it isn't "there" yet, but progress is being made and things are only looking up as of right now. And as of right now, it ain't so terrible.
