Tuesday, July 26, 2016

What are the residency prospects for graduates of offshore medical schools? 2016 update

Since I blogged about this two years ago, there is new data that may help clarify the situation for those who graduate from non-US medical schools. That post has had over 44,000 page views and 91 comments, some of which are responses from me to reader questions.

The National Resident Matching Program (NRMP) has published a 290-page summary [Characteristics of Applicants Who Matched to Their Preferred Specialty in the 2014 NRMP Main Residency Match (5th edition)] of the 2014 match, the latest year for which complete information has been analyzed.

The number of US graduates participating in that year's match was 17,374 compared to 16,896 graduates of other schools including non-US IMG's (7334), US IMGs (5133), DOs (2738), US graduates from previous years (1662), fifth pathway students (15), and Canadian grads (14).

From the Main Match Results Data for categorical general surgery in 2014:
One way to look at these numbers is that if you are US senior applying for a categorical surgery position, you have a 922/1274 or a 72% chance of matching. If you are in the "others" category, it's 283/1108 or a 25.5% chance of matching.
Another way to look at it is that of a total of 17,374 US seniors in the match 922 (5.3%) matched in surgery while at 283 (1.7%) of 16,896 "others" matched in surgery. Of course many factors can influence whether you match or not.

Most surgery program directors screen applicants by their USMLE Step 1 scores.

The average USMLE Step 1 score of US seniors who matched in general surgery in 2014 was 232 ± 13 and for Step 2 was 245 ± 10. A US senior with a Step 1 score of 200 has a slightly better than 45% chance of matching compared to any applicant in the “other” (independent) category where a Step 1 score of 200 would result in about an 18% chance of matching. An “other” applicant with a 260 score on Step 1 has about a 60% chance of matching in categorical surgery while a US senior with the same score has close to a 100% chance. The figure below compares Step 1 scores and match rates for the two groups:
Note: This means a candidate in the independent (other) category with a Step 1 score of 260 has a 40% chance of going unmatched in surgery.

Applicants who matched had somewhat higher amounts of self-reported research experience and publications than those who did not match. Not in the NRMP data are other important characteristics such as medical school attended, year of graduation, current employment status, and US clinical experience.

A paper published ahead of print in the American Journal of Surgery analyzed some of the same data and found that although surgical programs have filled at a rate of almost 100% for over a decade, the percentage of categorical positions filled by US seniors has declined at a rate of 0.5 percentage points per year. In 2014, 76.5% of general surgery positions were filled by US seniors compared to a high of 89% in 1995. The downward trend is similar for match rates in all non-general surgery specialties where the match rate for US seniors in 2014 was about 63%.

A figure from that paper shows that the non-US senior deficit in general surgery is increasingly being filled by US and non-US international medical graduates at similar rates (dotted and blue lines) and DO, Canadian and fifth pathway applicants (green dashed line). The solid black line represents all "others." The upper horizontal line indicates 24%.
Many students who want to become surgeons write to ask me what their chances of matching are. In most cases, it is very difficult to give a definitive answer.

In addition to reviewing the information above. I strongly advise you to look at the match results for your school if you can find accurate data. For example, one Caribbean med school, Ross University, lists 778 graduates who obtained a residency position in any specialty through the 2016 match. [The number who enrolled in the match and were unsuccessful in obtaining a residency is unknown.] Of the 778, 20 (2.6%) matched in categorical general surgery.

A total of 82 US IMGs matched in general surgery in 2016; 20 (24.4%) of them were from Ross. I'll do the math. That left 62 who matched in surgery from the rest of the 25 or more Caribbean schools and any other foreign school attended by a US citizen

Remember, statistics like these describe groups. Every applicant is unique. Your results may vary.

Addendum 8/5/16: See this post about the implications of the supposed doctor shortage on IMGs.


artiger said...

Hmmm, between this and the continued trend toward surgical subspecialty fellowships, I guess the emails, phone calls, and snail mails that I receive from recruiters and locums agencies will only increase. I keep telling myself it's good to be wanted.

On somewhat related note, where are all the grads from the newly opened/opening schools going to find ANY residency?

Skeptical Scalpel said...

Yes, a new survey from a recruiting company says "63% of residents surveyed have been approached by recruiters with hospitals, medical groups, recruiting firms or other organizations 51 times or more during their residency training. 46% said they have been contacted by recruiters 100 or more times during the course of their training."

As the new US schools and the increasing class sizes of the older US schools produce more graduates, it will inevitably put the squeeze on all the other categories. There are more than enough residency positions to support the US grads now and in the future.

Anonymous said...

True. The problem is no one going into the care areas needed: primary care, endocrinology, peds, FM, etc.

Skeptical Scalpel said...

I disagree. If you look at the link I posted for Ross U. med school, you will see that 625 (80%) of its graduates matched in either internal medicine (276) or family medicine (249).

Anonymous said...

I apologize. I meant that American students are not going into those areas. They need to move the residency match positions so all PCP type of specialties get spots first, then save residency spots for the specialists in demand (surgery being one of them). After that, use it for derm and other ROAD specialties.

Skeptical Scalpel said...

No apology needed. I'm not sure how your plan would increase the number of US grads who would go into primary care. Wouldn't many of them still wait for the specialty matches?

artiger said...

One way to get more US grads into primary care is obvious...increase the reimbursement. I know, everyone says in their interview that they didn't go into it for financial reasons, but there are realities like debt, mortgages, expenses, etc. I think there's some hope, though. Primary care seems to be dividing into two tracks, inpatient (aka hospitalist) and outpatient (aka office based). I guess you could say three, with some people coming out of residency and going straight to ER work or locums. All these things have something in common, and that is a lack of call after normal business hours or shifts. Time is worth a lot to today's younger physicians. It's worth a lot to me too, for that matter. That is one way primary care can become attractive.

Skeptical Scalpel said...

I agree. Increase the pay for primary care. However it's not so easy to quantify what they do. This may get me in trouble, but I have seen padded notes with "12-point" system reviews and cranial nerves which never happened. It's so easy to click the boxes in an electronic record. I don't know how that problem can be solved.

Anonymous said...

I have worked beside a fair number of MDs/NPs, etc., who I have seen go into a room, come out 3 minutes later, and dictate a complete history included palpating femoral and temporal artery pulses! With EMR it is worse, especially with pre-loaded templates. I was surprised to learn, reviewing a chart of a patient who needed her ears cleaned, that she had a soft abdomen and no murmurs! I don't recall writing that, just shows up when I select cerumen impaction as the C.C.

Skeptical Scalpel said...

Anon, I have seen similar things such as neuro exam normal in one place and right hemiparesis in another. This impacts the writer's credibility.

Anonymous said...

Could they afford to wait? There may not be enough spots for more than a year, and do you want the ones coming right out of school or those who got left out for a year & maybe did nothing? Remember those loans are also coming due. Not everyone is going to get a spot.

Personally, why should taxpayers be on the hook for training these people? Billions of dollars are in the bank of these not for profit hospitals, they get tax breaks, tell them that the $$$ from the govt. go to pay for those going in primary care, surgery, residencies in need. Let the hospitals part with the money for residency. Stop feeding at the public trough.

Skeptical Scalpel said...

Anon, I'm not sure what you're referring to in your first paragraph.

Regarding your second paragraph, I believe resident education is perceived as a public good. I also believe that hospitals make money on the resident programs they sponsor and do not necessarily spend all of the money the government gives them for this endeavor on program enhancements, faculty salaries, or resident salaries.

If hospitals did not make money on residency programs, I am certain they would stop sponsoring them. Either the government pays for resident education or the hospitals raise their rates to cover the cost plus a profit for doing it. Either way it's going to come out of your pocket just like defaulted student loans. Either the student pays back the loan or the government does--in which case it's you, the taxpayer, who pays.

Anonymous said...

This is what they'd be up against. I suspect that they would better off face life a PCP's and maybe moving on later. Other countries have like 70% PCP and 30% specialists. We have 30% PCP and 70% specialists. When it is easier to get an appt with a specialists than PCP, that's a problem.


Skeptical Scalpel said...

I agree with you about the distribution of specialists vs. PCPs. As long as people are free to choose and positions are available, it will continue.

Anonymous said...

The hospitals don't just make money from government sponsored training, they also make money by charging rack rate for patients being treated by doctors in training who practically work for minimum wage.

Skeptical Scalpel said...

In reference to hospitals, I'm not sure what "rack rate" means. They charge what they can get away with. I don't support that.

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