The proportion of international medical graduates, or IMGs, who enter family medicine residencies grew dramatically during the past decade, and IMGs continue to seek graduate medical education in the United States. Now, a group of family medicine educators and an expert in international issues have some words of advice to help IMG applicants successfully navigate the process of applying to U.S. residency programs.
According to an article in the January(www.stfm.org) Family Medicine in 1997, IMGs made up about 14.5 percent of first-year family medicine residents. By 2009, that proportion had almost tripled -- to 42.4 percent.
Co-authors Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education; Amy McGaha, M.D., the division's former assistant director; Alexander Ivanov, M.B.A., AAFP manager for international activities; and Kaparaboyna Ashok Kumar, M.D., professor and vice chair of medical student education in the department of family and community medicine at the University of Texas Health Science Center, San Antonio, acknowledge in their article that various perspectives exist regarding the advantages and disadvantages of increased numbers of IMGs in U.S. family medicine residency programs.
"IMGs bring to U.S. family medicine programs individuals with widely varying backgrounds, skills and levels of preparation for clinical practice in the U.S. health system," the authors said. "It is natural, therefore, for IMG applicants to have had widely varying experiences and expectations as they seek to enter the U.S. system of graduate medical education."
Pugno told AAFP News Now that the percentage of IMGs who become first-year family medicine residents has gone up as interest in the specialty by graduates of U.S. medical schools has declined. However, he said that trend will probably slow or reverse as the increasing demand for primary care expected in the wake of health care reform results in more U.S. student interest in family medicine careers.
Pugno said the top challenges among U.S. citizen IMGs (i.e., U.S. citizens who received their medical training abroad) seeking residency training in the United States are differences in their medical knowledge base and the variability of their clinical experiences and skills. For non-U.S. citizen IMGs, the top challenges seem to be making the transition from a foreign medical system to the U.S. system, as well as some language and cultural issues.
In their article, the authors offer all IMGs the following advice on preplanning, applying, interviewing and follow-up:
- Be realistic. Recognize that you are competing for a limited number of positions with other applicants.
- Contact the U.S. office of the national organization of physicians that represents your particular ethnic or cultural group. This could be your "best opportunity" for reliable advice, support and access to U.S. clinical experiences.
- Ensure that your visa status will allow you to enter and fully complete residency training.
- Be wary of companies, websites and salespeople who say they "guarantee" eventual residency placement. There are no such guarantees.
- Participate in the National Resident Matching Program(www.nrmp.org) to validate your capacity to be a "mainstream" applicant.
- Attend residency fairs, such as that held during the AAFP National Conference of Family Medicine Residents and Medical Students. Interact with faculty and residents in the exhibit area.
- Avoid companies that exploit IMGs, including those that arrange for clerkships and observerships with paid practitioners, as well as those that "blast" electronic copies of your application to all programs with open positions.
- Read everything available about any residency program that grants you an interview.
- Respond promptly when a program responds to your inquiry or application.
- Keep trying through yearly applications if necessary, and don't be discouraged.