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Discrimination against IMGs in the Match

November 13, 2011

An IMG who I counsel and who is a very strong applicant told me of his experience interviewing at a major medical center.  This individual had done an MPH and had success in research at that medical center and was given an interview.  During the interview he was told that he was a strong candidate but that he was unlikely to match as that program had not accepted an IMG for several years. Why is this? How did this happen to a top quality candidate, top of his class with steps > 230, six high quality publications and an MPH from top university, USCE as a medical student at a top hospital and US letters of recommendation? Is this discrimination because he is not from the US? Lets look at some studies on the issue.

There is not much data out there regarding discrimination against IMGs in the match. IMGs who go through the match process spend thousands of dollars and at least 2 years of their student or professional time. The process extracts great personal and professional cost to the IMG. I imagine that the 27% of IMG applicants who make it to residency are as qualified as 27% of the AMGs who match.

A 2010 article published in BMC Medical Education explores discrimination against IMGs in the Match process.

The article is about two studies that looked at “request for applications” sent to PDs in the early 1990s and a more recent survey sent to surgery PDs. There is no ability to now request applications so those 2 studies reviewed have little relevance in the match process today.

The other study quoted in the paper looked at surveys sent to surgical PDs.  The response rate from the surgical PDs was only 48%.  To accurately represent the views of the population studied a 57% response rate would be needed.  At any rate, it is interesting to see that in response to the query “In reality, all things being equal, our program would rather offer positions to USMGs than to IMGs”,  47% or responding PDs strongly agreed.  General surgery fills 22% of their spots with IMGs in the match.

I think that the statement in the paper “They may be concerned about image or that image will affect recruiting of U.S. applicants” is accurate but applies to university programs that are in the middle of the pack.  Stating that “changes made by the ECFMG have largely eliminated this problem” is not accurate.  Students at the medical school where I work take weeks to study for the step 1. Most AMGs (to be) study about the same amount of time. Compare that to the individual who really studies for the exam for two focused years and completes thousands of questions – he gets the same score.  One cannot really compare the two applicants as they are not the same. Four weeks is not the same as 2 years of study.

Lets look at the clinical skills exam, everyone passes except about 15% of the IMGs. The AMGs don’t prepare, the IMGs do. Thus the CS is not a helpful way to distinguish between candidates.

Few AMGs take the Step 2 exam and those that do don’t focus on it. IMGs again study for long periods of time. Again not a great comparison.

In general an application from an IMG differs in important ways from an application from an AMG. Courses and curriculum are different in every country of the world and it is hard to compare applicants. One thing that you can do to help your application is to make it look like an AMG application. See this example for how to phrase your accomplishments and your personal statement.

Smaller university programs and community programs have worked with IMGs for years and it is hard to believe that there is systematic discrimination as the numbers of IMGs who have matched at these programs is high.  The best programs in the country are not affected by image (as they are the best) and will take the most talented applicants regardless.  Most applicants (AMGs or IMGs) don’t get interviews at the best programs as they are extremely selective.

What can one do about bias if it exists?  Not much.  If you match, work hard to get your fellowship then no one will care where you went to medical school.

The views expressed in this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of Dr. Christopher’s employer Partners HealthCare.

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