Create a residency spot

[NotAProgDirector]

I think there is some chance (albeit low) that the ACGME will consider (or Congress will force) creating a 2 year, outpatient only PC residency. These could be hosted in small community clinics, as there would be no need for inpatient experience. There are huge hurdles to doing something like this, but they can be overcome:

1. Many states require 3 years of GME experience for IMG's for licensure. Changing this can be very complicated, and could require state congressional legislation. But a simple fix is to make the residency 2 years, with an optional 3rd year for IMG's (perhaps paid at a junior staff rate). Or the medical board could change the rules for licensure.

2. Some "board" probably needs to own this pathway. You could create a new board (Board of General Practice, or something like that), this would need ABMS approval which would be complicated. Or you could get the ABIM or the ABFP to create a pathway -- both options are very complicated. The ABOIM could easily do this -- they are likely to go out of business once the merger goes through anyway (unless they create a much less onerous MOC process than ABIM).

So, no easy answers, but it could be done and all comes down to politics. I think that 2 years of pure outpatient experience would likely be sufficient (assuming adequate subspecialty outpatient exposure also)

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[Law2Doc]

...MO is doing a common sense approach.

It's only a common sense approach if someone without residency training provides a better level of care than some layman you pull off the street. I think those of us who have been through med school are not so sure that it does. Intern year is when you start to learn to be a doctor. Before that you really are just a poser in a short white coat. Why do you think people are told to avoid hospitals in July? People with no training are truly dangerous individuals. The danger is that when patients hear you have an MD they THINK you know more than you do. So in fact that's much more dangerous than hiring someone with no advanced degree to play medic. At least then the expectation will match the ability. And it won't taint the reputation of other physicians when Bob the graduate from some medical assistant vocational school screws up as opposed to Steve the "MD". I'd say "common sense" has nothing to do with this plan. It was hatched based on some MO politicians total misunderstanding of the level of training one emerges from med school with. He figured, you come out of law school able to work as a lawyer so you must come out of med school ready to work as a doctor. But in fact you come out of med school ready to START your training, not practice. He's pulling the bread out of the oven before it has risen and trying to pass it off as cake.

 

[altap]

Agree to disagree L2D.
There are even board certified physicians from their countries of origin (some are heads of their respective departments, lecturers and professors at med schools and hospitals) who don't dare take the MLEs because of the uncertainty of the match. And that passing these licensing exams does not guarantee any job.
There should be a way for these individuals to become a part of the solution to the nagging problem of physician shortage in underserved communities.

 

[Law2Doc]

Agree to disagree L2D.
There are even board certified physicians from their countries of origin (some are heads of their respective departments, lecturers and professors at med schools and hospitals) who don't dare take the MLEs because of the uncertainty of the match. And that passing these licensing exams does not guarantee any job.

But see, the MO law doesn't specify that it applies to foreign practicing physicians, heads of departments, etc. if it was limited to these people you'd get a lot less flack from the medical community. Instead the MO plan has been touted as where Caribbean grads who can't get residencies can go. That's a huge difference and unless you sever those two groups the argument you just made is a false one.

However I think I would disagree that just because another country has certified a physician to practice that means they are up to par with US standards in all cases -- it would really depend on the country and its education. You can't wholesale throw open your doors to all comers.

 

[rokshana]

The simple fact is the US does not recognize foreign training as equivalent to US training in the vast, vast majority of cases. This is because there is a wide standard across the world from some truly excellent training programs to some truly horrifyingly poor ones. So the benchmark is, and should be, US training.

US medical school graduates are not prepared to practice independently without residency training. It would be a poor assumption to think that physician graduates from other countries, with widely disparate educational experiences, would be prepared to do so.

The bottom line is, this argument only ever comes from FMGs with a clear personal motivation.

let me start with...i do pretty much agree with L2D about the watering down effect...

that being said...I do think that the US is a bit xenophobic when it comes to medical training outside the US....are you really going to tell me that the foreign trained doctor who has been practicing for a few years in their home country (esp those that graduated from well respected domiciled medical schools) really are not capable of practicing medicine in the US without having to do a US residency??

Frankly there should be some other path to accredit, certify, license, whatever, to fast track some of these experienced physicians that more of an evaluation of their abilites as a physician vs true training to become a physician...it would be win-win IMHO...they could help supply doctors in some of the more underserved areas and open up residency spots for those that actually need to be trained.

and no personal motivation....i'm 7 months away from (finally!) completing training and will become a big girl doctor!

 

[NotAProgDirector]

In regards to the MO law, let's not forget that 1) everyone must take and pass the USMLE to get a license including these new "assistant physicians"; and 2) the law clearly states that anyone trying to use this pathway must pass both step 1 and 2 within 2 years of application and no more than 3 years after graduation from medical school. So it will be of no value to FMG's who have been practicing in their own countries.

 

[Law2Doc]

...

that being said...I do think that the US is a bit xenophobic when it comes to medical training outside the US....are you really going to tell me that the foreign trained doctor who has been practicing for a few years in their home country (esp those that graduated from well respected domiciled medical schools) really are not capable of practicing medicine in the US without having to do a US residency??

Frankly there should be some other path to accredit, certify, license, whatever, to fast track some of these experienced physicians that more of an evaluation of their abilites as a physician vs true training to become a physician...it would be win-win IMHO...they could help supply doctors in some of the more underserved areas and open up residency spots for those that actually need to be trained.)

I think it totally depends what country are talking about. A doctor who has graduated and practiced in a country in the EU is going to have very different training than a doctor who trained at the new hospital of some "banana republic" that was just established a few years ago. And guess which one of these guys is more likely to want to move to the US. It's not about xenophobia. It's that there are third word countries out there, unable to feed and clothe their population let alone teach them medicine, and yet most of tem build "hospitals" and internally gnerate "doctors" to work there. It's naive to think that the countries that are buying our used outdated technology for their hospitals (this actually happens) are going to provide the same kind of care or training. why do you think so many foreign doctors do doctors without borders -- it's at least partly because the level or training and care in most of the third world really isn't adequate. And yet nearly every one of these countries has a "medical school" of some sort. Again, this is not the same as saying a top graduate from a German or British school isn't top notch. But you really can't play that game with a lot of the countries that weren't even on a map when your grandparents were kids.

 

[evilbooyaa]

let me start with...i do pretty much agree with L2D about the watering down effect...

that being said...I do think that the US is a bit xenophobic when it comes to medical training outside the US....are you really going to tell me that the foreign trained doctor who has been practicing for a few years in their home country (esp those that graduated from well respected domiciled medical schools) really are not capable of practicing medicine in the US without having to do a US residency??

Frankly there should be some other path to accredit, certify, license, whatever, to fast track some of these experienced physicians that more of an evaluation of their abilites as a physician vs true training to become a physician...it would be win-win IMHO...they could help supply doctors in some of the more underserved areas and open up residency spots for those that actually need to be trained.

and no personal motivation....i'm 7 months away from (finally!) completing training and will become a big girl doctor!

You do understand, that for a first-world country, the US has some of the most relaxed laws on importing physicians across the board? I don't get why everyone assumes that IMGs should be immediately welcomed with open arms (without having to re-do a residency) when that isn't the case for pretty much every other first world country.

It's because the US used to accept a lot more IMGs than we do now. Ever since we started opening more med schools, IMGs have been clamoring for backdoors to practicing in the US as an attending physician.

 

[altap]

I have observed graduates of foreign medical schools, graduates of Carib med schools and US med schools and I have my own opinion regarding each group's competency.
BTW, this observation is limited to the med school grads that I worked with.

 

[rokshana]

You do understand, that for a first-world country, the US has some of the most relaxed laws on importing physicians across the board? I don't get why everyone assumes that IMGs should be immediately welcomed with open arms (without having to re-do a residency) when that isn't the case for pretty much every other first world country.

It's because the US used to accept a lot more IMGs than we do now. Ever since we started opening more med schools, IMGs have been clamoring for backdoors to practicing in the US as an attending physician.

yes, i do....and if the US policy was that they no longer accepted foreign doctors because there were enough US grads to fill the needs then that would be great...but given that 2% of US seniors go into primary care, that's not gonna happen anytime soon. Why do you think a state like Missouri even entertained the idea of having Assistant Physicians?

But let's not think that we are the only ones that can train competent physicians...and it isn't just the European countries that are the only ones to educate and train them as well...and please L2D...not every hospital in the US is that fabulous...having worked in poor urban hospitals, the lack of updated technology is alive and kicking in the US...and i would imagine there are hospitals in India, China, Singapore, and Japan that are far more up to date than quite a few hospitals in the US...

even as an IMG, I am all for the US having enough medical school spots to fill all the residency spots and then enough residency spots to supply enough trained physicians to make sure there are enough doctors to fill our needs for medical care...you really think all of those born and raised in the US who went abroad for med school would not have chosen to stay in the US to go to medical school?

 

[altap]

The problem with some of us is that we think we have the monopoly of intelligence and knowledge.

 

[altap]

Maybe we should travel overseas more often and if possibe attend international conventions of physicians

 

[Law2Doc]

...and i would imagine there are hospitals in India, China, Singapore, and Japan that are far more up to date than quite a few hospitals in the US...

I'm sure there are a few up to date hospitals in the places you mentioned. But a few good hospitals in a nation of literally billions (in terms of Chin, India) can essentially be rounded off to zero. And those people doing great work at the top facilities internationally sure aren't the guys looking to move to Missouri. This isn't what we are talking about when we talk out foreign licensed doctors. We are talking about the third world "doctor" who sees moving to Missouri as a big step up in career and lifestyle. (And again it's mostly US IMGs who can't match who are clamoring for this Missouri path, and as mentioned above, they don't know enough clinical medicine to provide any value.)

I think you need to appreciate the vast difference in what passes for "medicine" Internationally. "Doctor" means more training and schooling here than in some places. Not all. Certainly other first world nations can gave equivalent education but the number of them moving here is not big. But when you get outside of the first world nations, what I'm saying is you certainly need to filter pretty carefully because it's not enough to say this guy was a "doctor" or an attending or department head someplace else. That doesn't mean the same thing everywhere. You need a standard unit of measure and a nation calling someone a doctor isn't one.

Also a guy who trains with 1980s knowledge and technology is not going to be up to date or competitive or even useful in the US. For instance, there are more MRI machines just servicing NYC than all of South America combined, and African nations are continuously lining up to buy our used, failing, out of date circa 1990 CT machines. There are countries still using machines we would literally otherwise stick in the Smithsonian. Tons of operations that have to be performed "open" in much of the third world are done through minimally invasive approaches now in first world countries. Much of the prosthetic hardware, valves, stents, grafts we use in this country is not even an option in the third world. Organ transplnts and dialyses ar not as widely done outside of the US as anywhere else. We have entire databases full of medications that a third world doctor will never have heard of because they simply cost too much. Different pathogens abound in different parts of the world so the differential diagnoses you learn in Zimbabwe may be the reverse of likeliness in downtown Hannibal, Mo. So moving to Missouri after working with this knowledge and technology base would almost be like if a doctor took a time machine 25 years into the future. Sure diseases won't have changed much but if the primary care clinician we import is still stuck on the idea of treating people with open procedures or in ways that have fallen out of favor he's got too much to catch up on.

I don't see this as xenophobic. I see the converse view as incredibly naive -- that anyone a third world nation calls a "doctor" is by definition going to provide a valuable level of medical care. Again, some will and some won't. But you need a filter, a yardstick. And the notion that some country calls this guy a "doctor" isn't one. this isn't even a US idea. Let that same guy try to practice in Europe, Japan, Australia. Not gonna happen. they don't even pretend that other nations qualifications are meaningful. We are far more open already and it's absurd to take it a step further and relax the already pretty open standards.

 

[DermatoFIGHT]

No. There are a variety of legal and liability reasons for this. Given this countries history of slavery, the government takes a very dim view of unpaid exploitation -- we have explicit minimum wage laws and the like. There's also an issue of fairness -- we can't give away internships to rich kids who can afford to forego a salary while better qualified poor kids can't afford it. Also interns cost the hospital money, even beyond salary -- there are very real training costs, liability insurance, GME staff and overhead -- so just because an unpaid slot doesn't draw a salary wouldn't mean it's not expensive to the hospital. But mostly, it's unworkable to have someone on a call schedule etc who you really have no control over because you don't sign their paycheck, can't fire them, etc. I wouldn't hold your breath for this.

Tell that to some of the Osteopathic residency programs. This is fairly common. Yes, this is happening in the United States! Some programs will do "unfunded" positions in competitive specialties. I do not know how residents work there and the legality of it all. Law2Doc if you want program names, I will send them to you. I think it is very wrong for places to do this and really speaks volumes on the people that would want you to work for 4-5 years unfunded.

 

[Raryn]

Tell that to some of the Osteopathic residency programs. This is fairly common. Yes, this is happening in the United States! Some programs will do "unfunded" positions in competitive specialties. I do not know how residents work there and the legality of it all. Law2Doc if you want program names, I will send them to you. I think it is very wrong for places to do this and really speaks volumes on the people that would want you to work for 4-5 years unfunded.

It's an ACGME policy. AOA programs (for the next 1-5 years, as the merger goes forward) aren't subject to those requirements.

 

[rokshana]

I'm sure there are a few up to date hospitals in the places you mentioned. But a few good hospitals in a nation of literally billions (in terms of Chin, India) can essentially be rounded off to zero. And those people doing great work at the top facilities internationally sure aren't the guys looking to move to Missouri. This isn't what we are talking about when we talk out foreign licensed doctors. We are talking about the third world "doctor" who sees moving to Missouri as a big step up in career and lifestyle. (And again it's mostly US IMGs who can't match who are clamoring for this Missouri path, and as mentioned above, they don't know enough clinical medicine to provide any value.)

I think you need to appreciate the vast difference in what passes for "medicine" Internationally. "Doctor" means more training and schooling here than in some places. Not all. Certainly other first world nations can gave equivalent education but the number of them moving here is not big. But when you get outside of the first world nations, what I'm saying is you certainly need to filter pretty carefully because it's not enough to say this guy was a "doctor" or an attending or department head someplace else. That doesn't mean the same thing everywhere. You need a standard unit of measure and a nation calling someone a doctor isn't one.

Also a guy who trains with 1980s knowledge and technology is not going to be up to date or competitive or even useful in the US. For instance, there are more MRI machines just servicing NYC than all of South America combined, and African nations are continuously lining up to buy our used, failing, out of date circa 1990 CT machines. There are countries still using machines we would literally otherwise stick in the Smithsonian. Tons of operations that have to be performed "open" in much of the third world are done through minimally invasive approaches now in first world countries. Much of the prosthetic hardware, valves, stents, grafts we use in this country is not even an option in the third world. Organ transplnts and dialyses ar not as widely done outside of the US as anywhere else. We have entire databases full of medications that a third world doctor will never have heard of because they simply cost too much. Different pathogens abound in different parts of the world so the differential diagnoses you learn in Zimbabwe may be the reverse of likeliness in downtown Hannibal, Mo. So moving to Missouri after working with this knowledge and technology base would almost be like if a doctor took a time machine 25 years into the future. Sure diseases won't have changed much but if the primary care clinician we import is still stuck on the idea of treating people with open procedures or in ways that have fallen out of favor he's got too much to catch up on.

I don't see this as xenophobic. I see the converse view as incredibly naive -- that anyone a third world nation calls a "doctor" is by definition going to provide a valuable level of medical care. Again, some will and some won't. But you need a filter, a yardstick. And the notion that some country calls this guy a "doctor" isn't one. this isn't even a US idea. Let that same guy try to practice in Europe, Japan, Australia. Not gonna happen. they don't even pretend that other nations qualifications are meaningful. We are far more open already and it's absurd to take it a step further and relax the already pretty open standards.

i'll have to admit, i have lost a bit of respect for you with these posts...apparently you have not been out of the US to see the quality of education that does occur in other countries ( not the predominantly white countries that you feel have the potential to be equivalent to the US). And surprisingly have not had interaction as a resident with many of those trained in foreign countries that are and were amazingly qualified to be called doctors based on their education an training outside the US.

I don't believe EVERY country and everyone coming out of those schools are ALL up to snuff....just as i know some of those that went to a US med school are not capable of being even barely competent to be a doctor and to say i'm naive is a bit condescending...

and just because we have more toys and are reliant on labs, imaging, and procedures, does not automatically make us better physicians....bet you if the ED guy in Texas was an FMG trained in Zimbabwe he wouldn't have missed Ebola on the Ddx

https://asianheartinstitute.org/Hospital-Overview.html
http://www.mountelizabeth.com.sg/en/facilities-services

 

[Law2Doc]

i'll have to admit, i have lost a bit of respect for you with these posts...apparently you have not been out of the US to see the quality of education that does occur in other countries ( not the predominantly white countries that you feel have the potential to be equivalent to the US). And surprisingly have not had interaction as a resident with many of those trained in foreign countries that are and were amazingly qualified to be called doctors based on their education an training outside the US.

I don't believe EVERY country and everyone coming out of those schools are ALL up to snuff....just as i know some of those that went to a US med school are not capable of being even barely competent to be a doctor and to say i'm naive is a bit condescending...

and just because we have more toys and are reliant on labs, imaging, and procedures, does not automatically make us better physicians....bet you if the ED guy in Texas was an FMG trained in Zimbabwe he wouldn't have missed Ebola on the Ddx

https://asianheartinstitute.org/Hospital-Overview.html
http://www.mountelizabeth.com.sg/en/facilities-services

I think you read into my post a lot of ugliness you wanted to hear, rather than what I wrote. I never used the phrase "better" physicians or "white" countries. It has nothing to do with skin color and everything to do with level of training one must attain to be called a "doctor" in various countries. Most non-white countries don't let people just show up and practice medicine. It's really almost exclusively the US that allows far greater professional access than most of the world. My comment above has nothing to do with quality of the person and everything to do with the quality of training they receive. I think you are being horribly naive and are the one who needs to get out more if you think the same quality of "doctor" is being generated by every "medical school" internationally. And trying to spin other posters arguments as "xenophobic" or "racist" is both offensive and a sign that you don't have a real argument to stand on. These are the battle cries of someone who doesn't like what has been said, but has no rebuttal and so chooses to make the discussion ugly and something it's not.

There is nothing "racist" about saying that the training in eg Zimbabwe is different than in the US or that there are more MRI machines serving NYC than all of South America. Those are just facts. No reason to try to spin it that someone who says this has an issue with other races or nationalities -- I'm talking exclusively about the training/technology. Which are pretty undeniable. I lose all respect for anyone who wants to make a discussion about training a debate about race or xenophobia. Those are ugly ideas and when thrown around the way you just did are intended to stifle discussion because you are trying to put others who disagree with you at the wrong end of political correctness, despite you being the only one who used the phrases "white" countries, xenophobia.

All of us who have worked in medicine for a while have come across people whose skill sets really don't mesh well with the role as it exists in the US. The word "doctor" isn't an internationally accepted standard of training -- and there are people called "doctor" in many countries that are very differently trained than in others. I don't think you can debate this point. And no, you really don't have the same issues with even the worst of US grads -- not because they are "better" (they arent) but because they have at least received the necessary training for the job they are thrown into. And yes, I would say that if you don't have experience with the labs, imaging and technology we use daily as a resident or physician here in the US, you aren't far enough on the learning curve to be useful. It's absurdly hard to show up during intern year and usefully take care of eg a dialysis or transplant patient if you come from a country where those simply don't occur. It's hard to order an MRI on a patient when you have no sense what that might show. Very hard to order medications when you haven't been exposed to the ones a US hospital stocks, and so on.

And yes perhaps an African doctor wouldn't miss Ebola but you kind of just made my point because as much as people wanted to pass blame after the fact, I'm not sure most US physicians really considered it appropriate to even have Ebola high on the differential in an ED in Texas before we ever had a case stateside. if you are thinking zebras not horses you miss most of the horses. And in this country it's the horses that are going to kill most patients. When someone shows up in a Texas ED during flu season with flu-like symptoms you really need your differential to read: 1. Flu, 2. Flu, 3. Flu... 10. Flu, 11. Maybe something not flu. But this side argument you brought up is all a tangent.

The people interested in the Missouri law are Caribbean grads who couldn't match. There aren't foreign department heads looking to move to MO to sort of practice medicine for the underserved. We've explained above why someone coming out of a US med school or a Caribbean counterpart doesn't have useful skills before residency -- "training" doesn't start until intern year in our system -- and only will make "MDs" look bad. The rest of the discussion is a red herring.

 

[rokshana]

I think you read into my post a lot of ugliness you wanted to hear, rather than what I wrote. I never used the phrase "better" physicians or "white" countries. It has nothing to do with skin color and everything to do with level of training one must attain to be called a "doctor" in various countries. Most non-white countries don't let people just show up and practice medicine. It's really almost exclusively the US that allows far greater professional access than most of the world. My comment above has nothing to do with quality of the person and everything to do with the quality of training they receive. I think you are being horribly naive and are the one who needs to get out more if you think the same quality of "doctor" is being generated by every "medical school" internationally. And trying to spin other posters arguments as "xenophobic" or "racist" is both offensive and a sign that you don't have a real argument to stand on. These are the battle cries of someone who doesn't like what has been said, but has no rebuttal and so chooses to make the discussion ugly and something it's not.

There is nothing "racist" about saying that the training in eg Zimbabwe is different than in the US or that there are more MRI machines serving NYC than all of South America. Those are just facts. No reason to try to spin it that someone who says this has an issue with other races or nationalities -- I'm talking exclusively about the training/technology. Which are pretty undeniable. I lose all respect for anyone who wants to make a discussion about training a debate about race or xenophobia. Those are ugly ideas and when thrown around the way you just did are intended to stifle discussion because you are trying to put others who disagree with you at the wrong end of political correctness, despite you being the only one who used the phrases "white" countries, xenophobia.

All of us who have worked in medicine for a while have come across people whose skill sets really don't mesh well with the role as it exists in the US. The word "doctor" isn't an internationally accepted standard of training -- and there are people called "doctor" in many countries that are very differently trained than in others. I don't think you can debate this point. And no, you really don't have the same issues with even the worst of US grads -- not because they are "better" (they arent) but because they have at least received the necessary training for the job they are thrown into. And yes, I would say that if you don't have experience with the labs, imaging and technology we use daily as a resident or physician here in the US, you aren't far enough on the learning curve to be useful. It's absurdly hard to show up during intern year and usefully take care of eg a dialysis or transplant patient if you come from a country where those simply don't occur. It's hard to order an MRI on a patient when you have no sense what that might show. Very hard to order medications when you haven't been exposed to the ones a US hospital stocks, and so on.

And yes perhaps an African doctor wouldn't miss Ebola but you kind of just made my point because as much as people wanted to pass blame after the fact, I'm not sure most US physicians really considered it appropriate to even have Ebola high on the differential in an ED in Texas before we ever had a case stateside. if you are thinking zebras not horses you miss most of the horses. And in this country it's the horses that are going to kill most patients. When someone shows up in a Texas ED during flu season with flu-like symptoms you really need your differential to read: 1. Flu, 2. Flu, 3. Flu... 10. Flu, 11. Maybe something not flu. But this side argument you brought up is all a tangent.

The people interested in the Missouri law are Caribbean grads who couldn't match. There aren't foreign department heads looking to move to MO to sort of practice medicine for the underserved. We've explained above why someone coming out of a US med school or a Caribbean counterpart doesn't have useful skills before residency -- "training" doesn't start until intern year in our system -- and only will make "MDs" look bad. The rest of the discussion is a red herring.

maybe you didn't intend it, it you repeatedly made mention of European countries to be the one who may have comparable training...and repeatedly made mention of "3rd world" countries having people coming out of their medical schools or working in their countries as still not being up to snuff...and I pointedly states that I certainly do not think everyone coming out of medical schools abroad (and us here too) to have the skill set to be able to practice. Sorry, just because you don't blatantly state your bias doesn't mean that it doesn't come out....maybe you need to go back an re-read your posts and see how they can be interpreted...

and for your example of MRIs...MOST countries don't have the number of MRI we do...heck all of Canada don't have the number of MRIs that NYC does....doe that mean that a Canadian medical student would be able to handle a residency in the States...its poor example and your comparison wasn't Canada but an area of the world that you seem to feel has inferior medical schools and training...

maybe egotistical is a better word for you then? Because as much as we want to think, we are not the end all, be all in everything...there CAN be countries that can train a physician as well as we can...maybe even better....and if the who ha is all about the lack of physicians to work in underserved area then we need to either find a way to educate and train enough people to go and work in these underserved areas...or at least be willing to train others to meet the standards...or all those NPs and Pas will indeed take our jobs.

the evidence that many of these true FMGs don't need much in the way of teaching and training is the scores of residents coming out of many of the NE (particularly NYC) programs that just use the FMG resident as a worker bee...we all know that very little teaching is done at these places...and yet they manage to take care of patients...

and did you NOT see the smiley face? jeez...learn to lighten up!

 

[altap]

Mmmm you interviewed a black person who exhibited flu - like symptoms, and had history of travel from West Africa during the Ebola outbreak in West Africa yet you did not even consider or suspect Ebola is inept if you ask me.

 

[altap]

Anyone esp. a black person with accent who has flu like symptoms during Ebola outbreak. Ask travel history from West Africa or any recent contact with someone from West Africa.

 

[altap]

Ask history of travel or exposure (to a person from the outbreak) from someone w flu like symptoms esp during infectious dse outbreak.

 

[Law2Doc]

Mmmm you interviewed a black person who exhibited flu - like symptoms, and had history of travel from West Africa during the Ebola outbreak in West Africa yet you did not even consider or suspect Ebola is inept if you ask me.

This line of discussion is a tangent from the point of this thread, a distraction. But if you must go there, there's a lot of evidence that this patient was withholding information and didn't provide a useful history. And people of foreign origin with accents really aren't rare in Texas. And this guy had flulike symptoms during flu season, just like everyone else in the ED. So in Texas before we ever saw Ebola stateside this should still not have been high on anyone's differential, despite what Monday morning QBs would like you to believe.

 

[altap]

Travel history from a known hotspot whether he lied about contact or not, Ebola should have been considered.

 

[altap]

Travel history from West Africa, accent or not, lied or not, flu season or not, Ebola should have been considered.

 

[evilbooyaa]

The issue is that even the worst US trained doctors have met the minimum requirements to treat patients per the standards of the US.

The counter-point that there are SOME FMGs who are equivalently (or better) trained than their US counterparts does not mean that you open up the floodgates for ALL FMGs to come into this country and start opening up PCP offices.

Anyone who really cares about the underserved community would 1) open more residency programs for PCPs and the such in the community, 2) Incentivize doctors going to these rural areas as attendings. Some argue to close down specialist residencies (or make them pay to play, like that one article) and open up more rural PCP residencies (which while I disagree, is an opinion one is allowed to have). For the second point, doctors in rural areas generally do get paid more, but the negatives of being away from a major city or (more importantly) the bureaucratic red tape just to get paid for services rendered is too much to convince people to do so.

 

[ferning]

A big part of medicine especially in the USA is communication. Not just speaking english fluently, but being able to relate and understand ur patients background. Alot of fmgs in the past were real fishes out of water, but the few youngers ones ive met now are probably better than many us residents.

The states is a very weird country for new immigrants and especially if they venture out of their ethnic niche. People should live and work here for a few years before they become doctors although i know this isnt possible for man

 

[altap]

In the misdiagnosis of patient with Ebola, which happened in one of the most modern hospitals in Texas (possibly in the US) all the modern med equipments or "toys" did not help the ED staff come up with the correct diagnosis. So saying that by having better equipments you train better physicians is just not true. You have to balance the good old "detective work" (proper history taking and PE) with your reliance on "toys", giving more importance to the former bec you cannot come up w the correct diagnosis if you bungled your history taking (as what happened in this case).

 

[Law2Doc]

In the misdiagnosis of patient with Ebola, which happened in one of the most modern hospitals in Texas (possibly in the US) all the modern med equipments or "toys" did not help the ED staff come up with the correct diagnosis. So saying that by having better equipments you train better physicians is just not true. You have to balance the good old "detective work" (proper history taking and PE) with your reliance on "toys", giving more importance to the former bec you cannot come up w the correct diagnosis if you bungled your history taking (as what happened in this case).

Spoken like someone who has likely never worked in a busy ED... You get a few minutes with each patient. Many are not forthcoming or outright lie. This guy knew he had been exposed to Ebola and hid that fact. He lied. So I think "bungled" is very easy to say as a Monday morning QB but mostly just tells a lot of us you've never been in this position you are criticizing. In retrospect could the system be better? Sure. Can we conclude that diagnosing a deceptive historian with flulike symptoms during flu season in a country where flu is the prevalent illness as most likely having the flu a "bungle"? I don't think so.

 

[BoardingDoc]

In the misdiagnosis of patient with Ebola, which happened in one of the most modern hospitals in Texas (possibly in the US) all the modern med equipments or "toys" did not help the ED staff come up with the correct diagnosis. So saying that by having better equipments you train better physicians is just not true. You have to balance the good old "detective work" (proper history taking and PE) with your reliance on "toys", giving more importance to the former bec you cannot come up w the correct diagnosis if you bungled your history taking (as what happened in this case).

If an 80 yr old from Papua New Guniea comes in with ataxia, should I be seriously considering Kuru? If I find out later that they lied about eating the brain of their deceased relative even though I asked them this question explicitly and they said no, is it still my fault for missing it? You seem to be implying that it is.

Maybe you have extensive experience working in emergency departments in your home country. I don't know. Maybe you would have caught this person, quarantined them and had blood sent to the CDC even though they explicitly told you that they hadn't been near anyone with ebola. I don't know that either. It does appear from your post history, however, that you haven't been a practicing physician for at least 5 years, yet you're repeatedly commenting on what the physician "obviously should have done." Whether your intention or not, this has you coming across as argumentative at best and an arrogant dilettante at worst.

 

[Law2Doc]

...

Not to mention you just keep repeating yourself like an idiot for going on a half dozen posts now.

That will come in handy in the "do you want fries with that" industries... (jk)

 

[altap]

Are you kidding me? The patient came from West Africa (history of travel). This was documented that the pt told someone that he just came from Africa. So as the physician you should have immediately said to yourself , this could be the dreaded Ebola and immediately took precautionary measures (isolated the pt., informed CDC, etc.) But no the patient was given antibiotics and was sent home. How could the ED staff be so inept and put not only the pt but the whole community and the whole country in great danger is beyond me.
Making the "you only have a few minutes to see a pt at the ER and pts lie most of the time at the ER" as excuses is unacceptable.

 

[altap]

BTW, If you are not an ED attending, I have probably seen more pts in the ER than you.

 

[altap]

Southernsurg read my post again. I hope you can interpret correctly what I posted

 

[altap]

I value my anonymity...

 

[altap]

Changing of bedpans excluded

 

[Siggy]

Med students coming out without attending oversight? Scary.

It's a bad idea and it would mean setting the bar too high. I believe that most will be ready to be a GP post-internship...but definitely not post-med school. Not enough clinic experience...and definitely not enough experience with autonomy.

This times a thousand. The level of autonomy for medical students, even 4th year medical students, pales in comparison to the autonomy that interns get... and even then there's still a ton of calling the senior and having the 2 second conversation of, "Patient developed X, mind if I do Y?"

 

[BoardingDoc]

I value my anonymity...

Hi! I'm a foreign medical graduate working as a RN

I have a 3.5 undergrad GPA. I was a rural physician in my home country for a number of years before coming here in the US and working as a RN. I'm very interested in public health. After the MPH (possibly a doctorate degree in public health too), I'm planning to apply for a residency in Family Medicine and be a rural physician here in the US. Thanks.

I'm a dr. lol

ast I heard you never matched and were still working as a nurse.
has this changed?
if so, congrats.
if not, zip it.

 

[altap]

Boardingdoc are you serious? So you do not agree that the ED staff made a huge blunder by not considering Ebola? Really?

 

[altap]

I have an 85% average in med school. it is not great I know
Bdoc really? You do not agree that the ED staff dropped the ball in this situation? Seriously ?

 

[altap]

Bdoc even if the pt says otherwise, you as a physician should be wise enough to still consider it

 

[altap]

Bdoc even if the pt says otherwise, you as a physician should be wise enough to still consider it. Why? First, the pt just came from the hotspot. Second, we are talking about a possible infectious dse w a high fatality rate and without a known cure nor a vaccine. Third, people lie

 

[Winged Scapula]

Boardingdoc are you serious? So you do not agree that the ED staff made a huge blunder by not considering Ebola? Really?

Perhaps you are not aware that the emoji is supposed to relay a sense of playfulness, flirtation or "just kidding". Its presence along with your repetitive posts are incongruent.

I have an 85% average in med school. it is not great I know
Bdoc really? You do not agree that the ED staff dropped the ball in this situation? Seriously ?

"Bdoc" or @BoardingDoc does not man these forums 24/7; no one does. There is no need for this post, less than 20 minutes before the one above, asking the same question.

Bdoc even if the pt says otherwise, you as a physician should be wise enough to still consider it

Again, are you using the emoji correctly to tease "Bdoc" or are you being insulting. If it is the latter, please be advised that the TOS prohibits this.

Bdoc even if the pt says otherwise, you as a physician should be wise enough to still consider it. Why? First, the pt just came from the hotspot. Second, we are talking about a possible infectious dse w a high fatality rate and without a known cure nor a vaccine. Third, people lie

Please stop with the repetitive posting.

 

[altap]

Brdingdoc tried to stop me from speaking up. IMHO, that is worse than repetitive postings.

 

[rokshana]

Brdingdoc tried to stop me from speaking up. IMHO, that is worse than repetitive postings.

well, he failed miserably then...

 

[evilbooyaa]

Perhaps you are not aware that the emoji is supposed to relay a sense of playfulness, flirtation or "just kidding". Its presence along with your repetitive posts are incongruent.



"Bdoc" or @BoardingDoc does not man these forums 24/7; no one does. There is no need for this post, less than 20 minutes before the one above, asking the same question.



Again, are you using the emoji correctly to tease "Bdoc" or are you being insulting. If it is the latter, please be advised that the TOS prohibits this.



Please stop with the repetitive posting.

Oh please. I never ask for action to be taken on SDN posters... but this guy is just parroting to himself and harping on literally 1 point.

 

[Winged Scapula]

Brdingdoc tried to stop me from speaking up. IMHO, that is worse than repetitive postings.

I see no evidence that anyone tried to "stop [you] from speaking up". Repetitive postings are a TOS violation.

 

[altap]

If I did repeat my postings, it was so they would get it lol

 

[altap]

Rokshana, yup they tried to stop me to no avail by saying that I had no right to participate in the discussion because they thought I'm a nurse. lol
"I do not agree with what you have to say, but I will defend to the death your right to say it" - Voltaire

 

[rokshana]

Rokshana, yup they tried to stop me to no avail by saying that I had no right to participate in the discussion because they thought I'm a nurse. lol
"I do not agree with what you have to say, but I will defend to the death your right to say it" - Voltaire

*sigh* really need a sarcasm emoticon...

 

[gutonc]

*sigh* really need a sarcasm emoticon...

I don't think altap would get it even with the emoticon.