[aesclepius]

While there is gate-keeping in medicine (MCAT scoring preferring English-native applicants, limited residency spots, financial costs of medical school) I would argue the residency system as it is prefers American-educated applicants versus foreign-born grads.

You can see this when looking at prestigious residency programs where the rosters are primarily filled with AMGs. In fact, highly sought after specialties such as dermatology, orthopaedics or neurosurgery tend to accept only AMGs because the number of qualified applicants usually outstrips the available residency spots. Though International Medical Graduates (IMGs) are usually academically outstanding (in my experience as an MD working alongside them) they are more likely to fill residency spots (rural, less prestigious) that AMGs don't want. Not to say that there are not IMGs in highly-sought after residency programs, it's just that their qualifications usually outstrip comparable AMG or they have other connections.

[ghufran_syed]

I assume you meant “prefers American-educated vs foreign-educated”? If so, I think that’s true, but having trained in the UK and the US, I thing the US system is much fairer (= less unfair) than the UK. At least once you match to a residency program, it’s almost inevitable that you will complete residency and be able to get licensed and board-certified. In the UK, it was pretty easy for foreign grads to get stuck in some dead-end medical job with no way to advance - though my experience is at least 10 years out of date, so things may have changed since then. From my colleagues who have spent time working in France, France is apparently even worse than England in this regard.

The question is why are local grads preferred? I suspect because even with good USMLE scores, US program directors have no good way to judge the quality of applicants, compared to US-educated grads who have formal standardized letters of recommendation from other program directors where the applicant spent time during medical school (med students often do ‘sub-internships’ at outside medical schools during their studies in order to introduce themselves to those programs and improve their chances of matching there). I suspect that if a foreign-educated medical student arranged subinternships in the US in their chose specialty while in medical school, their success rate would be much higher, because it reduces the risk for the program. Unfortunately, most foreign grads (including myself) have already finished medical school by the time they think about coming to the US, and while I believe it’s relatively easy for foreign medical students to get sub-internships, it’s almost impossible for foreign doctors to do the same.