Medicare is a fund supported by the contributions of working citizens and legal residents of the United States. For the first time since Medicare’s inception, the needs of the population it serves are greater than what the fund can afford. This is due to a much larger elderly population combined with the increase generally in health care costs. The result has been a freeze on the money available for graduate medical education. In the last 10 years, the number of residents that have been trained has remained stagnant or declined, in spite of the growing need for physicians.
The Statistics Are Not Encouraging
In the 2012 Match, approximately 40,000 candidates applied for approximately 27,000 positions. Of those, 23,000 were filled by U.S. medical graduates, while 4,000 were filled by international medical graduates (IMGs). However, only 73% of U.S. medical graduates matched successfully, with the rate for IMGs being 42%. This trend continued in the 2013 Match and is expected to be even more discouraging in the 2014 Match, particularly for IMGs. What will follow will be a shift in the way U.S. medical graduates apply for medical residency and a decrease in the positions available for IMGs, at least in the short term.
Traditional IMG Positions Soon to Shift to U.S. Medical Graduates
There are two categories of positions that have been previously unattractive to U.S. medical graduates and therefore great opportunities for IMGs looking to pursue training in the United States. The first are positions that are geographically undesirable. They are located in remote or sparsely populated areas or in overwhelmed hospitals. The second are the categories of family medicine, internal medicine, general surgery and psychiatry.
Unlike the majority of IMGs, many U.S. medical graduates face enormous amounts of debt by the time they apply for medical residency. These amounts can easily range from $200,000 to $300,000, with the only way out being to secure a residency position. As the pressures on Medicare prevent U.S. medical graduates from being matched to their preferred programs, they will turn to second and third options. They will apply in increasing numbers to family medicine programs in North Dakota and internal medicine programs in Brooklyn, for example, and the IMGs who would have normally matched there instead will find themselves without a match.
Hope Is Not Lost; the Competition Has Simply Increased
Interestingly, as recently as 1975, there were actually more first-year residency training positions available than candidates applying for them, and as recently as 1980, the numbers were about equal. While changes in Medicare or in the cost of health care in the U.S. may see a return to those ratios, they will not do so soon, and so a different tact is needed for both U.S. medical graduates and IMGs applying for medical residency in the United States. Both need to put a greater emphasis on the quality of their applications—particularly on the descriptions of their experiences and on their personal statements—and both face inherent hurdles in achieving this goal.
The Plight of U.S. Medical Graduates
While many IMGs may be intimidated by the changing residency landscape, what they—as well as U.S. medical graduates themselves—should understand is the plight of U.S. medical graduates and how, in spite of their obvious advantages, they inadvertently concede opportunities to IMGs.
The greatest challenge we have seen preventing U.S. medical graduates from being more successful in matching to a residency training program is overconfidence. They are overconfident in their knowledge and in being fluent in English, and believe they can prepare all aspects of their applications in the most compelling manner possible without any assistance. In some cases they even believe that their scores and experiences are so compelling that they do not need to bother devoting significant attention to how they present themselves in their applications. The result is that their personal statements are underwhelming or simply bad. When an underwhelming or bad personal statement is put together with strong grades and test scores, it communicates that the applicant has taken a condescending attitude toward the application and, by extension, toward the program to which he or she is applying.
The Plight of IMGs
Similarly, the greatest challenge we have seen preventing IMGs from being more successful in matching to a residency training program is not taking the personal statement seriously enough, though for different reasons. It is commonly known that IMGs face a significant hurdle in pursuing residency training in the United States. For the majority, the costs are prohibitive and influence significantly the decisions they make. This leads many to mistakenly conclude that they can get all the assistance they need with their personal statements by researching on the internet, or by asking friends, colleagues or other physicians. We have seen the results of these efforts, which is that their personal statements all end up either sounding the same or simply failing to achieve the minimum goals of a personal statement. By cutting costs on this crucial aspect of their application with the goal of saving money for interviews, they produce applications that are inadequate to get them the interviews they had been saving for.
How Our Services Make a Difference
No matter your situation, we can help you achieve a successful residency personal statement. Our clients are U.S. medical graduates and IMGs alike, and many have had to face one red flag or another—and sometimes multiple red flags—from low Step scores to long gaps in medical training. We have even assisted clients who have been dismissed from residency programs. In each case we help our client tell his or her story—and not anyone else’s—in the most compelling manner possible, and the results have been outstanding.