60 Minutes and International Medical Graduates.

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Future GI Guy

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Did anyone watch the story on 60 Minutes last night, about International Medical Graduates filling US residency spots.

I thought it was very, very interesting.

One man, who seemed kind of mad at the world, suggested that IMG's should not be allowed in this country, especially from medical schools in third world countries.

Another believed these residents were as well trained if not better trained in medicine, and that their only deficit was in the English language.

I'm being too simplistic, of course.

But, what's your opinion about the topic.

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I saw it, and it was definately interesting, but (in good 60 minutes tradition) only presented enough information to support the 'angle' they wanted to put on the story, that being that many U.S. residency programs discriminate against IMGS.

Frankly, I don't believer we should have non-citizens in government-subsidized jobs (which is what residencies are.) We already waste too much money outside our country when there are issues within our borders that have been ignored for decades. If this were an instance of 'well, noone in the U.S. wants to be a doctor anymore, and the only place we can get them from is <blah>' then it would be completely different. However, that's not the case--the U.S. just doesn't put out enough Doctors. With that said, it's important that we expand out programs so that we aren't reliant on IMGs.

In reality, I doubt that guy was 'mad at the world' but I'd imagine it was more of a case of selective editting, it's one of the trademarks of 'television magazine' programs, and a trick that 60 minutes manages to pull of brilliantly--casting their own subtle bias on the newst while presenting it as an 'impartial' observer. It seemed to me that his issue was not that we allow IMGs into the country, but that very few IMGs come to this country with the intention of ever leaving it! Frankly, that sucks, IMNSHO.

I don't really have a problem with the foreign doctors coming here to get experiance, I have no doubt that the education they recieve will be absolutley invaluable when they practice in their own country, but those people should be the absolute best their country has to offer (i.e. extremely competitive) as well as sent home when their residency is over.

Finally, regarding some of the opinions offered by various doctors on the quality of IMGs, it's important to remember the bias that was being cast on this issue, this was a 'equal-rights' style report, and any testimony offered would be either be 'pro-IMG' or introducted in a way to discredit or make the interviewee look foolish.

The two things I kept in mind regarding this: (1) You can /buy/ your MD in some places, and there is no (American) oversight over the foreign medical schools. (2) Many of these people are just following the money. They aren't immigrants looking for a better life, they just aren't happy with the money they can make in their home country. THe majority of the 'issue' doctors weren't from third world countries, but rather developing second-world countries. These people aren't poor downtrodden souls coming to Ellis Island for a better life--they all had the ability to get an 'education' and if they stayed in their own country would be comfortable, just not 'rich'. I don't feel the need to finance some greedy foreigner with my tax money.
 
I think IMGs are OK, but if there is even the slightest hint of a doctor surplus, then their numbers should be reduced.

Residency programs SHOULD discriminate against IMGs as they do now. To do otherwise would be unfair to an American grad whose tax dollars have supported the residency for years.

If I wanted to practice in other countries, shouldnt I expect to be discriminated against? Of course. Each country needs to look after its own first and ONLY after that is taken care of should they worry about foreign students.

I also need to clear up something about the quality of IMGs. The first poster mentioned that in the TV program, somebody said that IMGs are better trained in some cases and may be better doctors.

Lets remember who we are comparing here. We are comparing the top 15-10% of the IMG population vs the whole US grad population. Thats not a fair comparison. OF COURSE the top 15% of the IMG pool who happen to get spots here in the U.S. are going to be very motivated and may be brighter than the average US grad. I dont think IMGs are subpar, but I disagree with any notion that they are better than US grads. Lets compare similar populations, not a highly select group of one population to the entire set of another population.

Lets also recognize that the vast majority of IMGs have no intention of ever going back to their home country. They want to come to the US for economic reasons which I understand. Who wouldnt want to come to live in a country with state of the art research and cutting edge healthcare advances which also happens to be the richest nation in the world? If India was in this position, suddenly we would see thousands of IMGs trying to go there instead of the US. There are a few IMGs who honestly want to get great training so they can help their homeland. But the vast majority do not do this.

As long as there is no doctor surplus, I dont think we should necessarily restrict IMGs from practice. But if there is even a HINT of a surplus, their numbers should be reduced. I'm sorry that its unfair, but the US needs to look after its own first and only after that worry about foreign nations.

How many qualified US students every year get turned away from med school? Yet we allow nearly equal numbers of IMGs take positions that could have gone to Americans. Talk about unfair.
 
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MacGyver said: Residency programs SHOULD discriminate against IMGs as they do now. To do otherwise would be unfair to an American grad whose tax dollars have supported the residency for years.

As a future US IMG, I hope you were referring to non-US IMGs with this statement, because my tax dollars pay for those residencies, too... And I sure plan on getting one of them. As far as IMGs being better prepared than US grads, I think that depends. You have (relative) slackers at every school. There's the old joke, "What do you call the guy who graduated at the bottom of his med school class?" Answer: "Doctor." So would people rather go to an IMG who graduated at the top of their class or a US grad who graduated at the bottom of theirs? [not counting the people who would never go to an IMG anyway...]
 
Austin and MacGyver, I completely agree with what the two of you have said (and you both were quite eloquent! :) ) The only part of the story which I felt wasn't slanted to fit their agenda was the small part about the National Health Service Corps. I appreciated hearing that the young woman from Brown thought that many of her classmates would have gone to underserved communities if there had been more spots in the program (because without some type of government financial help, this wouldn't be feasible for the majority of new doctors.) Maybe it would be wise of the government to cap the number of residencies and use the rest of the money for the NHSC.

One other thought that perhaps someone might comment on -- if doctors like the one featured in the story (the IMG at Texas Tech) are in charge of choosing who the residency program accepts, what is to stop them from choosing IMGs over Americans just to give the IMGs a chance like they had?
 
Folks,

I am one of those "Third World Country" IMG who missed to watch that interesting piece about IMGs on 60 minutes.I was unfortunately working at that time with my other IMGs in the underpreviliged hospital for the underpreviliged Americans in the Newyork city where AMGs hate to work,though Medicine is considered a noble profession.

I agree with all your all your points.If,I am an American like you, I will think just like you.You have every right to say who should be given the oppurtunity in your country.

My only Question in my heart is....
As you said IMGs from underdeveloped,poor,un-sophisticated country come to US either for money,training or for better life.They come to US to get what they do not have in their own country.

What do you guys think about IMGs coming from developed( who have everything from money to sophistication) or semi-developed countries like Britain,Australia,Canada,Ireland,Germany etc.(I am not talking about US-IMGs).Do you think that those IMGs should be allowed to practice in US? or you dislike only those third world IMGs? Are those IMGs not filling the spots ?
I am just :confused:
 
I am a US IMG. I applied three years running when the application cycle was at its highest, and was waitlisted (and not the one where you don't even have a prayer) each year. I was bound and determined to become a physician. I ended up at a caribbean school.

I lived for almost two years in a third world country. I did quite a bit of studying by candelight because the frequent power failures. I had a nightmare escape from a class 5 hurricane. I had to wade through a crocodile infested swamp that passed for a road to get to school each day. I've had three 4th year rotations decide that they don't want me after they already said yes just because someone in an office somewhere doesn't want a caribbean student in their hospital. If a magic genie said they could wave a wand so that I wouldn't have had to do any of this, but not become a doctor, I'd send him on his way.

Am I better than the average US grad? No, I'm just as average academically, but I am certainly am hell of a lot more dedicated to becoming a physician. So, the next time you are tempted to snear down your nose at a US-IMG, stop and consider what that person has done to get he is.
 
I don't think it's fair to assume that all US Physicians snear down their nose at IMG's. That's not true, and it's a stereotype.

Regarding the quality of the physician. I think a lot of times, if language is not a barrier (if, say an IMG is fluent in English or Spanish), there's a great potential for that resident to be a better than average doctor. I think of all the medical advances in this country, for instance, with an ultrasound in a majority of clinics just waiting to help a US doc out in diagnosing a patient. Many foreign medical grads have to rely on their physical exam skills, on their subtle history taking, to elicit the same information, and that gives them the ability to better practice the "art" of medicine.

However, I make no excuses about preferring US medical graduates as my physicians. I do so for many reasons.

One is, I believe the quality of US education to be superior to other countries in the world. I realize there are great medical schools in Europe and Australia, but I prefer US grads. What's more, I will sacrifice a little of the "art" of medicine for an experienced technition in the latest diagnostic technology. After all, it's technology that has reduced mortality over the years; the "art" has been around since Hippocrates, and mortality has been relatively unchanged until the 20th century.

Part of the problem was mentioned on 60 minutes and in this forum, I believe.

That is, there is not enough government support for medical schools in this country. At my school, it costs 3 times the amount of tuition we pay to educate us. That's what they say. There's no savings in medical school education. However, as pointed out in the 60 minutes story, Residents are worth double what they make to the hospital they work at; the reason why there are so many residency spots in this country, right now. It's profitable, especially for academic medical schools that need all the money they can get.

I would have loved to see my friends, the ones that partied a little too hard in college, come to medical school. I don't think they had the motivation in college, but I sure saw some disapointment when they didn't make it. They would have been fine doctors, and they were plenty smart enough.

There just wasn't enough room, and that should change, given the overwhelming "thirst" some small towns have for any physician to come there, regardless of where they went to medical school.
 
Madanraj:
My only Question in my heart is....
As you said IMGs from underdeveloped,poor,un-sophisticated country come to US either for money,training or for better life.They come to US to get what they do not have in their own country.

Actually, what I was saying, is that foreign IMGs come to the country (for the most part) based on greed. Being a 'Doctor' in the majority of the world generally means that you have the potential to live a comfortable and affluent lifestyle in any country. That is the nature of the profession. In all honestly, I don't have a real problem with people being greedy, mind you--it may be one of the 'seven' but I think it motivates the majority of people in the world anymore--but what I do object to is that the U.S. people are paying for it.

I would much rather prefer that my tax money goes to expanding programs that help U.S. citizens particularly when the programs are completely domestic in nature. We could do that by expanding existing medical schools (and more Osteopathic schools on the coasts--I wanna live on my boat, dammit) and by expanding programs such as NHSC.

dwstranger:
As a future US IMG, I hope you were referring to non-US IMGs with this statement, because my tax dollars pay for those residencies, too... And I sure plan on getting one of them.

For purposes of residencies and US IMGs, I look at this from two (or more?) points of view. First, yes, your tax money did/does pay for those programs, but in reality, individually our contributions are insignificant--even as a group (that being US IMGs) the amount of your tax money going into the program probably would not be very great. On one hand, I am against foreign med schools coming to this country because there is no oversight of those schools, which has the potential for underqualified graduates. Having said that, however, I imagine that it's common knowledge (just not to me) which schools graduates should be considered 'suspect' versus which attempt to provide education on par with the U.S. institutions. Therefore, I'd much rather have a U.S. citizen filling that residency then a non-citizen if both have foreign educations.

I think the true root of the problem is that U.S. citizens with the potential and desire to become doctors should not be turned away, which would make the whole issue of a U.S. IMG a moot issue.

Madanraj:
What do you guys think about IMGs coming from developed( who have everything from money to sophistication) or semi-developed countries like Britain, Australia, Canada, Ireland, Germany etc.(I am not talking about US-IMGs).Do you think that those IMGs should be allowed to practice in US? or you dislike only those third world IMGs? Are those IMGs not filling the spots ?

Frankly, I tend to think less of doctors coming from those countries for the exact reason that there is almost no other motivation for these people other then greed! The reason many of those people come to the U.S. is because in most (all?) of those countries health care is state-controlled, putting a cap on their earnings potential. It's not that their quality of life suffers under that cap, but that they could be earning more in other countries.

At the same time though, I dig the hell out of Irish and Austrailian chicks' accents, so maybe I'll lobby Congress to encourage more of them to come to the country. :)
 
This discussion reminds me of all the bitching that goes on in California regarding the influx of illegal immigrants from Mexico… inordinate amounts of whining about our hard earned tax dollars going to support illegal residences who have children on our side of the border… and of their kids accessing the schools that were paying for.

The only things we like less than them is having to pay extra at the grocery store for a head of lettuce... or worse yet actually having to do their job.

Bottom line is that california cant survive without illegal immigrants and US inner city hospitals cant survive without FMG's.
 
Well put, boo.

I think that the whole argument about whether or not progarms SHOULD discriminate against the IMG, is bogus...US residencies have ALWAYS heavily discriminated against IMG's and always will...its just a matter of how much.

To the guy who says IMG's should train here and then return to their country...You have no grasp of the notion of what this country stands for. If you want that kind of crappy system, then go to england.

To the guy who says Third World Students are better because they practice the "art" of medicine, and dont have ultrasounds...thats not true. These days there are CT's and ultrasounds EVERYWHERE. The only thing that makes IMG's "better" is their competetive drive to work harder on theory..thats why we are much stronger in our fundamentals.

To the guy who says IMG's are not as good, because the US system is better...maybe it is. But dont forget, any IMG who makes it to a residency in the US has not only PASSED the boards, but also has HIGHER board scores than the average amrican in the residency...because of the severe discrimination, We must go above and beyond.

ANyway..theres a lot of heated debate on this topic...Argue about tax-dollars, argue about nationalism, but PLEASE dont argue about quality...thats what the USMLE's are there for.
 
I agree somewhat with Aaliyah (sp). I dont think quality of IMGs is that much of an issue.

However, keep in mind that the influx of IMGs has done VERY LITTLE to ease underserved communities as a whole.

Dont believe me? Check out these facts. In 1985, there were about 2/3 the number of residency slots there are now. Between 1985 and 1994, the number of residencies was increased by 33%, the vast majority of which went to IMGs.

Now, the number of underserved communities and the size of the underserved population has increased GREATER THAN NORMAL POPULATION GROWTH between 1985 and today. So the myth that IMGs are curing the underserved area problem is just that, a myth.

Sure, IMGs are more likely to go into underserved areas than US grads, thats a documented fact. BUT, WHEN IT COMES TO LONG TERM PLACEMENT, IMGS ARE JUST AS LIKELY AS US GRADS TO LEAVE THE RURAL AREAS FOR THE BIG CITIES.

IMGs use rural underserved areas as residency placements, not with the intention of practicing long term there, but with the hope of using it as a foothold into America, after which they can move on to non underserved areas.

Is anybody really surprised that IMGs filter into underserved residencies more than US grads???? This same phenomenon would be observed every where in the world. For example, if England suddenly became a huge mecca for medicine with a booming economy, American grads would attempt to gain entrance into rural residencies (which the English wouldnt want) as an attempt to get a foothold. But they wouldnt want to practice there long term. This same analogy is true for IMGs coming to the U.S.

Now, if we are talking about fully trained foreign doctors coming to work in underserved areas, then I say let them come. After all, the US government would not be paying them to come. But US residencies are subsidized by taxpayers, and htere needs to be preference for US citizens.

Remember, the U.S. takes more foreign doctors than all other countries in the world combined. Nobody anywhere has done as much to educate people from other countries. However, 30% of all residencies going to IMGs is just too high. I can understand maybe 10% or so.

IMGs are just as motivated by greed as American grads are, so lets stop pretending like they are some kind of altruistic breed who cares ONLY about serving Americas poor and underserved. They are willing to do whatever it takes to get a foothold in America, not for the sake of helping the poor, but for the sake of their own careers and interests. There are a very few who honestly want to come to America for altruistic reasons.
 
Man.. MacGyver...you really think you have a grasp on the situation, dont you? One 60 minutes program, and an article with some statistics, and poeple think they understand the whole problem...

I would ask , How do you come to a number like 10% of residencies should be given to IMGs? What do you know about the economics, and the interactions of the US Healthcare System with IMGs? It is far more complex and far reaching than Tax dollars spent per residency.

I know one thing about the system, and its the same as the economic system in any other part of this great country.....IT DEPENDS ON FREE MARKET COMPETITION! Now, dont start whining about IMGs getting "dumped" onto the US system, like chinese fabric. The J-1 VISA is no longer being given out to many FMGs who seek green card status. The borders are ALREADY being closed by US beuracrats, and have been getting like that since the late 70's.. Residency Directors choose us for a reason...they dont HAVE to choose us. Telling them that they can only pick IMGs for 10% is absurd.

Like boo says, Many urban centers depend on the IMG to run the system. I think your argument that IMGs come to rural areas, in a ploy to fool the government into letting them get a green card, Is partially true. BUT WHY NOT? If i were them, I would too! Hey, any way you can, man. They are just looking out for their families.

Im sick of all the love for Mexican unskilled laborers, and the willingness to let them all come over and granting them immunity from the NIS. Compare this to the hurdles and stigmata that the qualified, and professional IMG has to overcome to get here. Maybe we should all start mowing lawns, and digging ditches, and then you will let us in.

Its all about jealousy...the same liberals who say, "The government should limit IMGs, the government should control their influx" are the same liberals that welcome in the poor mexicans with open arms, and deep pockets...

Get real Macgyver..its all about jealousy and skin tone(aka playah hatin) and the fact that there is a lot of money being made by brown "outsiders". Dont you realize that the "outsiders" you chastise, who "cheat the system" by springboarding out of underserved areas, are, for the most part, HERE TO STAY, and for the most part, naturalize soon enough. They become very productive citizens...you could say , model citizens. We dont ask for welfare, and we pay our taxes.

As for me, Im a US citizen. The reason i feel strongly about this topic, is that the climate right now is such, that America is not letting in many IMGs any more. THey are simply not granting Visas. This is a BIG mistake for the US. There are brilliant doctors and researchers from foreign countries that are now flocking to europe and australia, because the US no longer welcomes their "huddled masses"
 
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Well, this is definately a first. I believe I've been called a liberal. I guess I need to get rid of the guns and go hug a tree or something.

Aaliyah:
To the guy who says IMG's should train here and then return to their country...You have no grasp of the notion of what this country stands for. If you want that kind of crappy system, then go to england.

"Give me your tired, your poor, your huddled masses yearning to breathe free, the wretched refuse of your teeming shore. Send these, the homeless, tempest-tossed to me. I lift my lamp beside the golden door."

I'm curious if you know where that inscription comes from. I don't know if it's exactly right, but any errors should be minor (I hope.)

I don't support immigration to this country much, you can blame that on my Republican outlook on life. I'm against illegal immigration (which means that yes, I'm against people from Mexico working for less money then would be paid to a citizen of this country.)

However, with all that said, this country was built on immigrants. Hell, even the Native Americans came to this country from across the Bering Straights (or at least that was the last theory I heard on the matter.) We've taken all comers, with open arms, for the longest time--starting with people fleeing Britan for religious freedom and continuing through refugees from Bos-Hertz. Yet, in everythign I've been taught in school, I don't recall it saying anywhere 'give us your greedy, those who would live well in their country, but are not satisfied with just having a lifestyle many times better then most people in their own country.' If I missed that part of the insciription on the Statue of Liberty, I'm sure you'll correct me, since you, being foreign-born, obviously know so much more about this country then I do.

Personally, I'm just glad to know that when I swore an oath to 'preserve, protect, and defend the Constitution of the United States' that I had no idea what my country was all about.

ANyway..theres a lot of heated debate on this topic...Argue about tax-dollars, argue about nationalism,...

Actually, that's one of the main tenets of my arguement. I'm not against IMGs because they're foreigners, or because I'm 'jealous'. I'm against IMGs because I feel Doctors in America should god-damn well be Americans. We need Doctors in America? Then offer the opportunity for more Americans to go to medical school, rather then using tax-money to sponsor foreigners.
 
I'm against IMGs because I feel Doctors in America should god-damn well be Americans
no comment... and furthermore, i wasnt even arguing with you, because you are clearly a *****. My discussion was with McGyver.


Personally, I'm just glad to know that when I swore an oath to 'preserve, protect, and defend the Constitution of the United States' that I had no idea what my country was all about.
I should have figured you were just some grunt in the US military...oh well, Im glad they find something useful for guys like you to do...like swabbing the decks of a battleship that I, AN FMG, may be the chief surgeon on. HAHA!
 
i don't get why you should be allowed to decide who comes into this country and why. you want only refugees to be allowed here? well, that should offend your Republican fiscal sense greatly, as these folks have a rough time taking care of themselves here, and depend on the government for support.

the US has been here for immigrants of all backgrounds. if a person would like to contribute to the greatness of america, we should be a little more receptive. living somewhere where there is great opportunity is something we take for granted. if another person is willing to leave their home in pursuit of happiness, who the hell are you to say no?

i love america and it will always be my home. but many americans take what we have for granted. many people have died for what this country stands for, which is freedom and opportunity.

a few things to note:

America is NOT the best at everything, including medical education. This one particularly irks me. There are thousands of excellent doctors that never had 1 day of american medical training. i would gamble that anyone making such a statement has never been educated outside of america, and therefore has no right to any input at all.

There is plenty of room in America for immigrants. Sure, they take jobs..but than they have income which creates jobs. and, overpopulation my ass. we are one of the least densely populated countries out there!

i mean, i am as patriotic as the next guy. i want what is best for my country as well as the next guy. i just don't understand how it is that it was decided that immigrants are not good for the country.

i also hope that US med schools open more slots. but, what if i want to be educated abroad anyway? why on earth can't i? why is my choice of residencies going to be restricted if i do decide that? just because you believe american schools are better, does not make them so. and who cares? there are good schools, and bad schools and everything in between everywhere. what makes a good doctor is what he does with his education, not where he went.

it seems to me that they need to educate the military a little better about what America is about. it is not a country club, limited to a few choosen souls, but a land of opportunity that is great BECAUSE there is opportunity for EVERYONE!!!
 
Aaliyah,

I don't know where to begin with you. I think, first things first, you should come down from your ivory tower and face the fact that most IMG's are not better trained than US Grads.

You know and I know that the whole "USMLE" argument doesn't hold water in an era where the average US Medical Student gets 4 weeks off to study while IMG's get several months up to a year to study. How dare you insist board scores should be used as a comparison, even for those few IMG's who work their butts off and achieve an awesome score. Who cares, they studied for months!

But since you went there, let me ask you:

10 people out of 90 in my class got over 250 on Step I. They all studied for four weeks.
How do you think IMG's would fair in 4 weeks?

I've never known an IMG to take that kind of risk, to actually rely on their FIRST TWO YEARS OF MEDICAL EDUCATION ALONE. Why? Clearly, the answer lies in the quality of the education. It's too risky. Thus, they need more time to prepare for an exam that their first two years did not prepare them for.

And don't even say anything like, "Well, they have to study longer and harder because Step I is in English."

To be a good physician in the US, you NEED to speak English. I'm not being mean or biggoted or ignorant here; it's a simple fact. Spanish, of course, is helpful too.

By the way, if you're going to paraphrase what I said, get it right. I never said:

"To the guy who says Third World Students are better because they practice the "art" of medicine, and dont have ultrasounds..."

I said they have the potential. And, in the same post, I stated that I have always preferred United States Medical Graduates as my own physician because I believe technology saves lives more than the "art" of medicine. If a doc saves my life through ultrasound, he or she is a better doc. Period.

Oh, and Aaliyah, I got your name right. When you refer to us, please don't be lazy and say "to the guy who said..."

Do you refer to your patients that way?

I hope not.

GI Guy
 
hey gi guy, i have an answer for you regarding how IMGs would fare with 4 weeks of study for the USMLE. not as well. is that because they know less medicine? nope...at my school, all exams are oral. the years are divided into basic science (two years) pre-clinical (2 years) and clinical (2 years). with that set up it is pretty clear that the first two years have little clinical input. we take the same classes (anatomy, histology, etc...) but with a different teaching method. at US med schools, you have the advantage of a test designed to meet your curriculum.

the exception would be caribean students on a program similar to the US schools. but, i would be willing to bet that with students coming from the better schools (auc, st. georges, ross) the pass rates and scores are similar to the US schools.

no, the USMLE is not the perfect way to rate doctors. it is the best that we have now. however, i think we would all agree that it is foolish to judge ones ability based on this test. what the USMLE is best at doing is demonstrating a required minimum knowledge.

i really am bothered by the tone of some of these posts. do US students really think that the only good medical education is available in the US? this is not the case. sure, there are some diploma mills out there. but there are far more credible schools than shady ones! don't worry, the US students will always do well, and get most of the good residencies. just like americans get most of the good jobs...there is no reason to be so paranoid about this!

as soon as someone can show me a case where a US physician was denied a job because a less qualified IMG took it, than i will listen. but the opposite is surely true in many cases, and we americans still feel we are getting screwed? give me a break! open your minds people!
 
neilc,

I never said that the US was the ONLY place to get a good medical education.

What I DO say, is that, by and large, the US has the best medical and graduate education system in the world.

Of course there are individual schools out in the other countries that rival even our best medical colleges. But I'm talking about comparing ALL foreign med schools vs ALL US med schools. The US schools are clearly better when compared against ALL foreign counterparts, not just a select few like you want to compare them to.

Are there cases where a specific foreign medical school might be better than a given US school? Of course I'm sure there are cases of that. But those cases are few and far between. American schools on average provide superior medical education. Maybe your school IS better than some American schools, but that doesnt detract from my point.

Just because we dont have the highest population density in the world doesnt mean that we should take in as many people as want to come here. Do you realize how overcrowded our urban areas would become if we suddenly allowed everyone around the world to come here who wanted to?

Keep in mind that foreigners in general DO NOT settle in rural areas, they live in hugely populated urban areas. Our urban areas already have HUGE stresses on public transit, utilities, sewer systems, etc.

I do believe that foreigners can contribute valuable things to the US, but that doesnt mean we should just take everybody. 30% of all residencies being occupied by foreigners is just too high.

Lets let some in, maybe 10%. I say instead of funding residencies for IMGs, we should use those funds and encourage US minorities to enter medicine. Thats a MUCH better return on investment. In contrast to IMGs, US minorities ARE LIKELY to spend their entire practice in underserved/rural areas.

The US needs to reign in all these excess residency slots and divert money from supporting this excess to improving care for underserved populations. There are better and much more direct ways to do this than having all these excess residencies that usually go to IMGs.

In 1985, we had FAR less people who were underserved, and we also had a very minimal IMG population. So the assumption that increased IMGs automatically increases access to underserved is unfounded. Sure there are individual cases where this occurs, but on the national scale the impact that IMGs have had on underserved populations is minimal.

Lets remove the funding from these excess residencies and place them in funds that encourage the development of US citizen minority physicians and

In the last 10 years, the sudden increase in residencies was not due to a real need by hospitals for resident doctors. The hospitals saw an easy way to get "free" money from the government and they did so. Keep in mind that Medicare funds each residency position at $100,000 per year, which allows the hospital to make a profit. Thats the sole reason for the large increase in residencies, not because the hospitals were trying to reach out to the underserved.

If I was a hospital administrator, I'd try to get 100 residency positions at my hospital if I could. It would be money in my pocket. This is the thinking that led to the residency upsurge, and nothing else.

You've got to admit that a big reason why IMGs are here is because of the greed of American hospitals, not because they are interested in underserved communities.
 
two quick points...first of all, of the 30% non-US grad spots, about 15% go to US citizen IMG's. your 10% theory lets even fewer US students that go abroad for an education return.

second of all, i do agree that uncontrolled immigration is a bad thing. but i do not agree that it is the place of hospitals and medical educators to decide who gets in. we have immigration laws that need to be enforced bu the INS.

i also agree that encouraging minority students to pursue medicine is a great idea (but not through affirmative action...but that is another thread!!), and i do think we need more rural doctors.

so, we are not too far apart! but what i do not agree with is the sense that people think the pursuit of a better life and opportunity should be left to US citizens. hospitals do not create these positions of of a desire to educate physicians, that is true. but the residensts that they do get provide a very neccesary service while they are there. and if they don't stick around after they graduate, at least the hospital will have a new resident to provide the area with service.

one last thing to think about. with only 10% more residency spots than US med graduates, think of how that will further limit US student choices. many more students will be forced into areas they do not want, as well as specialties they do not want. in the long run, i would argue that this could easily be another reason that the best and brightest will not consider medicine.

so, in short, i think we really agree on the general principles. but, i see the problem not with the US residency system. it is an educational system, not an immigration prevention system.

the last think i want to mention, is that i also would have preferred an american medical education. as a system, the US is great. but, i know that you can get an equal education all over the world. i am not comparing my school to the US. what i am saying is that in general, you can get just as good an education as you can in the US. if you want to compare individual schools, or systems, or whatever, there is still great equality. huge differences in methods, but the end result is nearly always the same. so, i just do not buy that US doctors are the best educated.

anyhow, best of luck...i sure love a good debate, especially with someone who i typically agree with!
 
/I/ personally, don't get to decide who comes into this country or for what reasons, neilc, and to be completely honest, that may be a good thing. I am a very opinionated, and generally very unfair person. However, because of the Constitution of the United States, I am free to express that opinion, just as Aaliyah is free to call me a *****. While I agree with everything I've said (go figure) they are not policy of this country.

In the case of IMGs, I do not believe they add anything to this country that this country could not provide for itself and better. In that case, I don't feel we shoudl be importing doctors, I feel we should be providing our own trained personnel to fill the needed positions. Unfortunately, the United States has become a service economy, so it concerns me that one of the essential parts of a service economy (that being training of the 'server') is being handled in a manner without U.S. oversight and in a manner which, in all likelyhood, is inferior to the training recieved at U.S. schools.


Aaliyah:
I should have figured you were just some grunt in the US military...oh well, Im glad they find something useful for guys like you to do...like swabbing the decks of a battleship that I, AN FMG, may be the chief surgeon on. HAHA!

Regarding my being a 'grunt' in the U.S. military, all I have to say is: Effin'-A right. I'll be damned if someone is going to insult me for volunteering to serve my country. Everyone from the aforementioned Seaman swabbing the deck of a battleship (of which there are none currently in commission), to the Airman serving chow in a messhall in England, to the U.S. Infantryman humping his ruck on a little thirty kilometer jaunt, to the Guardsman doing his duty for one weekend a month holds a postion of honor and prestige in this country.

It is the soldier, not the reporter, who has given us the freedom of press.
It is the soldier, not the poet, who has given us freedom of speech.
It is the soldier, not the campus organizer, who gives us the freedom to demonstrate.
It is the soldier, who salutes the flag, who serves beneath the flag, and who's coffin is draped by the flag, who allows the protester to burn that flag.

--Father Dennis Edward O'Brien.

I don't give a damn who you are, what you've given to this world, what great research you expect to contribuate. You are not worth a damn in comparison to anyone who is willing to serve this country, defending your right to post your complete utter crap, that defends your right to have an opinion, and then defends your right to have an ignorant opinion, and finally, allows you to not only be derisive towards them, but to methaphorically spit on everything any one of those serviceman has done for you.

You aren't worth it, but that doesn't stop them/us from doing our duty, for love of our country, and all that it means.
 
glad to hear you are opinionated, cause i am too!

anyhow, i disagree that IMG's do not add anything to this country. at the very least they help America stay the diverse country that it is! and, i hate to say it, but education outside the states is not inferior. i kmow that we like to think so. i even expected it to be so when i left. but, the truth is, americans do things well, but so does nearly everyone. living in america almost forces us to think the american way is the only way. but, that is pretty ignorant. anyhow, i do not expect you to agree with me unless you actually go abroad and do some studying. lord knows that i was about as pro-america anti-foriegn as you could be before i travelled a bit and studied abroad. i would be right there yelling with you!

and the armed forces are the ones who defend our rights, i agree. but, it seems that you are a little gung-ho and misguided. everyone is an immigrant in this country. i am thankful that my grandparents came over...and they were middle class in portugal, not exactly refugees! but, if they did not come over than i would not be here...how long ago did your relatives arrive? and aren't you glad they did?
 
Austin.

You're totally right about not apologizing for being in the military. Thank goodness there are people like you out there!

My brothers were both Army, while I took the Academic track, but I was tempted to join (apart from my steadfast, overwhelming hatred of running.)

Nevertheless, for anyone to criticize people in the military, that's, well, it's dispicable.

I'm glad the US has a strong military, glad we had one in WWII. I don't think Europe would be as fun if everyone was speaking German.

GI Guy
 
One of the reasons for the GREATNESS OF THE AMERICA is it's tolearnce to immigrants and it's appreciation of their talents.No other country in the earth has so many foriegn doctors to serve their citizens.No other country gives the oppurtunity like America for the unlimited growth(financial and professional) of any foriegn doctor if he or she has the skills and deserves recognition.

I have heard many success stories of many Indian Physicians who immigrated to US when I was a kid growing up.Any smart kid with academic achievements will have a goal to go to America either for studies or for job.They dream for years and they achieve it at any cost.It could be in any field.

They believed that their talents and skills would be recognised in America eventhough nobody cares in their homecountry.

There are still many hundreds of young achievers working hard to reach their American dream.

What is happening to new generation of Americans?
Are their minds becoming small?
What is going to happen for the GREATNESS OF AMERICA?
Are they going to shatter the dreams of those smart Immigrants who want to play a role in building new,stronger,smart America.

I still believe Americans are fair people.
Few small minds cannot change American Hospitality.
America was built by Immigrants.There is still to come.There is more to build.
 
Please don't ask me...
why don't you build your own country and then,think about building America ?

India's population is more than 1 billion.
There are three types of Indians.

1.Smart Indians
2.Very Smart Indians
3.Super Smart Indians.

Only Super Smart Indians come to America.That is less than 1 or 2%.
India could be built with remaining Indians.They have no regrets about those small numbers of traitors.
America can use and have place for that small percentage.

GOD BLESS AMERICA!
 
Just because we were very willing to accept nearly all comers in the past doesnt mean that we have to do it ad infinitum.

What happens when the population of New York City is 50 million? Are we still going to take all comers who want to crowd into those already supercrowded boroughs?

What happens when the total population of hte U.S. is over 1 billion? Do we still have an obligation to take in millions of immigrants every year?

All I'm saying is that you cant justify current immigration policy SOLELY on what happened in the past. Times change, this isnt the same America it was 100 years ago.

It really irritates me when people say 'well we did it for so long that we have to do it forever'

Why doesnt India encourage people to immigrate there? Dont they think that a strong immigrant population will cause them to thrive? I sure as heck dont see them (or any other country) spouting off the virtues of having immigrants.

We take in more immigrants than all other countries in the world COMBINED. I think we've done our fair share. Why doesnt England open up its borders to all who want to come? Why not France? Why not Argentina? Why not India?

Why are we the ONLY country who is expected to do this? We are NOT the only wealthy nation in the world, but yet everyone acts like ONLY THE U.S. needs to take in everybody who wants to come and help out every single country on Earth.

America is NOT the only way out for struggling people in foreign nations. There are dozens of others, but yet nobody thinks they have any kind of obligation. According to the popular world view, ONLY the U.S. has the obligation to support all other countries.

Its time for the rest of the world to take care of its own.
 
Yeah MacGyver,

...the times they are a changing.

its us against the world!!!

lets build some fences.

lets draw a line in the sand.

Better yet lets start a militia. We could get dressed up in fatigues and carry out training exercises at the hospitals.

we need a mantra.

i know, how about ...a commy for mommy, and an fmg for me.

long live reagan
 
what kind of dumb remark is that?

indians are smart indians? super smart, and super super smart? are you some kind of *****?

whose fault is it that your population is 1 billion? Is it our fault that your country can't even control its own reproduction rate? remember, rajiv gandi who was assassinated for sterilizing his OWN PPLE>...

what a shame and dispicable state of affaris for a country full of "smart pple" were the leader has to sterilize their own pple! It sounds like hitler's final solution, the only difference its against its own kind...

indians themselves are very racist, and put down other races including americans...the majority of inner city hospitals are controlled by indians, who in TURN through NEPTISISM give positions to relaties and families and recruit others from india! that is the hypocrisy which you are trying to sell and we are not stupid...when you look at a rural community, indians acquire one position and then they try to recruit others regardless of their stats! someday, I will also get a law degree and sue all your asses for any sort of nepitism going on...if you have managed to get away from it these past 40 years think again....because I am aware of the inward political "favors" you do for each other...

as far as the remark for indians being "smart" have u ever lived in india? have u ever lived in the middle east? in the philliphines, in asian countries? the majority of indians there are brickbuilders, servants and maids! so your generalization that your pple are extremely smart, is very hypocritical...

the fact that u have huge numbers in the united states, is not indicative that you are a smart race....but RATher u even out number us americans....our population is 270 million

india's population is 1 billion...lets say 1 out of eveyr 4 indian is super smart, that will be 250 million! statistics would dictate that there would be 250 million doctors, and where are these 250 million super doctors...and if you pple really gave a damn about ur own country u would go and help ur own pple in india...not coming to the usa, taking positions and then giving them to ur relatives and friends...that is really hyporisy, and I resent that you try to create this super talented look for ur own race, where in fact the numbers of statistics dictate otherwise!

india is without a doubt one of the pooorest nations in the whole world, this is one of the few countries tODAY in the 21st century, where small pox, EVEN LEPROSY, and the CASTE system exist...so please dont give us the bull about how ur pple are very smart....if u look at the statistics, ur only outnumbering us! go back where u came from, this country is for immigrants who work hard, not for pple who give positions to each other through nepitism....and dont think ur group will get away from it. We are on your track, and we will hunt each and everyone of them down for any sort of corruption!
 
This is gonna be brief, 'cuz I gotta go to class real soon (well, about five minutes ago.)

'America is a land of opportunity' seems to be the major argument for why we should let IMG/FMGs into this country. It's important that America continue to be a place that the rest of the world sees as 'great', as a 'place where anyone can come and live the American dream.' This country was built on the backs of immigrants.

You, as a FMG/IMG, obviously do not need that opportunity. You've had plenty of opportunity in your own country. If I'm going to take immigrants to this country, I'm not going to take people who are already affluent and powerful in their own country (as any doctor will be in any country.) I'd rather take the people who are still super-smart but never had that opportunity. This country isn't about opportunity for the greedy, it's about opportunity for the downtrodden. I don't think a single one of you who are currently screaming 'Immigration /made/ America' could really be defined as downtrodden.

As foreigners, the burden of proof is against you (fair or not) to prove why you should be here, not why you shouldn't.
 
the burden of proof is on the immigrant? give me a break.

basically, what all of you are saying is that you want the door to close behind you. no that we (or our families) successfully immigrated, we don't need anymore. sorry guys, that just doesn't cut it.

because americas considers itself the defender of the free world, because we immerse ourselves in defendin or protecting the freedoms of other countries when we are not even asked, we are required to take it another step and provide opportunity to those that do not have it, or even simply want better.

think about it...who is more likely to become a better citizen? the family of a man who had to save every penny he had for years to even get here, a family that had everyone working in minimum wage jobs and going to school until they could better their life, or the family of the man who was born here, who sits on the porch of his trailer collecting disability.

again, i challenge any of you to tell me of a case where an underqualified immigrant took a job (through nepotism or whatever) from a qualified american citizen? it does not happen.

and the don't give me any crap about burdening our tax system. we already have the lowest tax rate of ANY industrailized nation. we are very well off here.

you want immigrants to go to other countries, and they do. sure most of them come here. we are a lot bigger than britain, france, etc...a lot of these places are smaller than single states! they do take a good share of immigrants, but the bottom line is only america has enough opportunities for most of them. you need to look at the numbers relative to the scale. america is big. america has money. america has land. more people+more jobs+more opportunity. we are not at some critical stage where we are running out of space.
 
neilc:
the burden of proof is on the immigrant? give me a break.

I'd be happy to give you a break, but that doesn't change reality. I'd advise you to take a look at Immigration Law in this country (or, more preferably, a simplified version of it.) Anyone wishing to come to this country must show cause to do so. Whether you like it or not is ultimately irrelevant, that is simply how the system works (for a number of reasons, and I could go on for hours as to exactly why it is that way.)

basically, what all of you are saying is that you want the door to close behind you. no that we (or our families) successfully immigrated, we don't need anymore. sorry guys, that just doesn't cut it.

I'd strongly advise you to carefully reread this topic, and my comments in particular regarding immigration. This topic is about foreign doctors not immigration law in general. It seems to me that because 'your' side can't argue my points effectively, you're attempting to move this conversation from a specific for-instance of foreign doctors into the realm of all immigration.

I've said several times that I recognize the contribution of immigrants to this country, and while I am personally in favor of much stricter controls on immigration, I have stated that part of what makes this country great is that it is a land of opportunity, and for it to remain so it must be accesible to those who need opportunity.

because americas considers itself the defender of the free world, because we immerse ourselves in defendin or protecting the freedoms of other countries when we are not even asked, we are required to take it another step and provide opportunity to those that do not have it, or even simply want better.

From a strictly semantical standpoint, you are wrong. The United States is not required to do anything not outlined within the Constitution of the United States and the associated treaties with other nations that have been enacted over time. Beyond that, America has zero 'requirements' to do anything. All immigration is controlled by legislation and all immigration to this country could be stopped simply by a a piece of legislature passing through Congress.

From your philosophical standpoint, you may think we have that requirement, and I strongly disagree. The United States has done singularly more then any other country in the last centruy for the betterment of the world, and will probably do so long after this conversation is long forgotten. I feel the United States shoudl continue to support the 'world', not only by providing opportunity to those who need it, but also by attempting to continue to improve the world as a whole, so that perhaps opportunities will be available not only in the United States, but in every country of the world.

think about it...who is more likely to become a better citizen? the family of a man who had to save every penny he had for years to even get here, a family that had everyone working in minimum wage jobs and going to school until they could better their life, or the family of the man who was born here, who sits on the porch of his trailer collecting disability.

I don't feel this question adds anything to the conversation, frankly. Neither of these aforementioned people is a foreign doctor which is the point of this discussion. Yet, you seem to be arguing that all immigrants are like the former case--this is simply not so--particularly not in the case of a foreign doctor, who obviously already has quite a bit of opportunity in his home country, as he has gone to medical school there (something, according to 60 minutes, 3 out of 5 Americas--in the land of opportunity--can't do, even if they want too.)

you want immigrants to go to other countries, and they do. sure most of them come here. we are a lot bigger than britain, france, etc...

Again, I feel you are attempting to broaden the discussion to an argument you feel you can win. This conversation is not about immigration in general. This conversation is about foreign/internationally-trained doctors coming to the United States in government-subsidized positions that coudl be better filled by U.S. citizens from U.S. medical schools.
 
i was responding to the anti-immigrant issues brought up in several other posts, not attempting to broaden the discussion. i do not believe this is an argument any one can win...i just like to see all sides of an issue!

first thing i would like to say is that you seem to think that being a doctor is a great opportunity in many countries. well, you are sadly mistaken. do you have any idea what doctors make in the Czech Republic? well, around 2000 bucks a year. most doctors have another job, such as driving a taxi or waiting tables to make ends meet. and this is true in many, many countries. most places in the world do not reward a doctor financially, it is considered to be a humanitarian profession. so, just because a person is a doctor in their home country does not mean that they are well off, or not in need of a better life!

but, as to your points on foreign doctors coming here to practice...the bottom line is, we need them. at least as of now. cutting residency positions to only allow 10% more spots than there are US grads will hurt patients and US citizens along with foreign doctors. basically, the residency system provides cheap labor and money for the hospitals. but those doctors in training treat thousands of patients that have nowhere else to go. so, by limiting positions you hurt patients. also, limiting positions means decreasing numbers in all specialties, requiring more US med students to enter training in their second choice feild. as it is now, the US grads nearly always get the first choice specialty with IMGs taking the leftovers. so, this would decrease opportunity for US students also.

a reasonable solution is to open more med schools. with the economics of supply and demand, one would assume that some schools should have opened by now. well, politics beingw what they are, this has not happended, and it doesn't look like it will. and also, this does not address the US citizen that wants to study abroad. why should we have to study in the US to practice medicine here?

the bottom line to me is, are we as a country even hurt by IMG's? i just cannot see how this is the case. there are too many people without medical care at all to say that we have too many doctors. and, prejudice being what it is, i just do not see IMGs taking away jobs from US docs. so the residencies are funded by taxpayer dollars. those dollars are caring for patients as well as training a doctor to take care of patients! many IMGs may leave for the city after the training, but another resident will fill in to take care of those people. and some do stay where they are needed.

in a perfect world, every US citizen that wanted a chance to be a doctor would get that opportunity. but, we do not live in a perfect world. we do not produce enough doctors in our medical schools, we must go abroad, both to educate our citizens and welcome new doctor/immigrants. i just cannot see why this is such an issue! we allow about 3000 new us citizens educated abroad and about the same number of foreigners into US residency. that is too much?
 
I do not want to waste my precious time with some people who do not know any history (Mr.Watchamaccalit...who told you Rajiv Gandi was murdered for sterilizing own people?)I do not want to call you a ***** like you called me.Then,There would not be any difference between you and me.I can forgive your ignorance.

America imports the best quality goods from all over the world.
It imports the best quality fruits,cotton,silk,cars,aeroplanes,art pieces,etc,etc,etc.You name it.
What is wrong in importing the skills and brains?

There are many IMGs who are leaders in many highly specialised fields of medicine like Neurosurgery,Cardiothoracic surgery,Transplant surgery etc.Do you know how much they have contributed to the world of American medicine? Most of the Research programs are led by IMGs.You do not even know the history of medicine in the US.
How could you reject something which helps in the health improvement of mankind?

History changes very rapidly.No country could be the "King of the World" forever. Remember Great Britain?

One famous Astrolger has predicted that Indian Sub-continent is going to rule the world in another 50 years.It is not a joke!
I believe it is possible.History is unpredictable.If that happens,I will welcome your greatgrandchildren and greatgreat grandchildren to my country.
It would be our payback time!
IMGs are here to save lives.Why you are not getting the basic point?

THINK OVER! and CHANGE YOUR MIND.
I LOVE AMERICA!
 
Originally posted by Madanraj:
•If that happens,I will welcome your greatgrandchildren and greatgreat grandchildren to my country.•

You would? Would you also welcome my whole family and every person I know in America?

Would you welcome the entire American population to come over and crowd into your cities? Would you welcome us to consume your water supply and increase the burden on your public transit?

How many would you welcome? 10,000, 10 million, 100 million? Just how many people would you welcome into your country if you suddenly became the dominant superpower?

Would you welcome 1 billion outsiders to come to your country? AFter all, dont we all DESERVE the Indian way of life? They surely will be the land of opportunity, so India would have the responsibility of letting EVERY SINGLE PERSON IN WHO WANTED TO COME, right?

So, I take it that you wouldnt mind if suddenly 1 billion people wanted to come to India because of their great economy and country?
 
hey mac you have a good point,

I took a "history of India" class in college. Look at how many people immigrated there: This list is probably not complete

Aryans
Israelis
Armenians
Greeks
Scythians
Huns
Arabs
Persians (including Parsis)
Turks
Mongols
British
French
Dutch
Portuguese

Many (though not all) of these people stayed there and plundered and/or overpopulated the country to the shape that it is in right now. The historical India was a great place (by historical standards, of course) -"an immigrant destination" - because of rich, arable land. The US is a destination for other reasons, but these reasons also ultimately have to do with money and lifestyle. Lets hope that America's future will be better than India's present.
 
"would you let them crowd your cities, and your public transport system?"

Is that your argument? come on. Your subways already crowded with gang members and AIDS patients. I like to drive car when i go to New York.

Your argument of, "Oh god! the resources vill dvindle!" is also wery bad. If you have ever driven through the great plains, you will know how much "resources" this country have.

Madanraj, brother...you cannot say that we are the smartest people in the world...if we were, our country would not be so corrupt and polluted. You are wery mislead. India will not be a superpower in the next 50 years. That is why I am Citizen of US, so my childrens grow up here in the great country.
 
please dont try to teach me a lesson about history...

Rajiv Gandi was hated for his implementation of the sterilization project.....he wasn't assassinated solely for that reason!

for jswed, read your book, you mentioned various races.....one of the is Aryan....I wonder how much you have learned about history, since French, British, and all the other european countries you mentioned are UNDER the classificaiton of ARYAN...SIGH :rolleyes:

India has the 2nd highest AIDS rate next to Africa? They are going to be the next powerful rulers in the next 50 years? your country is the pooorest in the world, and now your making a threat to us, that your going to be powerful ? who the heck do you think you are?

oh and an astrologer told you that? oh I am glad I am not using my common sense :rolleyes: maybe I should use my to figure out predictions astrologer.....

we have already talented skills and brains in the usa, we don't need pple who help each other through nepotism...THAT ISNT talent!
 
Originally posted by FunkaDesi:
•"would you let them crowd your cities, and your public transport system?"

Is that your argument? come on. Your subways already crowded with gang members and AIDS patients. I like to drive car when i go to New York.

Your argument of, "Oh god! the resources vill dvindle!" is also wery bad. If you have ever driven through the great plains, you will know how much "resources" this country have.

Madanraj, brother...you cannot say that we are the smartest people in the world...if we were, our country would not be so corrupt and polluted. You are wery mislead. India will not be a superpower in the next 50 years. That is why I am Citizen of US, so my childrens grow up here in the great country.•


How many Indian immigrants do you know that settled in the great plains? I'd say its probably around 1 in a 1000.

And yes, our resources are already crowded in large cities. So, according to your logic, since they are already crowded, we shouldnt even worry about letting them get more crowded?

You talk about the resources in the great plains, but how many immigrants move there? 1 in a 100 maybe at most.

Everybody keeps saying, America is a big country and can hold everybody. Excuse me, but immigrants generally DO NOT spread evenly distributed thru the U.S. We're not talking about foreign immigrants moving to rural Montana, we're talking about immigrants coming to NYC, LA, Houston, SF, etc.

My point is that land size by itself means nothing. Just because America occupies a relatively large amount of land does NOT mean that we have the resources to support everybody who comes.

Again, many of you are implying that America MUST ACCEPT all who want to come, simply because thats what they've done in the past. What kind of reasoning is that? Times change and nations change. Why doesnt anyone want to recognize that the dynamics in the present time are VERY DIFFERENT from the dynamics 100 years ago?
 
My Dear Friends,

SMALL MINDS DISCUSSES PEOPLE
GREAT MINDS DISCUSSES IDEAS

How Smart it would be if AMGs and IMGs discusses ideas about breaking the frontiers of medicine through research or innovation?

I have work to do........which is my primary Obligation to this great country which gave me an oppurtunity for better career and life.

I will prove myself and then let you know whether my Immigration was useful to you or not.
PS: It is heartwarming to know that there are people like neilc who supports IMGs.
 
this discussion went nowhere, except to make me realize that a lot of people just don't like immigrants. well, to be honest, i respect your opinions, but do not agree. especially as pertains to limiting educational opportunities as a means of controlling immigrants. whatever guys. but, economics being what they are, hospitals will never give up those residency spots. they need the cheap labor. so, i guess our discussions are moot anyhow! well, best of luck to everyone!

neil
 
Well, I feel compelled to add my .02 on the issue. My husband is an IMG who scored in the top percentage on USMLE 1-3...he had the second highest score of the residents in the hospital where he did residency and his USMLE scores are the highest of the people here in the practice where he works (brag, brag, I know...but I say this to make a point!)

My husband is an IMG...he was born and raised in Germany (a country that was teaching science and medicine before the US was even founded) and spent 7 years training to be a doctor including an additional year in which he did basic science research on neuroblastoma.

I have lived in Germany, the UK, and the US...and all I can say is that in the US...we just "cook with water" too. There is nothing magical or miraculous about a US medical education. If you were to complete your residency here and wanted to practice in Germany, your residency would be recognized. My husband had to start all over when we came here. He was denied the option to moonlight and was forced to work all major holidays because of his IMG status. The bottom line in our eyes was that you could be a US grad who failed the USMLE the first time around, did mediocre in med school...but you were considered the "cream of the crop", while anyone who was a dreaded IMG couldn't possibly be talented enough to deserve to moonlight. I have a lot of hostility still left about that...It made life really hard for us because I wanted to stay home with our children.

Most IMG's arrive in the US with what is called a J-1 visa. This can NOT be turned into an H-1 visa and you can NOT get a greencard from a J-1 even if you marry a US citizen. (My husband and I were married long before we came to the US).

My worst birthing experience in terms of quality of care was actually at a teaching hospital in the US where I had my son. The physician didn't clamp his cord properly and he bled out and spent 4 days in the NICU with irregular heartbeat from the blood loss...and I was tossed out on my butt with a hemoglobin of 7 after 48 hours.....but I don't think that it represents US medicine as being subpar. I didn't have a private room in germany when I gave birth, but I didn't have any serious complications either. In Germany, my husband never had to haggle with an insurance company for treatment, didn't have patients call him because they couldn't afford their medications...because these things were covered over there.

You are comparing apples and oranges and it is unfair to the IMG's who truly are talented who come over here for a variety of reasons.

The bottom line is that US grads don't want to go to underserved areas, do residencies in inner-cities...and that is why IMG's are coming into this country to do residency. Most of them are not able to stay here when they finish...that is no longer an option.

If you haven't experienced another medical education system personally, then I think you are in no position to judge. One hour of "60 Minutes" and a little article don't make you an expert! Learning a foreign language and spending some time working as a resident abroad might though...perhaps that's an option for some of you....
:rolleyes:
 
I was just visiting a practice today in a depressed area where the two docs were IMGs who built a great practice treating mostly people who were new to this country and needed a doc that spoke their home-language to get good care. In a highly diverse U.S., with many immigrants, having practitioners that somewhat mirror the population demograph-wise just makes great, great sense.
 
Originally posted by Stephen Ewen:
•I was just visiting a practice today in a depressed area where the two docs were IMGs who built a great practice treating mostly people who were new to this country and needed a doc that spoke their home-language to get good care. In a highly diverse U.S., with many immigrants, having practitioners that somewhat mirror the population demograph-wise just makes great, great sense.•


The greatest need for doctors who can relate to specific patient groups are for Mexican American and African American patients.

What do these two patient groups have to do with IMGs?

Instead of using IMGs, we should use American minority physicians to support these populations.

momofthree,

I never said that all foreign medical education was subpar compared to the U.S. Please tell me where I implied that every single foreign med school must be subpar.

I'm talking about averages here. Your husband's experience at 1 foreign med school DOES NOT mean that on average, foreign med schools and US med schools are exactly the same.

I also never said IMGs were subpar. You are doing exactly the same thing neil did. You are comparing the top 5-10% of the IMG population (who happen to immigrate here) vs ALL american grads. Thats not a fair comparison. Now what I will say is a fair comparison is to look at the top 5% of all US grads vs the top 5% of all IMG grads. You see the difference here?

The fact that your husband did extremely well DOES NOT detract from my argument. What if I told you that I know an American grad that got a perfect USMLE? Does that mean that the majority of foreign IMGs must be subpar compared to him? Absolutley not, so please dont try to use the same reasoning.

Are you saying that your husband would be willing to spend his whole career working in rural/underserved areas in the U.S.? If so, he is in the very small percentage of IMGs. And if German health care is so great, why the hell would he want to come to the U.S.? If things were better over there, wouldnt you want to move there with him? Why not do so?

How many IMGs did Germany take in last year? Surely they dont discriminate against IMGs and I can go there to practice with absolutely no hindrances, right? I mean, Germany understands that they should let all IMGs who want to practice come there right? And of course German citizens welcome IMGs with open arms, correct? Yeah, I didnt think so.

We are not talking about individuals, we're talking about populations and groups. Just because an Indian IMG got a 250 on the Step I USMLE DOES NOT mean that Indian IMGs must on average be better trained than US grads.

Stephen,

I see what you are saying here and I agree. So you think that we need to have a full 7,000 residency slots (1/3 of the total pool) devoted to these international minority groups? Surely these IMGs are not taking care of American URMS are they??? I'm assuming you mean that these IMGs are treating people who come from the same region of the world and/or country. ON the national scale, devoting 7,000 residency slots for these relative small international patient populations is WAY in excess of what is needed.

American URMs need doctors MUCH MORE URGENTLY than international groups who have moved to the U.S. American URM groups make up a far greater percentage of the population.
 
dude, i do not understand you. when did i ever compare the top 5% of IMG's to Us doctors. i would venture to even say that the IMG's we get are not neccesarily the best the country can offer. why would you assume this? img's on average are equal to US grads on average. my point is that you are not special because you went to a US school, that on average the medical schools of the world do just as well educating doctors as we do. there are diploma mills out there, but many countries are even healthier than us, and they import very few US doctors!

we do not have 7000 slots devoted to training IMG. we have 7000 spots that are available after the US schools fill the rest, and IMG's are the only way to fill them. when we have enough US students to fill those spots your argument will make more sense. but right now, those spots are there and need to be filled. IMG's can do a very good job at that.

if the US opens more med school seats, then i would always agree that US students should get them first. but, there will always be leftovers, and the IMG's do great at filling them with no cost to patient care.

also, momofthree had a great point. the US and canada are the only two nations that i know of that do not recognize any post-graduate training from another country. for example, i really dobt that her husband needed a full residency in order to be qualified to practice here. we are a very arrogant country, and we generally assume that the only good things come from america. this is wrong!
 
...some of the american boards do allow for overseas training to be credited towards meeting the US board requirements. It is then left to the descretion of specific training programs as to whether they will accept the overseas training. From the information Ive seen the boards that will accept overseas training limit the credit that can be granted to one year.
 
This may be slightly off topic, but I would like to add another perspective to this discussion. I am a canadian currently going to medical school in Canada, however I do have aspirations for obtaining an american residency. Unlike what has been previously suggested, my reasoning for wanting to go south has nothing to do with salary. I am very interested in research and thus would like to enter into a bona fide research residency program (as an aside, in pursuing this type of career, I will likely acquire a salary which is significantly inferior relative to that of a purely clinical physician). These types of programs are only available at massive tertiary care centres - which tend to be largely unique to the U.S. As a result, my preceptors have strongly encouraged me to consider entering the NRMP. Furthermore, because of the superior research infrastructure in the U.S., I would likely elect to try and remain in the U.S. for the rest of my career.

I do not feel that my desire to go to the U.S. is based on greed (it could be argued that I could enjoy a better quality of life in Canada - the converse, of course, could also be argued). My central intention for wanting to immigrate is to pursue a career that I otherwise perhaps could not. Should I be denied that opportunity?

I am a tremendous admirer of the United States and many of its philosophies. It is the sole superpower in the world today, owing in part to its relentless pursuit of perfection (I sound like a lexus commercial :)). Determined to succeed, the U.S. has recruited the most talented individuals (regardless of national origin) and thus has routinely finished on top. Its willingness to recognize and utilize global talent has had a major (positive, I feel) impact on shaping the country we know today.

I definitely do understand and appreciate the arguments of the americans on this topic. You have helped pay for these residency positions and should probably be given preference. But I do experience some disappointment to note that people are not purely selected based on qualifications (in some regards, it seems to violate an american tenet). To demonstrate that I am not hypocritical, I observed a similar situation at my university in Canada. A new faculty member was being hired by a panel of professors, one of which was my honours supervisor. I was discussing the hiring process with him, and was confused to hear him say that they would be unable to hire the top applicant (he very well may have been american). He explained that a strong preference is given to canadian citizens and it can be very difficult to hire foreign applicants. I, personally, felt that the department and the university were being cheated.
 
Your Canadian system, with preference giwen to canadians, Is the kind of system that McGywer wants us to have. If anyone here has ever been to canada and seen the state of healthcare in that country (or enhgland) they will not make such arguments, MacGyver is an ENGINEER with a vendetta against physicians. Go look at his arguments in "robotic surgery".
I feel like no matter what i say, he will retaliate with some stupid statistics about 5% of this, or 30% of that, and tell me how our resources are Dvindling.

BTW, Macgywer, when i spoke of Driwing through the great plains, I meant that there is ENOUGH WHEAT to sustain 10 times out our population, I didnt mean that there is simply enough space. You are deficient in the logoc department, brother...Please stop trying to be a debate expert, and stick to building gadgets for me to use on my patients. THank You.
 
We moved to the US because I am a US citizen...I lived in Germany for 4 years, the UK for 1 and was homesick. We may end up returning to Germany...but we also enjoy our life here. My husband does not put down the US system, nor does he deny his own heritage.

BTW, we are finished with fellowship now and are working in a rural area ....He doesn't have to..because his visa is open-ended..but we chose to for the family life it provides us and our three children.

Kris
 
Funkadesi,

In response to your most recent comments, I do not feel that the canadian health care system is in disarray (nor do I feel that there is a problem in England, having lived there for a while) - most importantly, my statement did not comment on that subject.

My post, like the others in this thread, was merely focused on the willingness of these countries to accept foreign graduates. Essentially, I feel that the United States (and Canada and England, etc.) should select people on the basis of qualifications and be largely oblivious to national origin. Such a process would likely be advantageous for both applicants and countries.

Momofthree, I do not understand how such a philosophy could suggest that I am disparaging my own heritage - where did that come from?
 
If you dont think canada has serious serious problems with its healthcare system, you are ignorant of the situation in your country. My relatives live in toronto. When i go there, and read the paper, every day there are articles about how bad it is getting.

please read this link to see how bad it is there: www.fraserinstitute.ca/media/media_releases/2001/20010125.html

here is a good quote from the article:
Waiting list data, presented annually by The Fraser Institute, and verified against estimates published in peer-reviewed academic medical journals such as the Journal of the American Medical Association and the Ontario Medical Review, indicates that patients are waiting longer than ever — almost four months — between visiting a general practitioner (GP) and receiving treatment.

Averaged across all 12 medical specialties and 10 provinces surveyed, total waiting time rose from 13.3 weeks in 1998 to 14 weeks in 1999, a 5.3 percent increase. Waiting times have increased a dramatic 51 percent since 1993, when the median total wait for Canadian patients to receive treatment was 9.3 weeks.

"How can these authors say there is no crisis?" asks Zelder.

The evidence also shows that Canadians are being deprived of access to vital high-technology medical equipment and procedures. In terms of technology per capita, Canada is clearly not a world leader. The country is generally ranked among the bottom third of countries in the Organisation for Economic Cooperation and Development (OECD) for availability of medical technology.

The report by the Tommy Douglas Institute claims that doctor outflow is not a serious problem, but recent research by Statistics Canada shows that for every one doctor permanently migrating from the U.S. to Canada, there are 18 Canadian doctors who are leaving permanently for the U.S. (and the migration to the US, across all occupations, is grossly disproportionately found among those earning $150,000 or more — the most highly-skilled).

Current data (again from the OECD) shows that Canada has one of the lowest ranks in terms of number of doctors per capita, 23rd out of 29, better only than countries like Mexico, Turkey, and Korea. Further, the OECD data combines general practitioners and specialists, understating Canada's true problem: few specialists per capita.

It is the same in england, and if you want me to pull articles on that too, i will
 
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