Foreign Medical Graduates in the USA

By Junaid Kamal, MD
Resident Physician Anesthesiology
University of Texas, Houston Medical School

I wrote a letter 2-3 years ago about the situation of FMGs in the USA and the problems they have to go through before getting the residency training of their choice. I think that letter did discourage some of my colleagues but since I am in the USA my duty is not to discourage people but to tell them the facts so that they could make their own decisions about future pursuits.

Let me give you some background. The FMGs initially started to come to the USA for post-graduate medical training (residency training) back in the 1970’s. There were times when it would become easier and times when it would get a little harder but it became real tough in the 1990’s. To the best of my knowledge 1994-99 were very tough years. The key factors which always help in getting the residency positions are USMLE scores, visa status and the type of training (field) that one wishes to pursue. Most of the times US medical school graduate would go for fields which they like most (easy to find job after residency and good working hours plus good money). I remember when the trend changed from subspecialty to more of general practice (it started in late 80’s and early 90’s), a lot of US medical graduates wanted to pursue that but that does not mean a subspecialty was easy to get into. It was never like that and is never going to be like that. Even today, General Surgery, Orthopedics, Ophthalmology, ENT and Uro

logy are dream fields for FMGs. And for some strange reason Pediatrics has always been tough to get into for FMGs.

Anyway, talking about recent changes, the good news is that residency would again become easier in the coming 2-3 years. There are chances that Family practice and Internal Medicine would be easier to pursue. The reasons are pretty simple: the trend is to go back to specialty and there is not good money in general practice but a lot of hard work. Now that means the residency would be easier to get but competition would be tough. In almost the last five years the total number of residency slots offered in the USA aggregated 24,000 every year of which 18,000 were US medical graduates (which means one way or the other they all have to get these residencies and they get them) and the remaining 6,000 slots were for FMGs (for these 6000 every year the number of FMGs was 13,000-15,000) . The American Medical Association (AMA) and ECFMG have tried to stop the influx of FMGs and they have succeeded in their goal. They started the new exam CSA (clinical skills assessment) in 1998 and it reduced the number of FMGs because it is an expensive exam and conducted only in the USA (initially the passing rate for this exam was 100% but later it dropped to 80-90%). Lot of FMGs were discouraged but on the other hand they opened up centers all over the world for USMLE exams to make the process easy but after passing the USMLE 1-2 people don’t get the visa for taking the CSA exams. So this year people could not get the visa or for whatever reason a lot of FMGs could not come to the USA and a lot of people in the States who were working or sitting got a chance to get the residency (total FMGs who applied were around 10,000). Looking at all these facts and numbers it seems that whoever makes it to the USA has a pretty good chance to get into the residency program. But AMA is now very actively thinking to cut down the number of slots every year to make it even with the number of US med grads so that they don’t have to get FMGs. Nobody knows for sure what’s going to happen but these are expectations and predictions. There are a couple of general guidelines and suggestions for all FMGs: if you are in the USA for 2-3 years and looking for a residency slot, please obtain some US educational experience by doing a Master’s degree in healthcare or related fields. If you are in your own country and plan to come to the USA, I would advise you to finish your house job (internship) back in your country, finish your USMLE exams and then come (just in case for whatever reason if you don’t get residency then you have a back-up plan). Try to get good scores in USMLE. People with a good background in fields like pathology, psychiatry and anesthesiology in their own country always have a better chance in the USA to get into their specialty.

By looking at the numbers this year, I could say that for 2-3 more years residency slots will be easier to get into. I am therefore encouraging the FMGs but I know that 2001 National Residency match would give us all a better picture of what’s exactly going on. So please don’t take my words for granted. Please visit my website (Http://www.geocities.com/JKAMAL97) for further updated information and facts. Please email me your concerns (IMGS2000@hotmail.com).