Big news! FMG can now receive a medical license and practice independently in TN without completing a US residency.

[Mad Jack]

Excellent points.

To what extent do you think an entity like HCA could circumvent this? They already self insure so they have malpractice covered internally. The new docs will be licensed and should have NPI numbers and be able to bill CMS payors. Getting on the panels with the commerical payors I'm not sure about, though HCA would certainly have leverage in many markets to make this happen. There are many areas where HCA hopsitals are the only option.

The more I think about this, I'll bet HCA and similar entities are planning to use this to bolster their EM and IM workforce for well below market rates. They're basically getting residents who can bill and still have no power to leave and work elsewhere.

Your points are well taken and are likely why we won't see a bunch of FMGs hanging out shingles in East Tennessee anytime soon.

HCA may try it, but truthfully once lawsuits start rolling in I doubt they'll stick to those guns. You would need to implement this at quite a scale to make it worthwhile and that scale creates the excess liability. The other issue is whether medical licensing boards will play along, as these licenses are provided on a may-issue rather than a shall-issue basis, which gives the board full scrutiny of each applicant and the ability to determine whether their particular credentials are sufficient. They could easily determine only, say, European credentials are sufficiently equivalent in their discretionary eyes, which would limit things quite a bit

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[Dr.SPAC3MAN]

List of medical schools in the Caribbean - Wikipedia

en.wikipedia.org

right on but those are still "US"

 

[deleted1095841]

In addition to the risk inherent in the provider, insurers also take into account the risk of litigation (i.e. the propensity of patients to sue).
The worry here is that these FMGs will be insured if they practice in areas with disadvantaged populations, but not be insured in other areas, which would lead to the concentration of FMGs practicing under this law in certain communities. I am not saying that the FMGs are in any way less competent than US-trained physicians, but a system that coerces them to only practice in certain communities seems discriminatory.

 

[operaman]

HCA may try it, but truthfully once lawsuits start rolling in I doubt they'll stick to those guns. You would need to implement this at quite a scale to make it worthwhile and that scale creates the excess liability. The other issue is whether medical licensing boards will play along, as these licenses are provided on a may-issue rather than a shall-issue basis, which gives the board full scrutiny of each applicant and the ability to determine whether their particular credentials are sufficient. They could easily determine only, say, European credentials are sufficiently equivalent in their discretionary eyes, which would limit things quite a bit

HCA has limited their liability quite a bit my helping get tort reform passed in TN. As it is there’s a gatekeeper statue to keep out frivolous suits and a 750k cap on punitive damages. I’ll bet the math works out that HCA can field a huge number of suits very cheaply and still come out way ahead on cost savings and increased revenue alone.

 

[Ho0v-man]

After their couple of years, would they be able to practice anywhere?

 

[Mad Jack]

HCA has limited their liability quite a bit my helping get tort reform passed in TN. As it is there’s a gatekeeper statue to keep out frivolous suits and a 750k cap on punitive damages. I’ll bet the math works out that HCA can field a huge number of suits very cheaply and still come out way ahead on cost savings and increased revenue alone.

Yeah, that could be a possibility then. More reason to never practice in Tennessee, I suppose

 

[Candidate2017]

The Man will just make employed physicians "supervise" IMGs as a condition of employment. US grads with lots of student loans will toe the line. After 2 years or whatever it is for IMGs to get licensure or cert, The Man will hire them to replace the US grad, at lower pay.

I wouldn't be surprised if hospitals are behind the lobbying for this, under the guise of "increased access".

 

[Mad Jack]

The Man will just make employed physicians "supervise" IMGs as a condition of employment. US grads with lots of student loans will toe the line. After 2 years or whatever it is for IMGs to get licensure or cert, The Man will hire them to replace the US grad, at lower pay.

I wouldn't be surprised if hospitals are behind the lobbying for this, under the guise of "increased access".

It is almost certainly hospitals and health insurance companies

 

[Mad Jack]

After their couple of years, would they be able to practice anywhere?

Yes

 

[Mad Jack]

The Man will just make employed physicians "supervise" IMGs as a condition of employment. US grads with lots of student loans will toe the line. After 2 years or whatever it is for IMGs to get licensure or cert, The Man will hire them to replace the US grad, at lower pay.

I wouldn't be surprised if hospitals are behind the lobbying for this, under the guise of "increased access".

The simple way to sidestep this is to have a spine

 

[voxveritatisetlucis]

Every physician should refuse to supervise. Sad thing is that will never happen as it was a surgeon who sponsored the bill. Of course he is retired and already made all his money

 

[deleted1095841]

Of course he is retired and already made all his money

He may be retired, but who said he's done making money?

 

[voxveritatisetlucis]

He may be retired, but who said he's done making money?

True. He’s even worse than retiring practice owners who sell out to private equity firms

Sabi "Doc" Kumar - Wikipedia

en.m.wikipedia.org

 

[Ho0v-man]

Yes

Yikes.

How does this affect board certification though? I may be misunderstanding some stuff so bear with me. But if someone is granted a license, that still doesn’t make them board certified. So that could still be a road block, no? For instance, in rads it’s common for academic attendings to be FMGs who got licensed through the alternative pathway. They can still practice at that institution without board certification, but options are extremely limited elsewhere. Of course this pathway grants board eligibility.

But unless you jump through the hoops to gain board eligibility (like completing a residency), I think these people will still be pretty limited.

 

[voxveritatisetlucis]

Yikes.

How does this affect board certification though? I may be misunderstanding some stuff so bear with me. But if someone is granted a license, that still doesn’t make them board certified. So that could still be a road block, no? For instance, in rads it’s common for academic attendings to be FMGs who got licensed through the alternative pathway. They can still practice at that institution without board certification, but options are extremely limited elsewhere. Of course this pathway grants board eligibility.

But unless you jump through the hoops to gain board eligibility (like completing a residency), I think these people will still be pretty limited.

The boards will eventually just be infiltrated. Look at how the leaders of EM and Rad onc destroyed their specialties out of greed

 

[Osminog]

We don't need more physicians from third-world countries. We need to stop pretending that a "Bachelor of Medicine, Bachelor of Surgery" degree from some unknown rural medical school in Pakistan is equivalent to a US medical doctorate. And we need to stop pretending that post-graduate clinical experience in a country where medicine is dominated by mysticism and folklore, is equivalent to American residency training. Most importantly, we need to recognize that prominent linguistic and cultural differences exist between these FMGs and American graduates, and that these differences can have a massive impact on patient care.

If we really want more doctors in the US, we need to get serious about producing them ourselves. We need to keep opening more US medical schools, and we need to work toward eliminating the idiotic barriers that discourage many talented, bright Americans from pursuing medicine.

Quite frankly, I'd rather receive medical care from an independently practicing NP than from a FMG without a Western medical education who also didn't complete US residency training.

 

[deleted1065184]

We don't need more physicians from third-world countries. We need to stop pretending that a "Bachelor of Medicine, Bachelor of Surgery" degree from some unknown rural medical school in Pakistan is equivalent to a US medical doctorate. And we need to stop pretending that post-graduate clinical experience in a country where medicine is dominated by mysticism and folklore, is equivalent to American residency training. Most importantly, we need to recognize that prominent linguistic and cultural differences exist between these FMGs and American graduates, and that these differences can have a massive impact on patient care.

If we really want more doctors in the US, we need to get serious about producing them ourselves. We need to keep opening more US medical schools, and we need to work toward eliminating the idiotic barriers that discourage many talented, bright Americans from pursuing medicine.

Quite frankly, I'd rather receive medical care from an independently practicing NP than from a FMG without a Western medical education who also didn't complete US residency training.

This is an absolutely ridiculous and, quite frankly, xenophobic thing to say. I refuse to believe you know enough about medical education in all of these countries to have an understanding of how medicine is practiced.

And it's incredibly ignorant to assume that these countries are a monolith in this regard. Many of the most competent and talented physicians I know completed their medical degree and residency abroad, and with a little adjustment to the US healthcare infrastructure, would have been able to practice fine without needing another residency. You're free to get your care from an NP with no medical training and an unregulated masters degree that may have been entirely online, but as somebody who actually grew up in the rural South being seen only by an NP, I'll take the doc with foreign medical training any day.

And you seriously need to check your biases and assumptions that medicine practiced in the West is inherently superior, especially considering much of our current medical knowledge is the result of Indigenous knowledge (e.g. vaccines having evolved from variolatiom, which was introduced to the US by Onesimus, and enslaved African whose ancestors had practiced it for ages; or the discovery of artemisinin, a Nobel Prize-winning anti-malarial drug that was discovered by researchers going through ancient Chinese texts). Please educate yourself on this.

 

[operaman]

We don't need more physicians from third-world countries. We need to stop pretending that a "Bachelor of Medicine, Bachelor of Surgery" degree from some unknown rural medical school in Pakistan is equivalent to a US medical doctorate. And we need to stop pretending that post-graduate clinical experience in a country where medicine is dominated by mysticism and folklore, is equivalent to American residency training. Most importantly, we need to recognize that prominent linguistic and cultural differences exist between these FMGs and American graduates, and that these differences can have a massive impact on patient care.

If we really want more doctors in the US, we need to get serious about producing them ourselves. We need to keep opening more US medical schools, and we need to work toward eliminating the idiotic barriers that discourage many talented, bright Americans from pursuing medicine.

Quite frankly, I'd rather receive medical care from an independently practicing NP than from a FMG without a Western medical education who also didn't complete US residency training.

I think you’re underestimating the quality of education and training at many places abroad. Sure, there are some really terrible ones around, but there are also places churning out truly excellent physicians.

I’ve been fortunate to work with a number of international docs in my own field and I can assure you they are excellent. Some of the biggest field changing research and new operations in my field came from Kyoto Japan. Another of the most prominent surgeons developing new techniques that advance the field is at North Thames in London. I tried to do fellowship with him but got stuck in all the red tape of British licensing. One of the most brilliant ear surgeons I know trained a AUB in Beirut, a school with a long history of turning out superb physicians. I’d let any of these surgeons operate on me or my family.

Much of the world doesn’t have the standardization that American med schools have so quality can vary widely. But there are many great foreign medical schools catering to the best and brightest in those countries. Thankfully it’s pretty easy for anyone in the know to distinguish the good from the bad.

Sadly I don’t think this program will be used to its greatest potential. In my fantasy I’d like to see the big TN academic centers use this to recruit some of the best physicians and surgeons in the world. Sadly it will probably be used by HCA to cut costs staffing their community hospitals with canon fodder docs who have no leverage.

 

[DO2015CA]

The rest of the world has similar systems to recognize foreign educated physicians and allow them to intregrate.

If somebody:

• Graduated from an accredited university
• Passed the same medical license examination like anybody else in the US
• Holds a legal permit to live in the country
• Has completed a medical residency deemed equivalent by the respective american board

Then that person has the same competency to practice as their american counterparts

I think many people don't even know how rigorous the Accreditation Policy of the ECFMG is. It took my university 4 years to achieve the recognition of the WFME after the ECFMG announced such policy change. They even take into consideration things like how wheelchair accessible the campus is.

Many people in the US disregard the rest of the world's education as sub-par and think that the US healthcare system is the best in the world. When important figures such as accesibility and mortality rates say otherwise. Sure, salaries are ridiculously better than in any other country, but that's a symptom of systemic problems, a whole can of worms that I don't want to open right now.

Some people comparing international graduates that have completed 6 years of medical school + 5 (in many cases) years of residency and have years of experience, to mid-levels in the US. You need a psych consult, STAT.

And we shouldn’t be pushing midlevels either. Our (the 2 institutions I did residency and now fellowship at) biggest hurdle for FMGs (especially those already practicing in another country) is adjusting to the American medical system. Many countries practice quite differently and having a US residency gives them standardized expectations. Maybe less residency time based on years of experience could be an option but none is less than ideal.

 

[Just D.O. it]

We need to stop pretending that a "Bachelor of Medicine, Bachelor of Surgery" degree from some unknown rural medical school in Pakistan is equivalent to a US medical doctorate.

Given how well some of the FMGs from those schools manage to perform as residents here, the evidence begs to differ with you. It may be a hard pill to swallow, but its not like other countries have an open admissions policy for their med schools. They also filter and train their candidates.

Many of the top students from these schools are about equivalent to a US MD/DO if they prepped and did will on their USMLEs and got a few months of US clinical experience. In fact you'd probably be surprised how much of the US physician workforce is actually from foreign med schools.

And we need to stop pretending that post-graduate clinical experience in a country where medicine is dominated by mysticism and folklore, is equivalent to American residency training.

While I agree that post-grad training in Pakistan is riddled with things like nepotism and poor oversight. I guarantee you they aren't practicing any mysticism or folklore in their hospitals or in the offices of medical doctors.

Certainly mystics and folk healers hang their shingles (again they are distinct entities from medical doctors with the MBBS).

Also you're talking as if America doesn't have voodoo healers and naturopaths, so I'm failing to understand what your point is exactly.

Quite frankly, I'd rather receive medical care from an independently practicing NP than from a FMG without a Western medical education who also didn't complete US residency training.

That's your right and you should have that option.

Me personally, I would think a foreign physician with 500 US "shadowing" hours is probably more competent than an RN with a 1 year degree and those same shadowing hours.

All this being said, I disagree with the Tennessee legislature, and I don't think we should be giving unrestricted medical licenses to foreign docs without a US residency.

 

[Candidate2017]

The simple way to sidestep this is to have a spine

But most doctors don't have a spine, as evidenced by our inability to stop non-physicians from practicing medicine, as well as the trend towards 90%+ of physicians choosing to be employees rather than independent physicians.

 

[Mad Jack]

But most doctors don't have a spine, as evidenced by our inability to stop non-physicians from practicing medicine, as well as the trend towards 90%+ of physicians choosing to be employees rather than independent physicians.

Be the change you want to see in the world

 

[ChordaEpiphany]

We don't need more physicians from third-world countries. We need to stop pretending that a "Bachelor of Medicine, Bachelor of Surgery" degree from some unknown rural medical school in Pakistan is equivalent to a US medical doctorate. And we need to stop pretending that post-graduate clinical experience in a country where medicine is dominated by mysticism and folklore, is equivalent to American residency training. Most importantly, we need to recognize that prominent linguistic and cultural differences exist between these FMGs and American graduates, and that these differences can have a massive impact on patient care.

If we really want more doctors in the US, we need to get serious about producing them ourselves. We need to keep opening more US medical schools, and we need to work toward eliminating the idiotic barriers that discourage many talented, bright Americans from pursuing medicine.

Quite frankly, I'd rather receive medical care from an independently practicing NP than from a FMG without a Western medical education who also didn't complete US residency training.

People need to understand that these bills aren't coming out of a place of "need" for more physicians. They are coming from a place of greed from entities who think they can cut your leverage and pay your less. The expansion of independent NP practice rights and push for FMGs to practice without a US residency will happen regardless of how many MDs and DOs we train on American soil and regardless of how many residency spots we open up.

Saying, "okay, okay we'll train more physicians here" would be a very foolish move. The people in charge of these movements would say, "Cool thanks, make sure you read through the new legislation we just submitted further expanding NP and FMG practice rights." The answer is stronger lobbying and unity throughout the profession.

Given how well some of the FMGs from those schools manage to perform as residents here, the evidence begs to differ with you. It may be a hard pill to swallow, but its not like other countries have an open admissions policy for their med schools. They also filter and train their candidates.

Many of the top students from these schools are about equivalent to a US MD/DO if they prepped and did will on their USMLEs and got a few months of US clinical experience. In fact you'd probably be surprised how much of the US physician workforce is actually from foreign med schools.


While I agree that post-grad training in Pakistan is riddled with things like nepotism and poor oversight. I guarantee you they aren't practicing any mysticism or folklore in their hospitals or in the offices of medical doctors.

Certainly mystics and folk healers hang their shingles (again they are distinct entities from medical doctors with the MBBS).

Also you're talking as if America doesn't have voodoo healers and naturopaths, so I'm failing to understand what your point is exactly.



That's your right and you should have that option.

Me personally, I would think a foreign physician with 500 US "shadowing" hours is probably more competent than an RN with a 1 year degree and those same shadowing hours.

All this being said, I disagree with the Tennessee legislature, and I don't think we should be giving unrestricted medical licenses to foreign docs without a US residency.

Just keep in mind that the FMGs you work with here are carefully selected. They are the best of the best from their countries, and they come from universities the residency programs know they can trust. That's why you'll see residents from University of Athens and the American University of Beirut and other known entities at top hospitals like Hopkins or MGH most years. Currently, the FMGs even at community programs are some of the top students in their home schools. This legislation opens the door to anyone an HCA hospital wants to hire, and HCA has no incentive to filter for the highest quality. They are literally incentivized to over hire just to flood the market and reap future benefits of lower salaries for employed physicians.

 

[voxveritatisetlucis]

Looks like there are already a bunch of job postings with “visa friendly” in the title

Visa Academic Gastroenterology with University of Tn - No call - Tennessee job with Jackson Physician Search | 658526

Join a Nationally and Locally Recognized Academic Health System in Tennessee • Guaranteed salary with teaching opportunities. VISA Candidates very ...

www.nejmcareercenter.org

Wonder if they might actually try to recruit for high paying specialties like GI given that there is a visa cap and it would make the most sense to depress these salaries

 

[Splenda88]

Looks like there are already a bunch of job postings with “visa friendly” in the title

Visa Academic Gastroenterology with University of Tn - No call - Tennessee job with Jackson Physician Search | 658526

Join a Nationally and Locally Recognized Academic Health System in Tennessee • Guaranteed salary with teaching opportunities. VISA Candidates very ...

www.nejmcareercenter.org

Wonder if they might actually try to recruit for high paying specialties like GI given that there is a visa cap and it would make the most sense to depress these salaries

I guess these GI docs make too much money. Imaging getting 5k/day locum rate.

There was one a few months ago at my shop who was contracted to work 2 wks straight and he told me would make more in the 2 wks than what he made for a whole in yr as a fellow.

 

[deleted1139416]

I guess this GI docs make too much money. Imaging getting 5k/day locum rate.

There was one a few months ago at my shop who was contracted to work 2 wks straight and he told me would make more in the 2 wks than what he make for a whole in yr as a fellow.

In about 2 years we are gonna start getting “OMG AI can interpret capsule scopes!” posts.

 

[voxveritatisetlucis]

I guess this GI docs make too much money. Imaging getting 5k/day locum rate.

There was one a few months ago at my shop who was contracted to work 2 wks straight and he told me would make more in the 2 wks than what he make for a whole in yr as a fellow.

True the delta between what American surgeons/sub-specialists make and what they make in other countries is much higher than the difference in primary care or hospitality medicine

 

[NotAProgDirector]

Looks like there are already a bunch of job postings with “visa friendly” in the title

Visa Academic Gastroenterology with University of Tn - No call - Tennessee job with Jackson Physician Search | 658526

Join a Nationally and Locally Recognized Academic Health System in Tennessee • Guaranteed salary with teaching opportunities. VISA Candidates very ...

www.nejmcareercenter.org

Wonder if they might actually try to recruit for high paying specialties like GI given that there is a visa cap and it would make the most sense to depress these salaries

There is nothing in that job posting that suggests they want people who have not completed US residency. It specifically calls out a J visa, which would mean someone who completed all US training. I don't think this is evidence of anything.

 

[voxveritatisetlucis]

Looks like the ama is all for it

Advocacy in action: Clearing IMGs’ route to practice

International medical graduates (IMGs) play a critical role in U.S. health care. Learn how the AMA works to help IMGs meet the nation’s health needs.

www.ama-assn.org

 

[ace_inhibitor111]

Everyone here is assuming that FMGs will somehow replace NPs. You’re forgetting NPs are still cheaper and still legally allowed to provide care and prescribe medications. NPs aren’t going to be replaced by foreign docs, they will just both be competitors to the domestic physician market.

 

[voxveritatisetlucis]

Everyone here is assuming that FMGs will somehow replace NPs. You’re forgetting NPs are still cheaper and still legally allowed to provide care and prescribe medications. NPs aren’t going to be replaced by foreign docs, they will just both be competitors to the domestic physician market.

They will be cheaper then NPs though. Many foreign doctors would gladly accept 80k if it meant getting to live here

 

[deleted1065184]

I could see an FMG being paid that amount for the 2 years they're being supervised, but I find it highly unlikely they'll be paid significantly less than considering how much or a demand there is for physicians.

Especially in the rural areas of Tennessee. We'll see what happens, but I personally believe this will be extremely helpful in getting rural Tennesseeans access to an actual physician...one that has already completed residency, at that.

I'd love to know how many of y'all who are concerned about this are actually from the rural South. Because I am, and I grew up seeing an NP because there simply weren't any available physicians nearby. The physician who supposedly was supervising the NPs at the clinic I went to was NEVER there. I would've HAPPILY seen an actual physician.

There's no reason to believe they will be less qualified than a physician who trained here. The US has exceptional resources, but our clinical training is not in any way exceptional compared to most other countries. The state of Tennessee does have some leverage considering the physicians will only be able to practice in Tennessee (for the time being), but they physicians also have leverage because rural Tennessee is DESPARATE for physicians.

We'll see what happens.

 

[Splenda88]

There's no reason to believe they will be less qualified than a physician who trained here. The US has exceptional resources, but our clinical training is not in any way exceptional compared to most other countries. The state of Tennessee does have some leverage considering the physicians will only be able to practice in Tennessee (for the time being), but they physicians also have leverage because rural Tennessee is DESPARATE for physicians.

We'll see what happens.

I am not sure what make you say that. As an average internist, I think our clinical training is very good. I guess you probably say that because we order too many tests. We do that because we are afraid the these damn lawyers/patients that are looking for easy $$$, not because we don't know what's going on. This is based on my limited 5 years (residency + attending) practicing medicine.

 

[deleted1065184]

I am not sure what make you say that. As an average internist, I think our clinical training is very good. I guess you probably say that because we order too many tests. We do that because we are afraid the these damn lawyers/patients that are looking for easy $$$, not because we don't know going on. This is based on my limited 5 years (residency + attending) practicing medicine.

I didn't say our clinical training isn't good, just that it's not exceptional compared to medical training in other countries. I.e. their training is often just as good.

 

[voxveritatisetlucis]

I didn't say our clinical training isn't good, just that it's not exceptional compared to medical training in other countries. I.e. their training is often just as good.

Think it depends on the country. And the way the laws are written, the board can be very liberal in regards to the training they consider equivalent.

Also if it’s really about access, why are they trying to pass similar bills in states like Massachusetts?

 

[NotAProgDirector]

I think this is a very complicated problem. I am sure that some internationally trained physicians are very good and could practice in this country with just a bit of oversight to get started. But we have also seen residents in our program that have international training prior. One of them actually finished a fellowship in the US first, and then wanted to do a residency program. All of them have had great difficulty requiring remediation. I realize my n is small so there's no way to generalize. But there's no real way to know if someone's training is OK or not, and I doubt that the oversight mentioned in this bill will really be intensive enough to know.

 

[deleted1065184]

Think it depends on the country. And the way the laws are written, the board can be very liberal in regards to the training they consider equivalent.

Also if it’s really about access, why are they trying to pass similar bills in states like Massachusetts?

Probably does depend on country, but would hope only people with degrees recognized as MD or MD-equivalent such as MBBS + residency would be allowed to practice.

Regarding Massachusetts, can't say whey they're trying to pass the bill. But I do think it's inappropriate to conflate Tennessee's reasoning with Massachusetts' reasoning. It's totally possible that Tennessee wants access, but Massachusetts doesn't. It's also possible that neither cares about access.

But whether Tennessee cares about access or not, it remains a fact that there are numerous regions in Tennessee where physicians are choosing not to practice, and the bulk of care is facilitated by NPs. Foreign-trained physicians who also completed residency will undoubtedly provide better care for those people.

The job opportunities for physicians are there, and the pay is very good. It's just that most physicians don't want to live in those areas. Somebody needs to be providing medical care in the rural South, and I'd rather it not be led by NPs.

 

[deleted1065184]

I think this is a very complicated problem. I am sure that some internationally trained physicians are very good and could practice in this country with just a bit of oversight to get started. But we have also seen residents in our program that have international training prior. One of them actually finished a fellowship in the US first, and then wanted to do a residency program. All of them have had great difficulty requiring remediation. I realize my n is small so there's no way to generalize. But there's no real way to know if someone's training is OK or not, and I doubt that the oversight mentioned in this bill will really be intensive enough to know.

Anecdotally, my spouse went to residency with several IMGs and they performed well. Did not require remediation at any different rate than US-trained MD/DO residents.

More importantly, I do think it's inappropriate to compare IMG residents with IMGs who have already completed residency abroad. There's no way to know for sure, but I seriously doubt a physician who completed residency abroad needs the same amount of supervised training as a newly-graduated US MD/DO student.

Furthermore, the supervised training period is 2 years, just one year fewer than many FM/IM/EM residency programs. Do you truly believe that internationally-trained physicians who have already completed residency need more than 2 years of supervised practice when newly-graduated US MD/DOs only need 3 years?

 

[ace_inhibitor111]

They will be cheaper then NPs though. Many foreign doctors would gladly accept 80k if it meant getting to live here

Okay great, that’s even worse for US docs.

 

[deleted1139416]

Regarding Massachusetts, can't say whey they're trying to pass the bill. But I do think it's inappropriate to conflate Tennessee's reasoning with Massachusetts' reasoning. It's totally possible that Tennessee wants access, but Massachusetts doesn't. It's also possible that neither cares about access.

Last I checked, Massachusetts was literally the only state with a physician surplus

 

[deleted1065184]

Last I checked, Massachusetts was literally the only state with a physician surplus

Which supports my point that we can't compare the motives of Tennessee vs Massachusetts. Very different states.

 

[NotAProgDirector]

Anecdotally, my spouse went to residency with several IMGs and they performed well. Did not require remediation at any different rate than US-trained MD/DO residents.

More importantly, I do think it's inappropriate to compare IMG residents with IMGs who have already completed residency abroad. There's no way to know for sure, but I seriously doubt a physician who completed residency abroad needs the same amount of supervised training as a newly-graduated US MD/DO student.

Furthermore, the supervised training period is 2 years, just one year fewer than many FM/IM/EM residency programs. Do you truly believe that internationally-trained physicians who have already completed residency need more than 2 years of supervised practice when newly-graduated US MD/DOs only need 3 years?

My apologies if I wasn't clear (and I see that may be the case).

We have had plenty of IMG's in our program over the years, the vast majority are relatively fresh out of school. And they have done absolutely fine. Rates of troubles or issues have been equivalent to everyone else. The people who have struggled are those who already had training of one type or another. It's possible that we just expected more from them at the start (since they already completed a full residency elsewhere), but often we ended up having to have them "unlearn" their style / skills they had picked up earlier. The biggest issues have been being too superficial, and not exploring social aspects of medicine. And having little insight into these problems -- "I was fine when I did my prior training"

 

[voxveritatisetlucis]

Facing a shortage of doctors and nurses, Mass. should open door wider for foreign-trained providers - The Boston Globe

Changing the medical residency requirement would help immigrants use their skills.

www.bostonglobe.com

 

[Maskchamp]

Don’t residents work like 30 hours per week in Europe. In what world is that equivalent to US training

In this world.

We definitely work more than 30, usually 45 on an easy week, and sometimes 60. Just because the work hours are lower, that doesn’t mean it’s not equivalent to US training. Keep in mind that we are free to do a bunch of exchanges or fellowships in other countries that count towards our residency, so we get a far greater spectrum of experience all around the world. We can go to North America for a year, or other places in Europe like France, or any Nordic country.

Also most of us speak at least 2 languages completely fluently, so our communications with patients tend to be better, generally speaking. And mentally I feel we are definitely less burnt out which helps keep us on a good level, much less lawsuits and simpler health system where people don’t get bankrupt by medical bills. But that’s more for the US doctors to answer.

I’m by no means saying we are better, but thinking we are not equivalent is wrong. Also there are 44 countries in Europe, so generalizing about not being equivalent is definitely incorrect.

 

[membername213]

I don't know if you guys read the fine print of this Tennessee law. Everyone has to obtain a Permanent ECFMG certification=the only way to get this is finish 1st year of ACGME residency.
Yes, international medical graduates do NOT have to finish US residency, but they have to start ACGME US residency.
This law is perfect for those who finished 1st year of ACGME residency and somehow resigned/fired and decided to do another 2 years of internship. But think about it, who on this planet is going to finish 1 year of ACGM residency and decided to do this 2 year internship for no reason? Unless you got fired/resigned. Or I guess for those super long residencies like neurosurgery, finished ACGME Neurosurgery 1 year residency and resign and start 2 years of internship and work in Neurosurgery.

 

[Vyzzle]

I don't know if you guys read the fine print of this Tennessee law. Everyone has to obtain a Permanent ECFMG certification=the only way to get this is finish 1st year of ACGME residency.
Yes, international medical graduates do NOT have to finish US residency, but they have to start ACGME US residency.
This law is perfect for those who finished 1st year of ACGME residency and somehow resigned/fired and decided to do another 2 years of internship. But think about it, who on this planet is going to finish 1 year of ACGM residency and decided to do this 2 year internship for no reason? Unless you got fired/resigned. Or I guess for those super long residencies like neurosurgery, finished ACGME Neurosurgery 1 year residency and resign and start 2 years of internship and work in Neurosurgery.

People who match prelim but not advanced positions, which is very common for IMGs

 

[voxveritatisetlucis]

I don't know if you guys read the fine print of this Tennessee law. Everyone has to obtain a Permanent ECFMG certification=the only way to get this is finish 1st year of ACGME residency.
Yes, international medical graduates do NOT have to finish US residency, but they have to start ACGME US residency.
This law is perfect for those who finished 1st year of ACGME residency and somehow resigned/fired and decided to do another 2 years of internship. But think about it, who on this planet is going to finish 1 year of ACGM residency and decided to do this 2 year internship for no reason? Unless you got fired/resigned. Or I guess for those super long residencies like neurosurgery, finished ACGME Neurosurgery 1 year residency and resign and start 2 years of internship and work in Neurosurgery.

I thought that ecfmg was required for residency not license

 

[EMhawkeye]

I don't know if you guys read the fine print of this Tennessee law. Everyone has to obtain a Permanent ECFMG certification=the only way to get this is finish 1st year of ACGME residency.
Yes, international medical graduates do NOT have to finish US residency, but they have to start ACGME US residency.
This law is perfect for those who finished 1st year of ACGME residency and somehow resigned/fired and decided to do another 2 years of internship. But think about it, who on this planet is going to finish 1 year of ACGM residency and decided to do this 2 year internship for no reason? Unless you got fired/resigned. Or I guess for those super long residencies like neurosurgery, finished ACGME Neurosurgery 1 year residency and resign and start 2 years of internship and work in Neurosurgery.

Wrong. You don’t need to complete ecfmg certification only complete the steps. All residency applicants have ecfmg certification before they start residency. Without it, you can’t even get a resident medical license.

 

[voxveritatisetlucis]

Wrong. You don’t need to complete ecfmg certification only complete the steps. All residency applicants have ecfmg certification before they start residency. Without it, you can’t even get a resident medical license.

But is there a distinction between permanent and temporary certification? The bill says permanent ecfmg is needed

 

[EMhawkeye]

Yes ecfmg certification is required for this. However you need no residency training to get ecfmg certified. All they require is graduation from am accredited international school and transcripts verifying all usmle steps have been passed. I became ecfmg certified 2 weeks after I graduated. Months before I ever started residency.