<p>In the Caribbean, students who have long been told they weren’t good enough find out they are.
<a href="http://www.nytimes.com/2014/08/03/education/edlife/second-chance-med-school.html">http://www.nytimes.com/2014/08/03/education/edlife/second-chance-med-school.html</a></p>
<p>There’s been a huge discussion of this article over on SDN and I believe in many ways the NYT article is misleading.</p>
<p>Only about half of the IMG (international medical graduate) applicants matched into US residencies last year. (As opposed to a 95-97% match rate for MD and DOs.) Most of those match positions IMG get are a preliminary (1 year) positions in medicine or surgery. At the end of the 1 year, the IMG needs to enter the match again and is even less likely to match anywhere the second time. (True for everyone, but even more true for IMGs.) This leaves the IMG in a position where they are unable to obtain board certification and may not be eligible for a state medical license because they haven’t completed a residency.</p>
<p>As for those “other” residencies that the article mentions. The NRMP instituted an all-in policy last year which requires all hospital programs that offer residencies to offer them all only thru the national match. And the stick used to enforce the “all-in” policy is the loss of accreditation by the ACGME if the hospital doesn’t comply.</p>
<p>Another detail the Times article omits is that a number of new MD and DO schools will come on line in the next 3-5 years. According to current projections, the number of US MD and DO grads will be equal to the number of available residency slots by 2018. Throw in the unification of the MD and DO residency match process in 2016–and it makes attending a foreign medical school even riskier.</p>
<p>In fact, I suspect that we’re going to see more IMGs working as PAs/NPs. (In fact Missouri has already passed a bill allowing IMGs who have completed a prelim year to work as primary healthcare providers in federally declared medically underserved areas but only under the direct supervision of an attending physician–just like a PA.)</p>