Where Do International Medical Graduates Fit in the US Healthcare Picture?

Leigh Page

Disclosures

February 03, 2016

In This Article

Having to Exceed US Standards

Even today, when there's a relative abundance of residency slots for them, IMGs still have to clear a set of hurdles to break into the US system, and only a minority of applicants will succeed.

First, they have to take the United States Medical Licensing Examination (USMLE), testing them for a somewhat different style of medicine than they were used to back home. What's more, many IMGs who are citizens of other countries (foreign IMGs [FIMGs]) have to take the test in an unfamiliar language.

All IMGs who pass the USMLE have to be accepted to the ECFMG, which verifies their medical education and issues certificates based on USMLE performance. Only about one half of ECFMG applicants get certified.

After ECFMG certification, IMGs have to be accepted into a US residency program. Again, only about one half get a residency slot, according to the National Resident Matching Program, which oversees placement of applicants into residency programs.

FIMGs have the further burden of being unknown entities when they apply for residency programs. In many cases, they haven't had a US clerkship and may not know a US physician willing to write them a recommendation letter, both of which are important criteria for the program directors choosing positions.

Because they're almost completely unknown, IMGs have to stand out in some way—which usually means being "academic rock stars," according to Geoffrey A. Talmon, MD, director of the pathology program at the University of Nebraska Medical Center.

For these reasons, FIMG applicants need to have higher scores on the USMLE than US graduates. A 2009 study[4] found that FIMGs have higher scores than USIMGs on Step 1 and Step 2 (Clinical Knowledge)—though not on Step 2 (Clinical Skills), which includes tests of spoken English and communication skills.

FIMGs may even outperform US graduates when they enter medical practice. A 2010 peer-reviewed study[5] found that among patients with congestive heart failure and acute myocardial infarction, those treated by FIMGs had lower mortality rates than those treated by graduates of US medical schools. The study was led by John J. Norcini, PhD, president and CEO of the Foundation for Advancement of International Medical Education and Research, which consists of organizations that certify the competency of US doctors. These groups include the Federation of State Medical Boards, the National Board of Medical Examiners, the Association of American Medical Colleges (AAMC), and the American Board of Medical Specialties.

"We have been blessed with the cream of the crop of the doctors from other countries," says Dr Norcini, who previously oversaw clinical evaluation at the American Board of Internal Medicine.

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