Why do programs sponsor candidates who won't stay in America after residency?

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zenlife

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Real question. I am a US citizen IMG who struggled to match. After a few years of trying, I have decided to move on with my life.


I know non-US IMGs who matched matched into US residency programs and went back to their country to practice medicine. Is there a reason why I worked, paid state and federal taxes, my parents work and pay taxes...and someone who won't even stay in this country after residency, gets paid by Medicare to be a resident? So the fact that I would have worked my tail off with the intention of serving my fellow citizens is somehow subpar a candidate who gets money from the government and then decides to go back to his/her country?

Can someone please shine some light on this.

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Real question. I am a US citizen IMG who struggled to match. After a few years of trying, I have decided to move on with my life.


I know non-US IMGs who matched matched into US residency programs and went back to their country to practice medicine. Is there a reason why I worked, paid state and federal taxes, my parents work and pay taxes...and someone who won't even stay in this country after residency, gets paid by Medicare to be a resident? So the fact that I would have worked my tail off with the intention of serving my fellow citizens is somehow subpar a candidate who gets money from the government and then decides to go back to his/her country?

Can someone please shine some light on this.
The first light that needs to shine is one in a mirror.

From your post history it appears you passed Step 1 by one point using today's standards, your Step 2 CK score while a pass at the time is considered a failure today, and you did indeed fail Step 3. Residencies weren't avoiding you because they wanted to train a foreigner instead. They were avoiding you because you presented a real danger of not being able to finish the residency.

Your intentions were not subpar, but your application was.
 
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Real question. I am a US citizen IMG who struggled to match. After a few years of trying, I have decided to move on with my life.


I know non-US IMGs who matched matched into US residency programs and went back to their country to practice medicine. Is there a reason why I worked, paid state and federal taxes, my parents work and pay taxes...and someone who won't even stay in this country after residency, gets paid by Medicare to be a resident? So the fact that I would have worked my tail off with the intention of serving my fellow citizens is somehow subpar a candidate who gets money from the government and then decides to go back to his/her country?

Can someone please shine some light on this.
Sorry to hear about that.

1) General answer: I don't think the two are necessarily related (i.e., you not getting in, an IMG getting in). Generally speaking, residency programs just want the "best" (however they define it) candidates. That's based on whatever metrics they want to use. If you make their cut, then you're in. Same with the IMG, if they make a program's cut, then they're in. Applicants are first filtered according to whatever metrics a program wants to use. Usually US MDs and DOs get priority over US-IMGs and IMGs. Usually citizens over people who need visas. Usually higher Step 1 and 2CK scores than lower ones. Usually people with USCE experience and good LORs over those without USCE or good LORs. But these are all just general statements. Programs can realistically do almost anything they want (within legal parameters) when it comes to offering interviews, matching candidates, etc. Bottom line is you are not competing against another IMG applicant per se (not directly anyway) but you are "competing" with the program and what the program wants in their applicants.

2) Specific answer: You would need to provide information about yourself that would be relevant. Such as your med school (e.g., Caribbean?), grades (e.g., AOA?), Step 1 and 2CK/CS attempts and scores, what specialty you applied to, how many programs you applied to, etc.

3) There are plenty of IMGs who do not get into a US residency, but we don't always hear about people who don't get accepted. It's usually the successful ones who matched that we hear about.
 
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Real question. I am a US citizen IMG who struggled to match. After a few years of trying, I have decided to move on with my life.


I know non-US IMGs who matched matched into US residency programs and went back to their country to practice medicine. Is there a reason why I worked, paid state and federal taxes, my parents work and pay taxes...and someone who won't even stay in this country after residency, gets paid by Medicare to be a resident? So the fact that I would have worked my tail off with the intention of serving my fellow citizens is somehow subpar a candidate who gets money from the government and then decides to go back to his/her country?

Can someone please shine some light on this.

USMLE performance is a major predictor of performance on your specialty boards. Barely passing scores across the USMLEs + 3 attempts at Step 3 would put you at a major risk of not passing your boards. The amount of taxes you and your parents pay doesn't change that or make you entitled to a spot over someone who may be from a different country but has performed very well and has a high likelihood of graduating and becoming a board-certified physician.

All of the FMG's and non-US-IMG's I've ever met/worked with have stayed in the US to practice. I'm not saying that there aren't those who go back to their home country, but from my admittedly limited perspective, I'd like to think they're in the minority.
 
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Real question. I am a US citizen IMG who struggled to match. After a few years of trying, I have decided to move on with my life.


I know non-US IMGs who matched matched into US residency programs and went back to their country to practice medicine. Is there a reason why I worked, paid state and federal taxes, my parents work and pay taxes...and someone who won't even stay in this country after residency, gets paid by Medicare to be a resident? So the fact that I would have worked my tail off with the intention of serving my fellow citizens is somehow subpar a candidate who gets money from the government and then decides to go back to his/her country?

Can someone please shine some light on this.
The first light that needs to shine is one in a mirror.

From your post history it appears you passed Step 1 by one point using today's standards, your Step 2 CK score while a pass at the time is considered a failure today, and you did indeed fail Step 3. Residencies weren't avoiding you because they wanted to train a foreigner instead. They were avoiding you because you presented a real danger of not being able to finish the residency.

Your intentions were not subpar, but your application was.


Fair enough. I did have attempts on an exam that is normally taken during residency. My scores are low.

So since you're so confident about knowing it all...let me present 3 real life scenarios

1) Student A - Caribbean US IMG - fails each exam once and matches on the first time applied in the match cycle. Mediocre LORs. Nothing extraordinary on the application. Matches into FM
2) Student B - Caribbean US IMG - passes every test on the first attempt. Mediocre LORs. Doesn't match. Ends up doing research and building a profile. Still unmatched. Does not match into FM.
3) Student C - US DO - fails Step 2ck. Matches in a competitive specialty (not primary care).

So you're basically telling me, that Student A and C are not at risk of failing their boards?Caribbean schools require a lot of self study and it sucks. I would think that at least a US student would be able to pass everything on the first attempt.

But clearly that's not the case in the 3 scenarios I presented to you. I'm pretty sure every resident I know says that residency is the place where you really learn it all. So unless you're super lazy and didn't get kicked out before sitting for the boards, I doubt someone will fail the boards or perform poorly in residency

As far as performance in residency...even in med school, I met lazy students who scored very high on exams who couldn't even talk to patients and obtain a proper history, let alone formulate a proper assessment and plan. Some didn't even show up to rotations on a regular basis. I'm not saying every one...but I have met surprisingly enough. And these people matched.
 
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Fair enough. I did have attempts on an exam that is normally taken during residency. My scores are low.

So since you're so confident about knowing it all...let me present 3 real life scenarios

1) Student A - Caribbean US IMG - fails each exam once and matches on the first time applied in the match cycle. Mediocre LORs. Nothing extraordinary on the application. Matches into FM
2) Student B - Caribbean US IMG - passes every test on the first attempt. Mediocre LORs. Doesn't match. Ends up doing research and building a profile. Still unmatched. Does not match into FM.
3) Student C - US DO - fails Step 2ck. Matches in a competitive specialty (not primary care).

So you're basically telling me, that Student A and C are not at risk of failing their boards?Caribbean schools require a lot of self study and it sucks. I would think that at least a US student would be able to pass everything on the first attempt.

But clearly that's not the case in the 3 scenarios I presented to you. I'm pretty sure every resident I know says that residency is the place where you really learn it all. So unless you're super lazy and didn't get kicked out before sitting for the boards, I doubt someone will fail the boards or perform poorly in residency

As far as performance in residency...even in med school, I met lazy students who scored very high on exams who couldn't even talk to patients and obtain a proper history, let alone formulate a proper assessment and plan. Some didn't even show up to rotations on a regular basis. I'm not saying every one...but I have met surprisingly enough. And these people matched.

Look there are always anecdotal reports of people who didn't have great scores, etc who match and then do well. But they are outliers. There are numerous reports on this board of people who lose their residency spot because of poor performance to contradict your supposition that only the lazy can't hack it in residency. I'm sorry you weren't able to find a residency position. But since you said you've moved on, don't torture yourself with all of this scenario nonsense. The measures by which residency applicants are judged are what they are and yours were poor and you didn't manage to be an outlier. Nothing else to say but that.
 
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Look there are always anecdotal reports of people who didn't have great scores, etc who match and then do well. But they are outliers. There are numerous reports on this board of people who lose their residency spot because of poor performance to contradict your supposition that only the lazy can't hack it in residency. I'm sorry you weren't able to find a residency position. But since you said you've moved on, don't torture yourself with all of this scenario nonsense. The measures by which residency applicants are judged are what they are and yours were poor and you didn't manage to be an outlier. Nothing else to say but that.

Yeah you're right. Moving along to better things in life. I'm not interested in having colleagues with a god-complex who are at the mercy of administrators, pharmaceutical and insurance companies anyway. Cheers
 
@zenlife I don't think you are putting enough stock in the interview portion of getting into a residency. We have interviewed people with excellent scores, but DNRed them because they couldn't hold a conversation and/or said some really rude/offensive stuff to people. On the other hand, we have had several people who had mediocre scores, but their interview skills knocked us off our feet. Those people had residents begging us to make sure they matched with us.

When you didn't match, did you contact the programs you felt good about and ask them why they thought you didn't match? There are so many things that could have prevented you from matching....none of which were because the other candidates were non-US IMGs. Everything's not always black and white and just about the numbers.
 
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@zenlife I don't think you are putting enough stock in the interview portion of getting into a residency. We have interviewed people with excellent scores, but DNRed them because they couldn't hold a conversation and/or said some really rude/offensive stuff to people. On the other hand, we have had several people who had mediocre scores, but their interview skills knocked us off our feet. Those people had residents begging us to make sure they matched with us.

When you didn't match, did you contact the programs you felt good about and ask them why they thought you didn't match? There are so many things that could have prevented you from matching....none of which were because the other candidates were non-US IMGs. Everything's not always black and white and just about the numbers.

Thank you LATigers. I appreciate your feedback.

I did contact the programs. During my interview, i was asked about my scores and I understand that completely. All the PDs that interviewed me and some faculty members were kind enough to pay compliments at my post-grad research work, commitment to the specialty and LORs (which came from academic faculty at universities I did clinical research at...I updated my LORs). One of the PDs even told me that I am my own selling point and have a great personality, which is very nice of him to say. Those on interview committees liked the answers I provided to the red flags in my application. I wrote them hand-written thank you letters expressing my sincere interest, I followed up with one or two emails even before ROL deadline.

But to be honest, it seems like my scores were still always a deal breaker. I did everything I could to really prove my interest in the specialty (psychiatry) and I worked my butt off. I understand that I come with shortcomings and I don't expect myself to match into top programs. I also understand that there are recent graduates as well. But somehow, I didn't luck out in this system. I see people with poor work ethic and excellent scores match...I see it every year. I see people who had poor bedside manners, poor English with high scores match. I'm not saying it's everyone. But as much as I don't want to believe it's all about numbers, I feel like it really is that way more so now (unless you're well connected). I guess I finally am at a point where I'm not going to prove myself to a system that has virtually has no respect for people in general, whether it's patients, med students, nurses, residents or doctors in different specialties. And at the end of the day, these same people hand over their autonomy to hospital admins and insurance companies, who are really the ones in power.
 
I guess I finally am at a point where I'm not going to prove myself to a system that has virtually has no respect for people in general, whether it's patients, med students, nurses, residents or doctors in different specialties. And at the end of the day, these same people hand over their autonomy to hospital admins and insurance companies, who are really the ones in power.
This is largely untrue. I get that you're angry at not having matched, but that doesn't mean that the whole system is wrong/rigged/unethical. You're going rather overboard with your criticism.
 
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As far as performance in residency...even in med school, I met lazy students who scored very high on exams who couldn't even talk to patients and obtain a proper history, let alone formulate a proper assessment and plan. Some didn't even show up to rotations on a regular basis. I'm not saying every one...but I have met surprisingly enough. And these people matched.

So, I'm not sure about other board exams, but the peds board exam traditionally has a relatively high failing rate. So even people who do well in residency can fail the boards. A weak person from the start is even more at risk.
 
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As far as performance in residency...even in med school, I met lazy students who scored very high on exams who couldn't even talk to patients and obtain a proper history, let alone formulate a proper assessment and plan. Some didn't even show up to rotations on a regular basis. I'm not saying every one...but I have met surprisingly enough. And these people matched.

You are correct. There are a fair number of dysfunctional people in residency, and even more dysfunctional people in medical school. Each successive level weeds some people out, but it's far from a perfect system.

But, there's a baseline level of competency necessary to make it in medicine. You can claim all you want that you could just "turn it on" in residency, but you had at least 4 exams that suggest otherwise. If you could have just "turned it on," you had ample opportunity to, and didn't.

Not trying to pile on, because it's a moot point by now, probably. But hopefully it will be a cautionary tale for other US students considering the Carib route: you have to outscore your US-trained comparables, because they will always have the tiebreaker. You can vent and rage about the "fairness" of it all you want, but it's there, and you have to account for that.
 
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OP, I'm curious, why give up medicine or psychiatry if that's what you really want to do (given you still sound upset and angry about it)?

I don't know where you did your med school, but are you able to practice in the country where you graduated from? Or you could try another nation like Australia or New Zealand. Not that it's easy to get into these nations, but at least they don't require USMLEs so that wouldn't be held against you. Your biggest obstacles would be (1) work visa but I know those who have overcome it and (2) YOG but if you pass the Australian Medical Council's exams (written, OSCEs, vivas) then that would help a lot.
 
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Thank you LATigers. I appreciate your feedback.

I did contact the programs. During my interview, i was asked about my scores and I understand that completely. All the PDs that interviewed me and some faculty members were kind enough to pay compliments at my post-grad research work, commitment to the specialty and LORs (which came from academic faculty at universities I did clinical research at...I updated my LORs). One of the PDs even told me that I am my own selling point and have a great personality, which is very nice of him to say. Those on interview committees liked the answers I provided to the red flags in my application. I wrote them hand-written thank you letters expressing my sincere interest, I followed up with one or two emails even before ROL deadline.

But to be honest, it seems like my scores were still always a deal breaker. I did everything I could to really prove my interest in the specialty (psychiatry) and I worked my butt off. I understand that I come with shortcomings and I don't expect myself to match into top programs. I also understand that there are recent graduates as well. But somehow, I didn't luck out in this system. I see people with poor work ethic and excellent scores match...I see it every year. I see people who had poor bedside manners, poor English with high scores match. I'm not saying it's everyone. But as much as I don't want to believe it's all about numbers, I feel like it really is that way more so now (unless you're well connected). I guess I finally am at a point where I'm not going to prove myself to a system that has virtually has no respect for people in general, whether it's patients, med students, nurses, residents or doctors in different specialties. And at the end of the day, these same people hand over their autonomy to hospital admins and insurance companies, who are really the ones in power.

The items/traits which you may possess do not substitute for the fact that you have performed poorly on key exams. You can first author/publish 100 papers per week, but if you can't pass necessary exams required to actually become a board certified doctor, you are pretty much unhireable.

Your personality, charm, whit, work ethic, etc. can't compensate for the exam performance.

You realize that if you are accepted into residency, that there is a strong chance you won't be able to pass your board exams, correct? This is based on your prior performance. We can all agree that future performance is best predicted by previous performance, which although not the nicest thing to hear, doesn't work in your favor.

The PD's may be doing you a favor by helping you NOT waste your time any further. It may be time to cut your losses.
 
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Residency is not the time to the raise the flag of nationalism. Der Trumppenfuhrer and his minions do that enough on their own. But I digress.

OP, here is what you're up against (quoting the wise @gyngyn):

The pool of US applicants from the Caribbean is viewed differently by Program Directors. The DDx for a Caribbean grad is pretty off-putting: bad judgment, bad advice, egotism, gullibility, overbearing parents, inability to delay gratification, IA's, legal problems, weak research skills, high risk behavior. This is not to say that all of them still have the quality that drew them into this situation. There is just no way to know which ones they are. Some PD's are in a position where they need to, or can afford to take risks too! So, some do get interviews.

Bad grades and scores are the least of the deficits from a PD's standpoint. A strong academic showing in a Caribbean medical school does not erase this stigma. It fact it increases the perception that the reason for the choice was on the above-mentioned list!

Just about everyone from a Caribbean school has one or more of these problems and PDs know it. That's why their grads are the last choice even with a high Step 1 score.

The point here isn't that there are successful Carib grads. The point is how many additional obstacles to success you face by having gone to a Carib school. FMGs do not have this stigma.
 
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No sympathy from me for Carib grads who do not match. There are now over 21000 US MD admissions and almost 7000 US DO admissions each year. All but those with pathetic stats can now get into a US school. Imo those with pathetic stats should work on improving their stats rather than going Carib.
 
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Your personality, charm, whit, work ethic, etc. can't compensate for the exam performance.

Pedantic/educational comment here.
Whit = a small amount e.g. "You don't have a whit of evidence!"
Wit = mental sharpness/guile e.g. "Your personality and wit can't compensate for the exam performance."
 
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Pedantic/educational comment here.
Whit = a small amount e.g. "You don't have a whit of evidence!"
Wit = mental sharpness/guile e.g. "Your personality and wit can't compensate for the exam performance."

Luckily for me, I only need a whit bit amount of wit
 
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No sympathy from me for Carib grads who do not match. There are now over 21000 US MD admissions and almost 7000 US DO admissions each year. All but those with pathetic stats can now get into a US school. Imo those with pathetic stats should work on improving their stats rather than going Carib.
This type of thinking never made much sense to me on a basic common sense/logic level.

Yes, there are ~28,000 US medical positions yearly now. So what. Do any of those spots go unfilled? No. Yet >2,500 US-IMGs continue to match into PGY1 positions every year.

So there's obviously still thousands more US citizens, on a yearly basis, capable of becoming physicians than spots in the US medical education. If all the people that went to the Caribbean just improved their stats and got into a US school, then it would just be >2,500 other US citizens without a US medical school spot.

Your grand solution, taken to it's logical conclusion, would just result in ~2,500 less US citizens entering GME every year and >6,000 foreign-IMGs entering GME instead of ~3,500.
 
To answer your question directly.

Residency is slave labour. These FMGs are paid below minimum wage, work excessive hours, providing a service that no other qualified American would be willing to do.

In addition, federal laws mandate that these FMGs must have evidence that their country require their services after the completion of their residency training. I can only infer that the USA's government status quo is to train quality physicians who would eventually return to their country of origin to fulfill a need. Therefore, those that eventually stay are actually "unexpected", although frequent.

Refer to the Statement of Need.

Furthermore, the most frequent visa status is J1, which further requires the person to return to his country of origin for 2 years. The only way "out" is to serve in an underserved area for the same amount of time. Which enforces some sort of service in return for the training if the person was to stay in the USA.
 
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only thing programs care about is their board pass rates

im in a similar situation to you, shoot me a pm if you can
 
But to be honest, it seems like my scores were still always a deal breaker. I did everything I could to really prove my interest in the specialty (psychiatry) and I worked my butt off.
There's something else going on here. There might be a specialty that cares less about Step I scores than Psychiatry, but I don't know what it would be. That's the specialty that has a reputation for caring the least about the exams (assuming someone passes).
 
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Yeah you're right. Moving along to better things in life. I'm not interested in having colleagues with a god-complex who are at the mercy of administrators, pharmaceutical and insurance companies anyway. Cheers

I guess I finally am at a point where I'm not going to prove myself to a system that has virtually has no respect for people in general, whether it's patients, med students, nurses, residents or doctors in different specialties. And at the end of the day, these same people hand over their autonomy to hospital admins and insurance companies, who are really the ones in power.

Yeah it TOTALLY sounds like you've moved on.

If you weren't interested in having "colleagues with a god-complex", then you shouldn't have gone to med school in the first place. Its not as they developed that ego in medical school. Moreover, the majority of students in medical school do not have a god-complex. What happened was that you got terrible board scores FOUR times. Not one bit of improvement from one to the other. I can understand messing up once due to nerves, anxiety, and the like. But to do horribly FOUR times and then blame administrators and PDs and 'the system' is just a deflection of blame and a lack of owning up to your responsibility.

Many of us chose medicine because we care about being in a collaborative work environment; consequently, we obviously would respect most of the people we work with, including the "patients, med students, nurses, residents or doctors in different specialties."

What you are doing now is trying to delude yourself into believing that you lucked out by not being in a profession that is at the mercy of administrators and filled with people with god-complexes that do not respect their patients or colleagues.
You're trying to make yourself feel better by rationalizing the outcome, when in reality, you missed out on one of the most rewarding professions there is in the world. In the words of that girl from Frozen, "let it go".
 
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To answer your question directly.

Residency is slave labour. These FMGs are paid below minimum wage, work excessive hours, providing a service that no other qualified American would be willing to do.

What???
Comparing residency to slavery is obviously hyperbole. A bit melodramatic, but whatever. The rest of your statement, however, sounds like you're saying that FMG residents are getting paid less than minimum wage and that they're doing a job which no other american resident would be willing to do. All of these statements are demonstrably false and border on the absurd. If I'm misinterpreting something here, I apologize... but what the hell are you talking about?

EDIT: I knew this sounded familiar. I responded to a nearly identical comment of yours several months ago. You can't honestly believe that residency is akin to slavery while maintaining a rational sensorium. As to the other statements... again, unless I'm misinterpreting them, they are obviously and unequivocally false.

EDIT2: fixed the above link. Thanks Light at end of tunnel.
 
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What???
Comparing residency to slavery is obviously hyperbole. A bit melodramatic, but whatever. The rest of your statement, however, sounds like you're saying that FMG residents are getting paid less than minimum wage and that they're doing a job which no other american resident would be willing to do. All of these statements are demonstrably false and border on the absurd. If I'm misinterpreting something here, I apologize... but what the hell are you talking about?

EDIT: I knew this sounded familiar. I responded to a nearly identical comment of yours several months ago. You can't honestly believe that residency is akin to slavery while maintaining a rational sensorium. As to the other statements... again, unless I'm misinterpreting them, they are obviously and unequivocally false.

Fyi: Your included link doesnt seem to work
 
No sympathy from me for Carib grads who do not match. There are now over 21000 US MD admissions and almost 7000 US DO admissions each year. All but those with pathetic stats can now get into a US school. Imo those with pathetic stats should work on improving their stats rather than going Carib.
Even with the number of spots increasing, starts have still gone up across the board for MD and DO students.
 
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There's something else going on here. There might be a specialty that cares less about Step I scores than Psychiatry, but I don't know what it would be. That's the specialty that has a reputation for caring the least about the exams (assuming someone passes).
Psych has gotten more competitive, and OP barely passed the boards and is a IMG. That's a bad combo. But even with good scores, psych is a bit of a difficult specialty to match into for IMGs due to applicant volume alone- there's probably a thousand applicants with better scores than OP in the pile, so his app gets filtered right out.
 
Even with the number of spots increasing, starts have still gone up across the board for MD and DO students.

FALSE!!! MCAT scores dropped this year for new DO students.

2016 matriculants;
Mean MCAT: 26.72 (502.17)

http://www.aacom.org/docs/default-s...riculant-profile-summary-report.pdf?sfvrsn=10

Mean MCAT
2015 matriculants: 27.33
2014 matriculants: 27.21
2013 matriculants: 26.87
2012 matriculants: 26.85

http://www.aacom.org/docs/default-source/data-and-trends/2012-15-matprofilerpt.pdf?sfvrsn=8
 
FALSE!!! MCAT scores dropped this year for new DO students.

2016 matriculants;
Mean MCAT: 26.72 (502.17)

http://www.aacom.org/docs/default-s...riculant-profile-summary-report.pdf?sfvrsn=10

Mean MCAT
2015 matriculants: 27.33
2014 matriculants: 27.21
2013 matriculants: 26.87
2012 matriculants: 26.85

http://www.aacom.org/docs/default-source/data-and-trends/2012-15-matprofilerpt.pdf?sfvrsn=8
Hmmm... I'm wondering how much of that is the new MCAT at play. Still, I'll buy it.
 
Hmmm... I'm wondering how much of that is the new MCAT at play. Still, I'll buy it.

Yes and we still have a ton of new MD/DO schools opening in the next few years...wouldn't be surprised to see stagnation or even drops.
 
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