Which Countries do most IMGs in US come from ?

A 2006 American Medical Association Discussion paper on IMGs called the "International Medical Graduates in the U.S. Workforce" did a pretty good study on the IMG distributions and other workforce data.


Here are some interesting facts that the paper presents :

1. As of 2006, IMGs came from 127 Countries !

2. IMGs constituted 185,234 physicians out of a total of 794,893 in USA

3. 44% IMGs worked in the Area of Primary Care

4. And here are the Top-10 Countries that most IMGs came from =

i. India : 24%
ii. Phillipines : 10.6%
iii. Mexico : 6.7%
iv. Pakistan: 5.7%
v. Dominican Republic: 3.8%
vi. Russia: 2.9%
vii. Grenada: 2.8%
ix. Egypt: 2.6%
x. South Korea: 2.5%

Interestingly Iran makes about 2.3% of the IMG population (12th on the Top-20 IMG countries list) despite Iran being a restricted area for taking the USMLEs or applying for exam visas. I had a reader ask me how could an Iranian IMG go about USMLEs and Residencies - I have yet to work on finding that out. I would appreciate any comments on that issue.

Another interesting thing is that while the Billion-plus populated India makes the most IMGs, its Billion-plus populated neighbor, China, way low. Pathology has a pretty good Chinese IMG population, but overall their volumes have stayed low on the clinical side, most probably due to English language barrier.

Data for Year 2007 in a 2009 IMG position paper (Download PDF Report) showed a similar IMG phyicians distribution profile:

India: 20.7%

Philippines: 8.3%

Mexico: 5.6%

Pakistan: 4.9%

Dominican Republic 3.2%

Grenada 2.7%

USSR 2.6%

Dominica 2.4%

China 2.2%

Egypt 2.1%

Iran 2.0%

South Korea 2.0%

Italy 1.9%

Spain 1.8%

Germany 1.7%

Syria 1.6%

United Kingdom 1.5%

Montserrat 1.3%

Colombia 1.3%

Ireland 1.3%

With a big physician shortage projected in the United States, IMGs will continue to play a big role in America health care arena.


Data Source: International Medical Graduates in the U.S.


You also might wanna check out this interactive map-based plot showing countries that IMGs typically come from, comparing patterns over year and also includes the top-10 medical schools supplying IMGs in USA

Sources:
- Workforce: April 2006 AMA Discussion Paper [pdf]
- - IMGs in American medicine: Contemporary challenges and opportunities: 2009 Position paper



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Barriers to the IMG race for a US Residency

Here's to enlisting some barriers that IMGs face en route to a residency spot

1. The Financial Barrier: All that Money for the USMLE Steps, for those expensive books, for the travel to and within USA - not every IMG's cup of tea :-(

2. The Exam-Visa Barrier for Step 2 CS and Step 3: It's ridiculous, you will agree, that IMGs are happily allowed to take the Step 1 in their own countries, but often blatantly rejected visa the Step 2 CS and/or Step 3 - "We sold you a movie ticket - Awrite! enjoy ! ..........Oh did you say you wanted to see the movie too ? Hmmm...bummer...we didn't think of that !" .lol

3. The Program-Visa Barrier: Now we really understand that one, but its funny when you sometimes see "We do not sponsor visas" and "We are an equal opportunity employer" statements on the same website of a residency program ;-)

4. The "IMG-Friendliness" Barrier: Not all Programs accept International Medical Graduates. And on the funny side, there are some that accept IMG applications but not the IMGs themselves ;-) Another Money maker for the ERAS-ECFMG folks, you will agree ;-)

5. The "US Experience" Barrier: You need a residency for US experience...but you need US Experience for residency ..Catch 22 eh ?

6. The Language barrier: "Well...we IMGs know English - we just speak it differently" ;-)

7. The Cultural barrier

8. The Specialty Barrier: Let me quote my friend here = "The 'hard cash' specialties are for American Grads - the 'hard work' specialties are for IMGs" :-) :-) :-)

9. The Score Barrier: "Most of our American grads can get that score ...it's that low.. you need to go higher Mr. IMG" ;-)



Well..most of it was on a funny vein anyways ..don't think we can complain too much, can we ?


Also Read:

- Tough and Easy Specialties for IMGs

RESIDENCY - MATCH : A TWO-WAY GAMBLE !

Indeed, BOTH parties play the "Match Game" : Candidates and & the Residency Programs ! BOTH take their chances in the game - For you, the residency-seeker, the game is about WHERE and HOW MANY programs to apply to, and for the resident-seekers, the game's about WHOM to Interview.

And why is this a "gamble" ? Coz both sides have to play with fixed resources...and Neither party likes to "scramble".. (wow..did that just rhyme ?)

Wut Resources are we talking about ? As usual, it's money, the root cause of most problems on this Earth ;-)

YOU are bound by the Money you can spend on applying through ERAS while Programs are bound buy the NUMBER of candidates they can call in their budget for the year (Remember, it costs the programs to arrange for Dinners, hotel arrangements besides Man-hours). [Usually, a program calls about 10 times more candidates than it's total PGY1 positions.]

It sure is tough for us to decide where to apply, given the competition. But I am thinking, it sure is equally tough, if not tougher for the Program Directors ! A moderately ranked program carries a certain risk by calling a highly credentialed candidate, who may also be interviewing in the top-ranked programs. Hence, most of the places you goto, you are very likely to be asked "So ! Where else have you OR are you Interviewing ?" It may sound like a casual question from the Program Directoy, but has a important purpose !
Hence, unless the programs are the top-notch, ivy-league kind programs that never go unfilled, the program directors must indulge in distributing risks by having a good mix of candidates interviewed.
After that, each interviewed candidates are studied based on how likely he or she is to rank the program high - which again is not an easy task for them. How do they do it ? Here are some techniques used:

1. Assess response of the candidate after the Interview.
2. Offer the Red-carrot to some good candidates ;-) I mean a Prematch ! There's always a debate on whether declining a Prematch means low-preference from the program on the match-list !
3. Some programs will have a resident give you his/her contact information and based on how you communicate with the resident in the long run also kinda assesses your enthusiasm about the program.
4. Lastly, another strategy is to offer a "second Look" to candidates, just to look around, meet more faculty. It's there way of showing that they are interested in you and would like to see if you are ! Most of them will pay again for your hotel stay - I say accept if unless you totally HATE the program.


The purpose of this post is to educate ourselves in the fact that the match process is never over after the Interview, you gotta continue to feed your enthusiasm and keep yourself in the spotlight to stay in the race until the match day. Some pointers:

1. After you submit your application and don't hear anything for 2-3 weeks, contact the programs about the application status ! use email, phone wutever...Definitely shows you are interested in the program.

2. After the interview, a good enthusiastic "Thank you" email to the program director, coordinator and all those interviewed you.

3. If you land a project, Observership or externship anytime after you applied, do update the programs about the new experience...makes a lot of programs give your application a second look besides exhibiting your continued interest.

4. Have posted about Prematches elsewhere on this blog


5. At the same time, don't bug the program ! Maintain a decent frequency of contact...don't overdo it !


Thus, To Improve your chances of a 'Match', try to 'Match' your moves with the programs moves...if you know wut I mean ;-)




[watch out for updates]





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DO CONTACTS MATTER FOR A RESIDENCY ?

"Shhhhhhhhhhh !! ...don't talk aloud about that... ", Melissa told John as John asked her if it was true that Maria got in because she had 'friends' in the program ?

Connections, Nepotism, Cronysim , Bias, Partiality , favouritism ....all leaves of the same tree, eh ? :-) Contacts and connections have always mattered to various degrees - do matter - and will matter in all walks of life - not just a residency. It's undispensable and as much we hate to admit it, every now and then we hear rumors about someone who got in because of connections.

Connections work like powerful recommendation letters. As a program director, would YOU too not be inclined to interview a person who is personally recommended by someone within your program or someone close ? The question we all have is : How much do they really matter ?

It's well known now that knowing residents in a program seems to help getting interview spots - especially the ones that have been your medical school seniors or batchmates. In most cases, this helps ONLY upto the stage of getting an interview call. After that, the person must impress the selectors based on his OWN credentials, personality and strengths. As example, let me cite a story I heard from a old pal the last year: A candidate got called in for a interview at an excellent IM program after a 3rd year resident suggested him to the director. However, during the interview, the candidate could not justify his very low scores on the Step 2 , could not carry himself well through the interview questions and was NOT ranked.

Program Directors carry a responsibility of a good resident team and are answerable not only to board of directors of the program but also to the American Medical Association. So, while its true that contacts give an edge, eventually choices are made based on merit and impressions of the faculty and residents during the interview.

As my observership-sponsoring physician joked, "Sometimes, it's not HOW MUCH you know , it is WHO you know " ;-)

Having said that, let's go over some scenarios where contacts have proved helpful for interviews and, if candidate was good, a residency spot :

1. Knowing a current resident of good standing / Chief Resident - So if you are still in medical school while you read this, it's time to do your seniors favours more often ..you never know whose help you will need ;-)

2. Your spouse or spouse-to-be is a current resident : Some say that works better than going for a couple match ;-) i.e. one person gets in first and 'pulls in' the second the next year!

3. Your Observership / Externship / Clinical Research physician personally calls / writes to the Program director - especially if in the same institution

4. Relatives in high positions......(hmmm, need I say more) ?

5. Plus getting those vital US Clinical Experiences themselves often needs contacts. Like this 2006 paper [PDF] that discusses IMG resident issues found:

"Of the 33 IMG residents interviewed, 18 expressed frustration with the difficulty getting clinical externships in the US. Ten of the 33 IMGs had a friend or family member that was able to provide or arrange an externship in the US."


All this discussion carries a long-term lesson though - when you all have your residencies and get working, it's important to be known as a reliable, high-quality, hard-working and pleasant personality. Work on your contacts as friends and treasure them always - NOT as something you need to use, but because you are good, warm human being. Your professional impression at work goes a subtle but long way in opening new doors in the future career paths :-) Recommendations are of great importance in the US and in the medical field, the importance of recommendations goes back to history ! Yeah, long long time ago where there no AAMC, physicians had to rely only on the word of fellow physicians for the quality of new recruits...



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