why do some programs fill pgy1 with almost all Indians?

[Dr McSteamy]

I've noticed this with some family and IM residencies.

is it because no americans want to apply there?

why don't they take caribbean graduates instead?

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[masterofmonkeys]

Its because we secretly rule the world.

 

[NewmansOwn]

I've noticed this with some family and IM residencies.

is it because no americans want to apply there?

why don't they take caribbean graduates instead?

Perhaps the Indian physicians are better qualified.

 

[Dr McSteamy]

actually i've noticed this at hospitals in the middle of nowhere......

 

[NewmansOwn]

actually i've noticed this at hospitals in the middle of nowhere......

Truth be told, many hospitals would probably rather have US MDs or DOs, but IM and FM are not hot specialties right now and some programs have trouble attracting US grads. These programs are usually in less desirable locations (i.e. - "the middle of nowhere") or have no big name -- Hopkins and UCSF have no trouble attracting IM or FM applicants from the US grad pool. But the others, they take the best qualified of what they can get.

 

[Law2Doc]

I've noticed this with some family and IM residencies.

is it because no americans want to apply there?

why don't they take caribbean graduates instead?

There are more residency slots than US educated students. So hospitals fill the difference with foreign educated folks. They usually are in the less desirable locations and are the slots that the US folks didn't want. Countries like India, where English is a commonly spoken language, tend to be prime suppliers of these remaining slots. Some of the top caribbean schools do better in landing their students residencies than other countries, but once you get outside of the top couple which do rotations in the states, (which gives them a certain element of quality control), it makes sense to focus on other nation's applicants.

 

[exPCM]

The situation should change. The medical student class of 2009 is the largest ever ( http://www.aamc.org/newsroom/pressrel/2007/appsenrollcharts.pdf and http://www.osteopathic.org/pdf/ost_factsheet.pdf ) with 17003 allopathic and 3880 osteopathic students. There are approximately 25000 first year funded residency spots total (allopathic and osteopathic). The class of 2010 is even bigger ( http://www.aamc.org/newsroom/pressrel/2006/apps_entrants2006.pdf ) with 17361 allopathic and ~ 4100 osteopathic students ( http://www.jaoa.org/cgi/content/full/108/3/116/FIG3 ) . The class of 2011 is still larger with 17759 allopathic and 4408 osteopathic students and we will see more increases in the coming years as US medical schools are ramping up enrollment. All of these students are going into a static pool of first year residency slots so that we will be seeing less IMGs matching each year. The alternative would be to have more and more AMGs not match which I think would cause an outcry.

 

[deleted21609]

I've noticed this with some family and IM residencies.

is it because no americans want to apply there?

why don't they take caribbean graduates instead?

Are there Indians on the admissions committee?

 

[rvarsity]

I've noticed this with some family and IM residencies.

is it because no americans want to apply there?

why don't they take caribbean graduates instead?

You can't be serious. Why would a program take a person who could not get into a US medical school?

I'm an american allopathic grad but did a transitional intern year. The categoricals were all FMG's, carribean grads, and DO's. The "Indians", "Hungarians", and "Korean" residents you speak of would hit 99 percentile on all the in-service exams while the remainder got lost walking to the cafeteria.

It was embarassing.

The only thing holding the FMG's back was the language barrier, but that dissapears as the years go by. I'm sure there are a small % of decent carib grads, but every one I worked with was, lets say, subpar.

I had the same perception as you before I did my intern year, but after working with the true FMG's, I was actually pretty impressed. The "American" carribean grads not so much.

Again, the FMG's that come here are academically near the top of there respective countries, the "American" carribean grads are obviously...not.

 

[sandraf]

Its because we secretly rule the world.

The world would be better if that was true... (I am NOT indian, before somebody asks...!!!)

 

[sandraf]

Again, the FMG's that come here are academically near the top of there respective countries, the "American" carribean grads are obviously...not.[/quote]

It makes a lot of sense to me.

 

[dragonfly99]

Agree w/some of the above posts.
Also, if a program director at one of these out-of-the-way or otherwise less desirable (to US grads) residencies accepts a couple of folks from a certain university in India or Pakistan, and finds that they perform well, then he/she probably would be induced to accept more. He/she might also figure it's good to accept IMG's of the same ethnicity and/or background, because then said residents would have a built-in support system. Just some thoughts.

I think characterizing all US Caribbean and DO grads as "not being able to find their way to the cafeteria" is incorrect. I have worked w/some anesthesia and cardiology attendings who were DO and Carib grad, respectively, and they were quite good. Perhaps the problem was that the hospital where you did your transitional year was didn't have a desirable categorical residency program, and thus had to take some of the lower-ranking DO and Carib students. I do agree that most of the IMG's tend to be near "top of the heap" folks in their countries though...gotta be smart to ace the USMLE's after not having gone through our particular educational system. The language barrier problem is not unimportant though, especially to patients.

 

[howelljolly]

You can't be serious. Why would a program take a person who could not get into a US medical school?

I'm an american allopathic grad but did a transitional intern year. The categoricals were all FMG's, carribean grads, and DO's. The "Indians", "Hungarians", and "Korean" residents you speak of would hit 99 percentile on all the in-service exams while the remainder got lost walking to the cafeteria.

It was embarassing.

The only thing holding the FMG's back was the language barrier, but that dissapears as the years go by. I'm sure there are a small % of decent carib grads, but every one I worked with was, lets say, subpar.

I had the same perception as you before I did my intern year, but after working with the true FMG's, I was actually pretty impressed. The "American" carribean grads not so much.

Again, the FMG's that come here are academically near the top of there respective countries, the "American" carribean grads are obviously...not.

Yes and no...

 

[superoxide]

Here we go again.

 

[howelljolly]

sorry

 

[peerie]

I was wondering if there was much teaching in a residency program that had alot of FMGs who had already done residencies in other countries. Do they teach less because they don't need to? What would that mean for a US grad in that program?

 

[dragonfly99]

peerie,
there are a lot of things that affect/influence teaching in residency.
One is what kind of faculty are there (? all private attendings vs. a more academic/traditional program).
Another is how well funded is the hospital (i.e. city hospital hanging on by a thread where everybody is overworked, vs. a cushy wealthy university program).
I think in general university programs have better teaching vs. the community ones, but that is a generalization and likely reflects some bias I have (in favor of academic/traditional residencies).
I don't think the past experience of IMG's influences the teaching much. A hospital that has a lot of IMG's usually is a less desirable location to do residency...that's why the IMG's were able to get a spot and it wasn't filled with all US grads. "Less desirable" might be because it's in a bad climate (i.e. North Dakota), bad working conditions (i.e. poorly funded, crumbling inner city hospital), and/or bad teaching (i.e. malignant program or some community program run by a bunch of private practice docs who don't make time for teaching, and/or where there isn't a residency structure that facilitates teaching, and that only does the minimum grand rounds, morning report, other scheduled teaching conferences, etc.).

 

[peerie]

Thanks Dragonfly, good points. Interesting to think about why IMGs/FMGs were there and whether the program started as a 'bad' one or became 'less desirable' because of not being able to attract US grads. In other words, is a program in ND now 'not good' because it couldn't attract people due to the -20 F winters? or has it become 'not good' because now it is filled with FMGs who don't really require teaching. What about programs in NYC, filled with non-US grads with previous residency training? Are the programs just being lazy and taking advantage of good labor? (ok, I am a cynic.)

Man, that is an interesting problem to consider. And then, what can a program do to change that? I kind of like North Dakota.

 

[dragonfly99]

I was not implying that a program with IMG's sucks because it has IMG's in it, if that's how it came across.

I don't think the programs decide to teach less because the IMG's "need less teaching". There are a lot of IMG's who might need more teaching than a comparable US grad, since some med schools in other countries don't provide as much hands-on patient interaction (prior to internship/residency) as our schools, and many IMG's don't have years and years of residency in another country before coming here. A few do, but not that many I've met.

Yes I was saying that North Dakota (for example) might have difficulty attracting residents because of the -20 degree weather, as well as not having any really big cities around there, etc. It might be a very nice place. I heard Fargo is actually kind of cool, at least from 1 person. It may depend on what you like and your personal circumstances also (i.e. married guy with 2 kids from the upper Midwest, it may be your ideal school...single Jewish woman from Boston, it might not...).

I think some programs with bad or little teaching might only be able to attract IMG applicants to rank that program...US grads may get the "scuttlebut" through the grapevine, and/or have other options about where to train. Also I do think that programs with tons of IMG's do sometimes lead US grads to assume there must be SOMETHING wrong w/the program. Otherwise, why can't it attract US grads?

 

[rockit]

I wonder if all the FMGs are really better than their DO/Carib counterparts. Some of these 'first years' have completed multiple residencies and were fellowship trained in other countries.

It's easy to get 99% on in-service exams when you were an attending for 10 years.

 

[peerie]

Thanks for the follow up comments Dragonfly99, I sure didn't mean anything by saying what I did. Just that it's such an interesting phenomenon, I really don't know what to make of it. I guess like anything, it's a case by case situation.

 

[howelljolly]

I wonder if all the FMGs are really better than their DO/Carib counterparts. Some of these 'first years' have completed multiple residencies and were fellowship trained in other countries.

It's easy to get 99% on in-service exams when you were an attending for 10 years.

This is silly. Like just about everything else, it depends on the individual. The FMG might have been an attending in another country, or be a complete newbie... The Carrib might have been lounging on the beach during med school, barely passed the Boards, and know nothing, or they might be some of the best docs out there. Some of the best attendings that Ive rotated with, went to school in Mexico or the Carribean. When you're bored, look up your attendings online. You might be suprised to find out where they went to school.

As for DO, I still dont understand why people question their training. They have the same curriculum that MDs have, plus they have to learn osteopathic manipulation. And residency equalizes everything anyway. The MD and DO have to do the same procedeures, read the same literature, etc etc/

 

[MyNameIsAlex]

for those that asked why...

many carib grads i came across are way above the average US medical grads, some are not. after all the education and boards are mostly the same for everybody +/- 5-10% at most. esp when it comes to carib vs US, in general those from caribs who score the same as an avg US students on boards are the same. in my opinion however, the tradional 6 years european education in medicine is way above both systems, when it comes to general medicine, while residency is better in north america, however their board scores are normally not representitive of their knowledge simply because the education system is very different.