AAMC Reporter: May 2009

International Medical Grads Use Controversial Match Services

To this day, Keny Sandhu can still recall the anxiety. Two years ago, the graduate of Windsor University School of Medicine in the Caribbean island of St. Kitts waited for the results of her residency Match—and was ultimately devastated when she learned she had not matched to any program. Not too long after, though, her optimism was rekindled when a friend told her about Electronic Residency, a company that claimed it could help her clinch a residency spot for that fall. Electronic Residency would give her a hand with the "Scramble," a two-day window after the Match when those who did not match may contact residency programs directly in hopes of gaining acceptance. Sandhu decided to give it a try.

"When you don't match, you think about your family, your parents, your debt," Sandhu said. "What are you going to do for the next 12 months? I was a clueless foreign graduate and didn't know if the Scramble would work, but Electronic Residency encouraged me to go through the process."

Sandhu is part of a growing cohort of people, mainly consisting of international medical school graduates (IMGs), who are using for-profit companies to gain entry into American residency programs. Informal estimates show that Electronic Residency is one of about a dozen other companies providing a variety of Match-related services to its customers; these services include interview preparation, developing effective personal statements, providing individualized lists of residency programs company officials claim are likely to accept each client, and even setting up hands-on clinical experiences known as externships. Perhaps the key service these companies provide, however, happens on Match Day, when the companies send client applications, often via fax and e-mail, to residency program directors.

Unfortunately for Sandhu, who is a Canadian citizen, her 2007 scramble did not yield her a U.S. residency spot. In the intervening years, however, she has not given up hope of entering an American graduate medical education (GME) program. She has since purchased several different lists of residency programs that Electronic Residency claims are likely to accept her. Sandhu is still not in residency training, but remains a loyal Electronic Residency supporter.

"They want to help you," Sandhu said. "Their prices are reasonable. They have a really individualized process for their clients. They call me up and drop me e-mails asking how I am doing. I've recommended their services to a lot of people."

Sandhu stands on one side of a growing debate over these companies. The companies—and many of their clients—believe they help IMGs gain a foothold in the complex world of American GME. Others, including some medical school officials, worry that some companies might mislead IMGs by providing application services to those who lack the necessary credentials to enter a U.S. residency program.

"Someone not familiar with the system may feel that they can buy expertise from someone in this country," said Charles C. Daschbach, M.D., M.P.H, director of academic affairs at St. Joseph's Hospital and Medical Center in Phoenix. "They are in a very vulnerable position, and probably decide just to take a chance. They rationalize that it is better than doing nothing."

Generally speaking, IMGs use the companies because they feel that American residency programs are reluctant to accept foreign graduates, Daschbach said. On average, IMGs are unsure how to navigate the American residency process, have limited resources about American GME programs, and may be desperate for help.

Data does not exist on the number of people who have used or found success with these services, although anecdotal evidence demonstrates their mushrooming popularity. Melhim Bou Alwan, M.D., the International Federation of Medical Students' Associations president, estimated that nearly 75 percent of his medical school class at the American University of Beirut used the companies. John R. Potts III, M.D., surgical residency program director at the University of Texas Medical School at Houston, said that in his 18 years on the job, last year was the first time he felt overwhelmed by the scads of residency applications that companies submitted on behalf of their clients.

Various Match-related services provided by the companies can range from $59 to $575. Electronic Residency, IMGPrep, and other Match services companies declined to disclose financial figures.

The notion of charging IMGs for these services has caused some unease within academic medicine, Daschbach said.

"The concern from program directors is that the companies are giving their clients false hope when [the clients] may not be very competitive," he said. "I hate to see these young people potentially exploited."

Messages about the programs' lack of efficacy can be found in online chatrooms such as USMLE Forum and Prep4USMLE. In these venues, medical students write each other notes about many aspects of medical education, including the for-profit companies. One anonymous person wrote on USMLE Forum that "[The companies] are opportunists in essence that they use this situation to try to get money from us."

Sam Musa, a representative of Electronic Residency, dismissed claims of exploitation.

"We don't want to discourage anyone from using our services," Musa said. "History has shown that people who have been rejected for years and years do get in. We are very honest with everyone. There is no guarantee with our services; we don't have connections at programs."

Musa and Johnathan Pellegro, M.P.H., an IMGPrep official, both described several individual success stories, although Musa added that Electronic Residency does not track every client over time, and noted that company officials make it clear that their services are not a magic bullet to residency.

For the scramble services, companies often send blast faxes and e-mails of their clients' applications to residency programs. Attached to the e-mails are resumes, academic achievements, and other documents, which can slow the computer system, Potts said. Musa said his company does not use that tactic. "For the Scramble we help our clients introduce themselves appropriately without flooding the residency programs side with unnecessary documents," he said.

Potts said that he has not accepted anyone into his program because of applications the companies submitted during the scramble.

"I couldn't delete the e-mails fast enough last year," Potts said. "Same thing with the fax machine. We got so many faxes last year, we ended up turning off the machine."

—By Elissa Fuchs