U R lucky, Be grateful

[Panscan]

To anyone else reading this outside the narrow group that is typically here at WCI forums, it's not that the folks here do not feel bad for those who have repeatedly failed to match, or left residency for one reason or another and now are without a medical license and saddled with 100s of thousands of $ of student loan debt. We all feel the system is less than ideal, and there needs to be a method to cut people off earlier in the process. More accountability, probably at the medical school administration and to a lesser extent at the residency program levels. But remember people here are typically already established in their medical careers and come to it with a corresponding perspective. Plus there is a healthy libertarian streak on this board too. Just look at the initial post and the next 2 posts on page #1 (start of the thread). No likes for the OP, 10+ likes for the next 2 posts that critique NYT take on this story.

I agree with a lot of what you said but there's also usually a healthy dose of delusion/terrible decisions in a lot of these stories. People who apply to 3 residency programs and then don't match, take numerous years off and then expect to pick it back up. Or people who are statistically significantly different from the average person that matches in their field. These things aren't isolated to the physician world, lets face it, it doesn't get easier to learn new tricks and you don't get more flexible as you age, completely discounting being up to date with current times, prevailing treatment sentiments and etc. It's not hard to understand why programs prefer US seniors.

As I said originally I think there should be alternative pathways for docs that don't match to serve as midlevels or a similar position and then perhaps they could re-apply in subsequent years. I'm not sure how putting the onus on the schools would actually look, would there be a weeding out process similar to how the carribean schools do it?

One of the other troubling things to me about medical education is the continual lengthening of the process, you have tons of students who do post-bacs, gap years, research years, it seems like various residency programs are continually debating the merits of lengthening or talking about lengthening. Some surgery programs are 7 years now with multiple years of research built in. It's a highly inefficient model because we are incapable of figuring out means of earlier stratification. It's also essentially how all these academic hospitals provide coverage for a discount. Our entire academic medical system is incredibly dependent on residents/fellows.

[Lordosis]

I know at least a couple people who realized that medicine may not be their ideal career during the first 2 years. If given such an out to get out of their outstanding debt I think they would have happily failed step 1 and gone down an alternate route. But by the time step 1 rolled around they already had too much debt to feel they could back out. They did just fine in Med school and matched just fine, but I suspect they may have taken the exit ramp of no debt in exchange for failing step 1 if it had been offered. That’s the problem with saying it’s the school’s problem. Rather, if we are going to cap residency spots we also need to cap medical school spots so there isn’t such a mismatch. If you as a medical school can’t match x students per year, you lose the accreditation for those spots, until equilibrium is reached.

Good point. It is not just on the school but the student as well. I am just thinking aloud (actually in silence with my fingers)

I am just remembering my 1st and 2nd year and out of the 150 or so of us only 3 did not make it past step 1. 1 willingly dropped out to pursue research. The other 2 could not pass the test. One was my roommate and I know his situation of being forced into medicine somewhat against his will to appease parents. Smart guy but it is hard to cram for a test with 2 years + of material especially if you do not care. I remember the great effort and handholding that was done to try and keep them all.

I cannot think of anyone who did not match after that point. A couple scrambled but everyone got a spot.

What is the Step 1 pass rate at these schools? What is the match rate?

[MPMD]

I agree with a lot of what you said but there's also usually a healthy dose of delusion/terrible decisions in a lot of these stories. People who apply to 3 residency programs and then don't match, take numerous years off and then expect to pick it back up. Or people who are statistically significantly different from the average person that matches in their field. These things aren't isolated to the physician world, lets face it, it doesn't get easier to learn new tricks and you don't get more flexible as you age, completely discounting being up to date with current times, prevailing treatment sentiments and etc. It's not hard to understand why programs prefer US seniors.

As I said originally I think there should be alternative pathways for docs that don't match to serve as midlevels or a similar position and then perhaps they could re-apply in subsequent years. I'm not sure how putting the onus on the schools would actually look, would there be a weeding out process similar to how the carribean schools do it?

One of the other troubling things to me about medical education is the continual lengthening of the process, you have tons of students who do post-bacs, gap years, research years, it seems like various residency programs are continually debating the merits of lengthening or talking about lengthening. Some surgery programs are 7 years now with multiple years of research built in. It's a highly inefficient model because we are incapable of figuring out means of earlier stratification. It's also essentially how all these academic hospitals provide coverage for a discount. Our entire academic medical system is incredibly dependent on residents/fellows.

the issue we have now is that to become a doctor in the USA the main qualifications are some baseline level of ability coupled with persistence and willingness to take on debt.

being a doc is great and i love it. if i were designing a society from the ground up i'd want it to look more like a German model where it's more "you are smart, have done well in school, and we need X number of doctors" as opposed to "i will beat my head against the wall until i am unconscious to achieve this dream regardless of what it does to me or my family."

all of that being said, it is difficult for me to understand the mindset of some folks who can't get into more established schools and then think they are going to excel at a for-profit Carrib school and get a great residency. does the first reality not inform the later plan? it often doesn't seem to do so.

the next step of this is accusations (sometimes very acrimonious ones) of "bias" against DO, IMG, Carrib, etc. the challenge comes when you have a neurosurgery residency at Ivy U with 4 spots and you have 400 qualified applicants most of whom are all AOA from established US schools with letters written by people you know. who among you is going to commit to spend hours scouring applications from a brand new school you've never heard of? it's a massive time commitment and guess what? the incentives aren't there.

if i could advise students at any school i one thing i would labor hard to convey is you cannot count on holistic application review to overcome shortcomings in your application. you need to work your arse off to avoid shortcomings. if you have shortcomings you need to change your plan (more programs, less competitive shops, less desirable cities) not sit and wish that a PD you've never met will invest in understanding why you failed anatomy. the question posed to that PD is not "why did Joan fail anatomy?" it's "how long am i going to look at this before moving on to the hundreds of other applications that didnt."

[fatlittlepig]

The post was not written as a judgment on the wisdom or lack thereof of attending a foreign medical school, but rather to illustrate that there are a lot of people struggling to be where you are right now, and to appreciate that. Some of the responses here demonstrate that many of us here don't.

[GastroMastro]

They are Americans who graduated from medical school, but they are not ‘American medical school’ graduates. The article makes it seem that they are being denied something that they should have an equal shot as their American Med school peers, When in fact, they are literally going to medical school in a different country or at least a US territory.

It’s just not the same playing field for them, and while I feel for their struggles, as many others have said they must know the risk they’re taking when signing up.

The NYT article really wasn’t necessary. Just another ill conceived swipe at the reputation of the medical establishment.

[loeffy]

Sure I'm grateful, as should many people be for a variety of reasons, but I worked my butt off to get here, especially getting into MD school. DO or Carib school would've been easier and was suggested to me, but even as a naive college student I knew the hill I'd have to climb graduating from there and the stigma. If carib school was my only option I'd likely found another career. It sucks if the schools are misleading students or predatory, but I don't think we should open residency spots for just anyone who wants it. I'm not keen on the idea of a doctor shortage so much as a distribution problem. Add more doctors and they'll still all go to desirable areas. A midlevel pathway for folks who don't match would be a welcome idea, but I bet NPs would have a fit.

[childay]

Is there any thought on the education provided at the caribbean schools vs all these new for-profit DO schools?

[pierre]

Is there any thought on the education provided at the caribbean schools vs all these new for-profit DO schools?

I can’t speak to the DO schools, but the education I received in the Caribbean I do not think was subpar. There was plenty of support if you wanted it. We had visiting professors from brand-name US institutions.

When clinical rotations came around, I think we were a little behind with physical exam and such, but it all evened out within weeks

[tylerjw12]

I read the article this way:

There's been a ton of interest lately in health care capacity (flatten the curve!). Research suggests a possibly large shortage of doctors coming up. Here are a bunch of med school grads who are struggling to become certified. Some of it is due to the individual (shortcomings in application) and some of it is more systemic (more grads than residency spots, some PDs by and large overlooking foreign grads whatever the reason).

I thought the article was careful NOT to put it as establishment bully doctors vs poor poor fmgs who did nothing wrong.

[StarTrekDoc]

The post was not written as a judgment on the wisdom or lack thereof of attending a foreign medical school, but rather to illustrate that there are a lot of people struggling to be where you are right now, and to appreciate that. Some of the responses here demonstrate that many of us here don't.

This is along the lines when I went through training and the concept of limiting weekly hours to a mere 80 hours and post call hours was met with much the same tone you're suggesting: Be grateful for the crappy job environment. There will be 10 folk happy to be in your shoes.

The caveat would be -- would those 10 folk be equally qualified or execute the duties as effectively?

Being from UMiami, we had plenty of Caribbean folk doing 3rd/4th year rotations and it was definitely more variable then the FMGs we had. The FMGs would be cream of the crop Latin America who were often academic attending level folk just wanting to get into the USA.

So if the intent is 'be grateful' -- this misses the larger point being made that your replacement may not be as equally qualified either. Our administration learned that the hard way with a large exodus of academic physicians leaving which they tried to backfill with community oriented physicians and patients gave plenty of feedback on that to them.

[fatlittlepig]

OK, I’ve obviously have been proven incorrect- no gratitude is indicated as your success is deserved, through your hard work, superior academic achievement, grit and fortitude. It was preposterous to compare your journey to those who have traveled a more winding road and have hit some of life’s potholes. Okay we can go back to discussing our high salaries, and griping about our high taxes.

[Tim]

OK, I’ve obviously have been proven incorrect- no gratitude is indicated as your success is deserved, through your hard work, superior academic achievement, grit and fortitude. It was preposterous to compare your journey to those who have traveled a more winding road and have hit some of life’s potholes. Okay we can go back to discussing our high salaries, and griping about our high taxes.

Some have had more than a pothole. Sink holes , hurricanes, tornadoes, fires, toxic attending, complete loss of possessions, and hit and run car accidents and are doing just fine. Winding roads are not endless. Some actually complete difficult journeys. Survival is a learned skill.

[GastroMastro]

I read the article this way:

There's been a ton of interest lately in health care capacity (flatten the curve!). Research suggests a possibly large shortage of doctors coming up. Here are a bunch of med school grads who are struggling to become certified. Some of it is due to the individual (shortcomings in application) and some of it is more systemic (more grads than residency spots, some PDs by and large overlooking foreign grads whatever the reason).

I thought the article was careful NOT to put it as establishment bully doctors vs poor poor fmgs who did nothing wrong.

Disagree. Did you see the quote, “...wrote Dr. Suzanne Karan, an anesthesiologist at the University of Rochester, in a 2019 blog post. “It makes my job a lot easier when I can filter your applications by M.D./D.O./foreign graduate.””

[Tim]

Disagree. Did you see the quote, “...wrote Dr. Suzanne Karan, an anesthesiologist at the University of Rochester, in a 2019 blog post. “It makes my job a lot easier when I can filter your applications by M.D./D.O./foreign graduate.””

I saw that. It brings up the question of “Where is the fiduciary responsibility?”
Sort through a stack A or stack B or stack C.
A has 90% and B has 70%. C 50%.
Need to fill 16 spots, maybe 100 interview spots?
Probably to the institution, not the applicant.

Search criteria is used to narrow the results to a minimum level to accomplish the objective, 16 spots.
I think “efficient” would have been a better choice of words.Filters have a legitimate purpose. Whether one agrees with them depends on which side of the filter one falls.
That is the match process. Better chances in stack A.

[Panscan]

End of day all these program have 1000 applications for 10 spots due to how the online apps work now. An extremely simple stratification tool is to look for us seniors first bc it basically ensures they are at least somewhat up to date with treatment norms and social norms. It’s not possible for PD to look into all of these people from a detailed perspective unless you want them to spend months going over apps and the whole process to be lengthened.

People always look at residency as like “ this program is lucky to have me” or like they are significantly different than the next person on the list who would have ended up there. I try to bust my butt and go the extra mile but if I didn’t exist and the next person on the list took my spot the program probably wouldn’t be significantly different. It’s like they expect for the PDs to spend hundreds of hours pouring over the applications trying to find minute differences between candidates. Realistically there are probably like low single digit percentages of people that are avoided , multiple failures, substance abuse issues, repeated disciplinary issues, people with 0 social intelligence. these people are very high risk and most programs immediately exclude m. After that there are levels of knowledge and social intelligence but within various tiers it’s not like one candidate is significantly different from the other.

I look at programs the same way. Your life and medical training/knowledge probably isn’t going to be significantly different if you go to two similar programs and give the same effort at each. Ya one could be a total sh*t show but probably not. Sure if you go to ivory U vs bumble F community center it may be different but typically the same person isn’t debating that.

overall I think candidates in general are way neurotic about differences between places as well as their relative importance in the grand scheme.