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

Leigh Page


February 03, 2016

In This Article

Gaining Entry Via Caribbean Schools

An increasing number of IMGs entering the US system are US citizens, mostly from medical schools in the Caribbean. The oldest Caribbean schools—St George's University School of Medicine and Ross University—were founded in the late 1970s, when it was becoming more difficult to get into US medical schools. Students with grade point averages and scores on the Medical College Admission Test that would have gotten them into US schools only a few years earlier found themselves shut out.

Today, the competition for enrollment in US medical schools may be even more intense. The AAMC reported[9] in 2013 that a record number of people applied to US medical schools, yet despite an increase in the number of positions available, only 41% of applicants were accepted. About 28,000 students who had planned a medical career were turned away from US schools.

Some of these students apply to Caribbean schools, which have been growing rapidly. The ECFMG's 2014 Annual Report[4] shows that the number of ECFMG applicants from Caribbean schools doubled from 2000 to 2013, and USIMGs now account for almost one third of ECFMG certificates.

Fully 31 medical schools in the Caribbean cater to US students, and the flow of graduates back to the United States has been growing, according to the AAMC report. The quality of Caribbean schools varies. A peer-reviewed study[10] of Caribbean schools led by Dr Norcini found that the rate of a school's graduates getting ECFMG certificates ranged from 28% to 86%. Many of the established Caribbean schools, such as Ross and St George's, were at the top end.

Working Hard to Erase a Stigma

Caribbean schools have been champing at the bit to prove their quality. Accreditors of Caribbean schools have been at the forefront of qualifying for the ECFMG's new accreditation standards. In 2015, with the deadline for approval still 8 years away, the ECFMG announced[11] that the accrediting body for several Caribbean schools was one of only three accreditors to be approved so far.

USIMGs have a leg up on graduates from other foreign schools because their schools closely imitate US schools. The USIMGs' schools have basically the same curricula, employ US-trained faculty, and even send their students to clinical clerkships in the states. They tend to go to clerkships in New York State, where the state Department of Health takes on the unusual role of monitoring the quality of these clerkships.

In US clerkships, students can audition for US-based physicians, who may write letters of recommendation for them for training programs. FIMGs, in contrast, rarely are able to enter US clerkships and are always struggling to find US doctors who could recommend them.

US program directors who screen applicants for the crucial step of residency training like being able to assess an education similar to that of US graduates, says Dr Talmon. "I don't treat USIMGs any differently than medical students from US schools," he says. "When they come into the program, I can't tell the difference from the US graduates."

Program directors' greater familiarity with USIMGs' experiences may explain why USIMGs have somewhat better odds of being matched to a residency program than do FIMGs: 53.1% for USIMGs in 2015 compared with 49.4% of FIMGs, the ECFMG reports.[12]

Whereas some program directors require a minimum score on the USMLE—typically around 230 or 240 out of a perfect score of 300—Dr Talmon isn't so hung up on scores. "The USMLE was initially designed as kind of a driver's license test, in which passing or failing was the important thing," he says. "If you get just a few answers wrong, it can have a huge impact on your score."

According to recent statistics, USIMGs fit very well into US workforce needs. When they go into practice, they fill in the gaps in primary care even better than FIMGs or DOs. A 2013 report[13] found that 56.7% of Caribbean-educated USIMGs chose a primary care specialty, compared with 54.0% of osteopathic graduates, 42.3% of non-Caribbean IMGs, and 32.9% of graduates from US allopathic schools.


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