The Residency War – AMGs vs FMGs
Posted by: drhaisook on: December 19, 2005
- In: Dr Haisook| Misc| USMLE
- Comment!
Well, I’ve read that sentence in a website a couple of months ago (..don’t remember the URL). So they say it’s getting even harder for a foreign medical graduate (FMG) to get a residency in the United States. That may lead to sending the foreign doctors to remote places, like rural areas,..etc.
Racism? mm,.. I think it’s like “Yes and No” at the same time.
Why “No” ?
Rationally, people of a certain country has given a lot to their country throughout their life. They’ve grown in it, and are more able to cope with most of the circumstances that occur. Whether it’s social, cultural, or economic, native people are more aware and more familiar of what to think, and what do about it. That’s unlike the case with a foreign person, who in most of the cases is not that oriented with the country he’s going to live in. That was generally speaking..
Now let’s come to the medical part. The USMLE exam requires a specific way of thinking; an intelligent, concise, and more importantly ‘clinical’. American medical students study medicine that way in their medical schools, so they automatically graduate with minds that we can call: “American Medical Minds”. On the contrary, the majority of the FMGs applying to the USMLE come from developing countries (statistics) whose medical schools lack of any sort of appropriate, or sufficient way of teaching. The lecturers are way too narrow-minded; there are only very few, or no modern equipments available for the student; there are ‘too’ many medical students that sometimes a single grade includes over 900-1000 students, and a single practical section may include over 80 students.
I think it’s very fair to say that the native American MGs are worthy of residencies more than FMGs are. Even the statistics show that over 90% of the AMGs pass the USMLE exam, in comparison to only 50% for the FMGs.
Why “Yes” ?
I think it’s very unfair that FMGs need ‘more’ marks in the USMLE to get residencies for certain specifications, like surgery. It would’ve been a lot more fair for the USMLE to be equally applied upon all the takers, regardless of their ethnicity. Normally, most of the FMGs do not pass the USMLE (like I said above. The percentage is 50). Now it became even harder, as for instance, scoring a 150 is equivalent to an AMG scoring a 100! Sometimes AMGs get better residencies though they score less than FMGs in a certain exam. This is totally unfair!
What do you all think?
18 Responses to "The Residency War – AMGs vs FMGs"
June 17, 2006 at 6:25 pm
Hi Dr.W
I’m not an American, or even a native English-speaker. Though the English language constitutes most of my life activities; my studies, my interests, music, movies, books,..etc, I still consider myself to be not that experienced at English, esp. speaking. Plus, I believe the USMLE requires good orientation of the American way of life in general; very apparent in the questions. So, the average FMG lacks a good bit, if not all, of these two things. That’s why it’s virtually harder for a FMG to get high grades, even though he/she might be medically oriented in an efficient way.
I agree with you that on getting a job, both – AMG and FMG – are pretty on the same line, since both have passed the same steps beforehand. The differences vanish especially in fields like surgery (as you’ve said).
As to psychiatry, I think it needs an efficient ability at manipulation of the language (being American-accented English in the US), since you’ll be in direct contact with patients for a relatively longer times than other specialities would require. So typically, an AMG would be more able to cope with such specialty.
I wonder if you – through all that time you’ve spent alongside foreign students – have noticed any sort of racism, offense, or looking down upon? I’m aware that the US is naturally a mixed population, but I get a bit nervous when I think of that part. I don’t look like any distinct foreign race; asian, black, indian,..etc. I’m white-skinned, and green-eyed. I think I’m typically a caucasian by that.
Do you think apparently foreign races are more looked down upon than those who’re white (though both are known to be foreign)?
Thanks
June 20, 2006 at 5:43 am
Dr. H:
I think it depends very much on the community make-up. For example, where I live there are many foreign doctors, and in many specialties. I think this community is “de-sensitized,” perhaps, to seeing a foreign doctor. On the other hand, I have seen some patients absolutely refuse to see any other than an American doctor, usually only in psychiatry, however.
I do think that if you look Caucasian people will accept you as “less foreign” (even though there is no such thing) than someone who looked Indian, Asian, etc.
Willow-e
November 26, 2006 at 7:15 am
I am a FMG. I worked as a dermatologist for 6 years and left the medical field for about 7 years. Now I have been thinking about getting back to medical field by passing USMLE. I am really hesitating because it was such a long time ago since I took the courses. If it doesn’t scares me to pick up all the courses again, the language is still my big concern. It wouldn’t be easy for me to repeat all those courses. But nothing worries me more than study them in English, which is not my native language. I wonder if you have some advice for me about this. Do you know if I could find more information about it? Actually, I don’t even know how I could find good books for the exams.
November 26, 2006 at 9:47 pm
Hi Dr Yan D.,
Do you mean you’ve worked as a derma. for 6 years in the US or in your own country?
If you haven’t taken the USMLE before, it would be more of a tough challenge to you to start preparing now especially that you left the medical field many years ago.
Your written English seems to be OK.
In order to get into the dermatology field in the US, you’d need to get a relatively high score in the USMLE. This field, as well as Surgery and Radiology, are highly competitive.
Anyway, if you really feel like preparing now, you will initially needs the books and the CDs (DVDs). The commonest and popular are:
- KAPLAN Lecture Notes
- KAPLAN CDz (or DVDs)
- First Aid for the USMLE
Be aware that there are 3 obligatory steps (Step 1, Step 2 CK, Step CS) and an optional step (Step 3). Step 1 and Step 2 CK could be taken in your country, while the latter two are to be taken in the US only.
April 6, 2007 at 2:53 am
I just came across your website and will have to strongly disagree with your comments posted here. You generalize too much on your statements and come to inadequate conclusions. There is one main reason as to why AMG get higher passing grades than FMG. First off, medical schools in the US have one purpose in mind, have their graduates pass the USMLE, they dont care about teaching medicine as much as teaching how to pass the boards. Most med schools requiere their alumni to give Step 1 after finishing the basic sciences portion, step 2 after their clinical, etc. AMG have the subjects very fresh in their heads when they give the boards. The majority of FMG apply to the boards after they have graduated as MD’s in their home country, thats generally a six year lapse from studying basic sciences and having to prepare for them for the boards. Not only that, but their native language aint english…adding to the pressure. One of the hardest parts I myself found was the lack of information and guidance as to the content for the examsand how to prepare for them. If it wasnt for the people @ the Kaplan courses I doubt I would have succeded. I believe FMG deserve more merit for passing any Step compared to their counterparts. A FMG has to work hard at passing this exams.
April 6, 2007 at 3:20 pm
Hugo MD,
I think both of our thoughts are pretty much the same. We just showed them off in different ways. So, I agree with what you’ve said. It’s just the way of orientation. Foreign medical students are not that oriented with the whole thing. The point I was stressing on is that sometimes, for instance, an AMG scoring 150 is better and much more acclaimed than a FMG scoring 180. Why on earth is that?
January 25, 2008 at 12:05 am
hii, i m a fmg with scores around 90 in both steps but seems no hope for getting residency here ….i dont know whether i deserve or not but i spend 2 imp years of my life and whtevr i had ….. so its really not good for me … well i accept it but it could haVE BEEN BETTER WAY ..EITHER THEY SHOULD STOP IT FOR FMGS …..OR SHOULD SET MINIMUM crtiteria like no less then 95 ….or ecfmg should alow to take exam once more if they expect above 95 frm fmgs ….. i may be totally wrong when i write all this but i m feeling relieved …thx
May 29, 2008 at 1:03 pm
my scores r 88/90 cs pass 5 month usce ….did nt match ..may b scores nt 99s nor i hv any contacts
dont knw wht i will do next …will be taking step 3 in july bt i dont knw hw much it will help me …i think i will pass bt if i dont score more thn 90 thn i think it wont be of any help ….if u can help me to get in to some residency in any way i would be so thankful
thanks
May 29, 2008 at 1:43 pm
Hi doc, are you also ‘vg’ who posted above you?
First, don’t lose faith. You still have a chance.
Well, I’m curious, what kind of USCE did you get? And do you have any letters of recommendation (LOR)?
Have you tried the ‘FindAResident’ service? It’s a service offered by the AAMC to physicians looking to find a job at any hospital in the United States with empty positions. It is completely different from the postmatch scramble and is unrelated to the main match. FindAResident is open all year long and constantly updates the list of hospitals with unfilled positions. It may be helpful if you didn’t match. To use FindAResident you have to access its webpage ( http://www.aamc.org/findaresident ), register to the service and pay a fee.
You may also take Step 3, take more externship, and then try to re-match. Step 3 is important for IMGs.
Best of luck.
June 4, 2008 at 7:42 pm
I can understand the debate between the FMG and AMG issue, but I think that there is a lot about this subject that is being overlooked. I am not anti-FMG, I know that we need more physicians in this country, but heck, we need more physicians all over the world, so that point is moot. As far as trying to discuss or argue over who deserves a spot more or whose score is more reflective of a better student, that goes both ways. I see on here, responses about how FMGs have it harder because of language differences, drug name differences and differences in the western way of life, but they also have a lot more on their side. I am an American medical student and I have to take the Step 1 after 2 years of class and I get about 5 weeks total to study for this exam on my own. The average FMG has 3 years of classroom experience to learn what we are taught in 2 years, they then have clinical experience and then have as long as necessary to study for the USMLE. There are lots of forums on Kaplan’s website with FMG test-takers asking for advice because they only have 2 months left to study for the exam— I’m sorry but if you can’t get it in your head in 2 months there’s not much we can do. My roommate and I covered 2 years of education in 4 weeks. I understand the language barrier, but everyone needs to understand that if you want to practice medicine (a profession that puts the lives of loved ones in your hands) you better do all you can to break down that language barrier and learn whatever it is you need to learn in order to communicate to patients and other physicians. You could be the greatest mind in the world, but if you cannot communicate with patients effectively and compassionately, you have no business seeing them. I also see a lot of language problems in comments on websites like this….this is another problem, we all need to be on the same page in medicine to communicate and that page is communicating in English and writing and reading and speaking it FLUENTLY. I do not expect to be treated differently if I wanted to practice medicine in France and had trouble with the language, I would expect them to hold me to the same high standard that they hold themselves, if not then I would not want to be a part of a system that made exceptions for me because I had it a little harder than other individuals.
Another point that is often overlooked is that fact that most residency salaries are paid for by Medicare, that means that US federal tax dollars are paying the salary to train physicians. Based on this, I have no problem giving American students first pick at residency spots because they are the citizens that have paid the taxes that are funding these positions. To come from another country and be upset if you are on the back burner as far as matching for residency because an American citizen who has paid tax money into the system and has been a part of this system their whole life is ahead of you is unconscionable. people should be grateful that American even allows others to enter this country, most other nations would having you jumping through more hoops than you could imagine to practice in their country. I am well aware of our need for doctors and I am also well aware of the sacrifices that American citizens have made for this country. To think that it is unfair that an American is ahead of a FMG is in my mind ridiculous. Our citizens are giving themselves to make this country a better place, if there is a problem with them being first in line, one should first question why FMG are leaving their country of citizenship to begin with, where is the loyalty to one’s nation?
To answer all your questions about national loyalty, tax paying and etc. First of all I came to USA as refugee due to a political situation. I started to work in a month after I arrived. I worked full time, and still work, I did my observership in the university, I passed USMLE steps including step3, I had good medical experience. I applied to residency, and I found nothing despite my letters of recommendation from the world known American professors, despite I am citizen of US, despite I paid taxes. My children graduated from school and university with honors and my children pay taxes too, and I think much more than you did or do. I did not wait that someone will treat me better than AGM. But people like you treat me like I am stilling something from you. My family contribute much more to make this country better than somebody who was born in US. What did you contribute to improve this country? Did you pay any penny as taxes? And you try to accuse the FGM? Who gave you the rights to do so? I think you really did forgot that your Ancestors came to this country little bit earlier than I did. Only Native American can say something. You are the same immigrant as I am!!!!!!!!!!!!!!!!!!
[...] Filed under: Dr Haisook, IMG, USMLE — drhaisook @ 9:47 pm Today I received this interesting comment from 1/2 way, an American medical student, on the blog entry: “The Residency War – AMGs vs [...]
June 4, 2008 at 9:48 pm
Hi 1/2 way! Welcome to my medical blog.
I’ve added your comment to a whole new blog entry because I thought it was pretty interesting. Please check it out here:
http://medicopedia.wordpress.com/2008/06/04/are-fmg-incompetent-stupid-parasites/
Also whoever wants to reply to 1/2 way’s comment, please follow the same link.
Thanks!
July 4, 2008 at 8:48 pm
this is more of a cry for advice, basically i am an american citizen and decided to start medical school in europe, found a cheap and accredible 4yr english program. well the thing is i just finished my first year and trying to decide if i should go back. i have multiple friends in the caribean that are having problems either pass or get matched in ANY residency in ANY state, especially with the increase in USMLE requirments for FMGs it is extreemly difficult. well i have a chance to stay and take a shot to finish my B.A.(since i only have 93 credits) and improve GPA take MCAT (since it was not needed for Europe) and apply to get into a D.O. school. it seems no matter what way i take i still am taking a risk. by staying i am lossing the time and money invested in my first yr and must start over and hope that i still get in a U.S. Med school or by going i take a risk of being stuck in Europe. but i am sure many have more expirence then i do thus could help me. i would very much appreciate any advice or expirences as guidence. thank you for your time
July 5, 2008 at 1:27 am
Annmarieski,
I understand what you’re going through. Unfortunately, I don’t have any advice to give as I’m in pretty much the same dilemma. I study Medicine in Egypt, and I’ve heard getting a residency is very difficult. However, every now and then I hear about FMGs who successfully match. You’re an American citizen, and I think this should help a lot. Anyway, hope someone who’s acknowledged about this answer you, or you could try http://www.prep4usmle.com/forum/ for faster answers.
Leave a Reply
Recent Comments
Copyright 2009
Dr Haisook's
Medicopedia
June 17, 2006 at 1:53 am
Hi, Dr. H:
I agree with you on this one, and I am an AMG. It seems to me that if FMGs can get a passing score on the USMLE, it really means more than if an AMG gets the same score because of language issues. I do have some concern about the language issue, though. The program I am graduating from is known as an FMG-friendly program. I have worked side by side with many FMGs, and my best friend is an FMG. Before I got to know the FMGs, however, I had a very, very hard time understanding them through their accent. Now that I’ve been around them for four years, I usually understand, but not always. In a field such as surgery, does it matter? What about psychiatry?
Dr. Willow-e