Monday 23 May 2011

IMGs - Know Your Competition (part 2)

This article is a continuation of the analysis of who we are as IMGs. In the first part I talked about the nature of the applicants based on the geographical location of the candidate. We learnt that even though these are 'international' medical graduates majority of these apply from with in US itself. Today, I will demonstrate some differences between US IMGs and Non-US IMGs. This stems from an article that studied a cohort of applicants from 1992 to 2006. 

According to the publication, Non-USIMGs come from many source countries, and they seek opportunities not only in the United States but in other countries. USIMGs are, for the most part, simply that segment of the overall U.S. medical student applicant pool that has chosen to attend an international school, either by primary choice or because of failure to gain entry to a U.S. allopathic or osteopathic medical school.(1)
Figure 1. Comparison of Mean Age of IMG applicants

There were significant differences between USIMGs and non-USIMGs during the period studied. At the time of initial application, USIMGs were younger than non-USIMGs (mean age at initial application: 28.8 years versus 29.2 years), this is shown in Figure 1. Though the difference is not impressive, it does make for a older non-USIMG work force. 

Figure 2. English is not the native language of non-USIMGs
Also interestingly, US-IMGs  are more likely to claim English as a native language as shown in Figure 2

Figure 3. Language of instruction in medical schools for IMGs
Not only is the native language not english a good proportion of the non USIMGs, they also received education in language other than english. USIMGs are more likely to have received medical school instruction in English (90.5 percent versus 66.3 percent). This is shown in Figure 3

Figure 4. FAIMER® US work force article.
This was very surprising, given how well non-USIMGs do overall with regards to patient care along with professional and academic achievements. A study (Figure 2)  by FAIMER® which showed that specific cause mortality rates of patient treated by non US IMGs was better than US IMGs. This goes on to demonstrate that language and medium of instruction is no deterrent to delivering high quality medical care. 
Figure 5. Caribbean grads top the USIMG pool
Also per the article, Although USIMGs attended many different schools, more than half attended one of four institutions. Of the total USIMG population, majority attended Ross University (Dominica), followed by St. George's University (Grenada), Universidad Autonoma de Guadalajara (Mexico), and American University of the Caribbean (AUC) School of Medicine (Netherlands Antilles) in decreasing order (Figure 5). 
1. U.S. Citizens Who Obtain Their Medical Degrees Abroad: An Overview, 1992-2006. John R. Boulet; Richard A. Cooper; Stephen S. Seeling; John J. Norcini; Danette W. McKinley. Health Affairs, Medscape


  1. Hi, Dr. This website has been so insightful and helpful, thanks! I am a US-IMG interested in dermatology. I understand the competitiveness of the field, however I have also educated myself on how to maximize my chances of obtaining a match. What is your advice and opinion? Do you feel I have a chance if I get involved in research, get good LORs, and do well on away rotations? Or, do you think I have no chance, and should not even attempt it, even with all else things being equal to that of a US grad?

    1. Thank you for the kind words. The best way to deal with super competitive specialties is 2 ways: bolster your application by dermatology specific research/projects and work with dermatology faculty so that they can endorse you or help you find residency in derm. All things being equal once you are done with your USMLE steps, your status as a citizen will help you seek jobs/opportunities in derm. The scores need to be exemplary because many derm programs have very high requirements.


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