1231 



on State Boards have been as high as 59.2 percent in 1941 and as low 

 as 29 percent in 1961, with a 31-year average between 1935-66 of 40.2 

 percent. In 1966, a total of 3,691 FMGs took State Board examinations ; 

 2,281 passed, and 1,410 or 38.2 percent failed. Performance varies ac- 

 cording to State and affects national statistics. In 1966, four States 

 (Illinois, Maryland, New York, and Virginia) represented 73 percent 

 of all State Board failures by FMGs. Of the 3,691 FMGs taking the 

 tests, 1,960 were in the above named four States ; 925 of them passed, 

 while 1,053 or 53 percent failed. '^^ 



Comparisons between FMGs and USMGs on performance in State 

 Boards are revealing. According to Margulies and Bloch, the national 

 average of failures for FMGs in 1966 was 38.2 percent ; the national 

 average for USMGs was 4.2 percent. Among eight selected States 

 (Connecticut Illinois, Indiana, Maine, Maryland, New Jersey, New 

 York, and Virginia) 50.1 percent of the 2,409 FMGs taking the State 

 Boards in 1966 failed, while only 10.1 percent of USMGrs failed out of 

 a total of 602.^82 The inequality in State Boards continues, to the dis- 

 advantage of the FMGs. In 1970, 51.3 percent of FMGs failed in their 

 state licensing examinations compared with only 9.3 percent and 1.5 

 percent respectively for American graduates of medical and osteo- 

 pathic schools.^** 



FMG experience on the FLEX examination reveals the same joat- 

 tern of poor performance. In 1968, the Federation of State Medical 

 Boards established a new Federal Licensing Examination (FLEX) 

 designed as a standard test for licensure in the states. FLEX draws 

 on questions from the National Board examination (which is given in 

 medical school) and is designed for physicians who are in house staff 

 positions or in practice (for example, a physician leaving one State to 

 practice in anotheV) . In theory FLEX offers a standard test of compe- 

 tence for both USMGs and FMGs. By the end of 1971, 29 States 

 adopted the FLEX program. It is expected that FLEX will become 

 a standard test for licensing for those without the National Board 

 examination.^^^ It was reported that in 1973 all but two States used 

 the FLEX examination as their own State licensing examination*^* 

 Apparently, a majority of physicians taking licensing examinations 

 are now taking FLEX.^^^ Studies on FMG performance indicate that 

 between 1968 and 1972, 50 percent of the FMGs taking FLEX failed. 

 USMG failure rate was much smaller, reportedly about 15 percent or 

 less. In a recent study in the United States, Lowin and Cohodes 

 conclude : 



The 50 percent failure rate for FMGs on the FLEX examination is perhaps 

 even more disturbing than the 60 percent failure rate on the ECFMG exam, since 

 most of those taking the FLEX have (1) passed the ECFMG and (2) have then 

 received between one and three years of residency training in the States. These 

 data suggest that the ECFMG exam has little validity, and that years of gradu- 



58S Margulies and Bloch, op. clt., pp. 54-55. 

 M3 Ibid., p. 57. 



^8* Stevens and Vermeulen, op. cit., p. 44. 

 •* Stevens and Vermeulen, op. clt., pp. 39-40. 



^ Sen. Edward M. Kennedy. Remarks In the Senate, Congressional Record, June 5, 1974, 

 p. S9679. 



^^ Stevens and Vermeulen, op dt., p. 40. 



