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

Leigh Page

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February 03, 2016

In This Article

Breaking Into the US System Has Always Been Hard

IMGs often have to take extra steps to ensure entry into the US system. Busharat Ahmad, MD, a retired ophthalmologist who helped found the IMG Section of the American Medical Association (AMA) in the 1990s, recalls that he didn't get into the US system in one easy step.

Dr Ahmad was part of the first great wave of IMGs into the US in the 1950s. He came here hoping to train in ophthalmology after graduating from the University of Karachi in Pakistan in 1956. "I got a couple of responses, but no dice," he recalls. He was told it was impossible for an IMG to get into a US ophthalmology program. However, he tried a program in London and was accepted there. On the strength of the British diploma, he was able to get into an ophthalmology program in St Louis and, finally, into one at Harvard.

Getting into the US system is still a difficult task for IMGs today. Because their educational backgrounds are often viewed here as being unclear, and because they often lack a favorable letter of recommendation from a US physician, "It's harder to get a sense of their medical reasoning abilities and procedural skill sets from the standard outside documentation," says Dr Talmon, the pathology program director.

"So when we look at foreign-national IMGs," he continues, "we tend to look at only the very best." These applicants have very high USMLE scores and high grades, or have done research work at a world-class institution. Many other program directors feel this way, too. A 2010 study[6] found that when psychiatry and family practice programs were given identical applications, they were 80% more likely to respond to US seniors than to IMGs.

The higher bar for FIMGs means they have to work harder and do more. Writing in 2011, Kenneth Christopher, MD, a nephrologist who is assistant director of the Preliminary Residency Program at Brigham and Women's Hospital in Boston, estimated that whereas most US seniors take about 4 weeks to study for Step 1 of the USMLE, some IMGs study for 2 focused years.[7]

Carl Shusterman, an immigration-law attorney in Los Angeles, reports that many FIMGs arrive in the US on student visas 2 years before applying for programs, so that they can take prep courses for the USMLE at such companies as Kaplan. They also try to get paid observerships and externships at hospitals, so that they can gain some clinical experience and make contacts with physicians. In addition, they may take research positions in the United States as another way to stand out when they contact program directors.

But many don't make it. "I spent close to US $18,000 [and] wasted 2 years," a Pakistani IMG who failed to get a match wrote[8] on a website for IMGs in 2013. "My fiancée of 5 years almost left me and it was very hard convincing her to stay."

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