Doctors on H-1B visas are dangerous

[Standish-holmes]

visit: http://new.petitiononline.com/Standish/petition.html

To all US citizens, permanent residents and GC holders

DOL (Department of Labor) has clear regulations that US citizens and permanent residents are to be considered for vacant positions before such vacancies are offered to applicants from abroad.

In most fields, obtaining an H1B visa is a very difficult process and stringent conditions apply before an H1B petition is approved. In medicine it is just the opposite.

Administrators of hospital residency programs, in contravention of DOL rules and regulations, are routinely offering vacant positions to foreign medical graduates (FMGs) not living in the US without first attempting to fill such vacancies with qualified candidates residing within US borders.

Hospital residency positions, including internships, are filled through a centralized electronic application system. Anyone, anywhere in the world with internet access can use this system to apply for hospital residency positions. This allows applicants from abroad to apply at the same time as US citizens and permanent residents.
Since the number of applicants from abroad far outnumber US citizens and permanent residents applying for each vacancy, qualified US citizens and permanent residents are frequently never interviewed for some positions which ultimately are given to non-resident foreign applicants who are then supplied with H1B visas enabling them to work as physicians in the US.

Hospitals are therefore determining who receive visas. Screening of these H1B recipients is minimal at best as hospitals are virtually unfettered in sponsoring H1B visas for candidates they hire from abroad.

Hospitals receive federal, city and state funds from tax dollars, yet citizens and permanent residents residing in the US who contribute these tax dollars are being outnumbered and ignored.

There are currently thousands of unemployed, qualified graduates of foreign medical schools; both US citizens and permanent residents; residing in the US capable of filling these vacancies.

Only after all US citizens and permanent residents who apply are found not suitable, should programs be free to hire non-resident applicants. To interview and subsequently employ non-resident applicants without first interviewing US citizens and permanent resident applicants in order to ascertain their suitability, is utter disregard for US labor laws.

This practice is dangerous in that doctors provided with H1B visas in this manner are not screened as thoroughly as other prospective immigrants are. This practice must be stopped outright.

Please sign this petition and help safeguard the health and safety of our communities.
I ask your help to ensure that:
1.Current laws are respected and enforced.
2.Applicants are appropriately screened before being provided with H1B visas.
3.Regulations stipulating that vacant positions be offered to qualified US citizens and permanent residents before attempting to fill such vacancies with applicants from abroad are complied with.

There are already thousands of qualified, unemployed foreign medical graduates residing in the USA capable of filling these vacancies. Why take this unnecessary risk?

Please sign and forward copies of this petition to your Congressmen, Senators, City and State representatives, newspapers, radio stations and civic organizations in your state.

visit: http://new.petitiononline.com/Standish/petition.html
and sign the petition.

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Members don't see this ad.

 

[EctopicFetus]

ok.. someone with a cause..

 

[APACHE3]

...or someone who didn't get an interview!

 

[FACS]

visit: In most fields, obtaining an H1...All that's needed is an employers letter. ;)

 

[robotsonic]

Although I really think this thread should be closed, I will add a few comments.

Standish-holmes, a lot of the things you say are incorrect. You try to make it seem like foreign medical graduates have an advantage over American graduates. They do not! It is very difficult for them to get residency spots, because programs prefer American grads, even if they are less qualified. The foreign doctors often have to apply to 70 or more programs just to ensure that they get a few interviews, usually at less desirable programs. Most of them end up at crappy programs in crappy locations that American grads don't want.

I was talking with a very good friend of mine the other day. He happens to be an Indian grad - he went to AIIMS for medical school, which is one of the most elite medical schools in the world, and the guy is brilliant. He is currently a third year resident (even though he already completed residency in India) and he has been involved in the residency applications. He said that his program, which is in no way desirable, tries to get as many American grads as possible, but many don't apply. When they do their rank list, the American grads always get ranked at the top, regardless of credentials. The foreigners are put on the list after that. They always put the Americans first on the list. You act as if these programs are screwing over Americans, but as you can see, they are not. If an American ranks one of these programs high enough, he/she will likely go there. Unfortunately, these tend to be programs that people are not fighting over, so they end up with foreigners. Americans are not losing interviews to foreigners.

Take your racist crap somewhere else.

 

[PatrickBateman]

Standish-holmes, a lot of the things you say are incorrect. You try to make it seem like foreign medical graduates have an advantage over American graduates. They do not! It is very difficult for them to get residency spots, because programs prefer American grads, even if they are less qualified. The foreign doctors often have to apply to 70 or more programs just to ensure that they get a few interviews, usually at less desirable programs. Most of them end up at crappy programs in crappy locations that American grads don't want.

This would be good if it were true.

I was talking with a very good friend of mine the other day. He happens to be an Indian grad - he went to AIIMS for medical school, which is one of the most elite medical schools in the world, and the guy is brilliant.

Elite?? How so? Do you have to be Brahman to get in? Really, this guy you know may well be gifted, and the school he went to may well be something special within India. But really, India is not a leader in the modern world - in anything.

He is currently a third year resident (even though he already completed residency in India) and he has been involved in the residency applications. He said that his program, which is in no way desirable, tries to get as many American grads as possible, but many don't apply. When they do their rank list, the American grads always get ranked at the top, regardless of credentials. The foreigners are put on the list after that. They always put the Americans first on the list. You act as if these programs are screwing over Americans, but as you can see, they are not. If an American ranks one of these programs high enough, he/she will likely go there.

This would be good if it were true.

Unfortunately, these tend to be programs that people are not fighting over, so they end up with foreigners. Americans are not losing interviews to foreigners.

I really don't know if this is true. Remember, not all "foreigners" are from India. Many are from advanced countries like Germany and France. I've seen a few of these guys at top programs.

 

[robotsonic]

Elite?? How so? Do you have to be Brahman to get in? Really, this guy you know may well be gifted, and the school he went to may well be something special within India. But really, India is not a leader in the modern world - in anything. Have some humility.

Ugh, no you don't have to be a brahman. It is based on scores - you have to have very high scores to get into AIIMS - and there are only 50 spots a year. And if you think Indian kids don't get a good education, think again. Although half of the population can't read, the half that does get an education gets a very good one. I wish my elementary through high school education had been half as good as some of the Indians I know. And what is this about humility? I'm not Indian; I'm a white American of European ancestry. Anyway, the fact that he went to AIIMS isn't really relevant, I was just pointing out that he was definitely qualified.

I really don't know if this is true. Remember, not all "foreigners" are from India. Many are from advanced countries like Germany and France. I've seen a few of these guys at top programs.

Many of the foreigners getting accepted have green cards or permanent residency; they are not on H1 visas. Foreigners who need H1's have difficulty finding residencies in the U.S.

The things I said are true. I wish people didn't have to blame others when they can't get the residency spot that they want.

 

[GoofyDoc]

Ugh, no you don't have to be a brahman. It is based on scores - you have to have very high scores to get into AIIMS - and there are only 50 spots a year. And if you think Indian kids don't get a good education, think again. Although half of the population can't read, the half that does get an education gets a very good one. I wish my elementary through high school education had been half as good as some of the Indians I know. And what is this about humility? I'm not Indian; I'm a white American of European ancestry. Anyway, the fact that he went to AIIMS isn't really relevant, I was just pointing out that he was definitely qualified.

I think it's racist for people to imply that doctors coming from third world countries are stupid. Many of them are absolutely brilliant and I feel quite small compared to them. (not you, Robotsonic - I'm adding to your comment)

However, I think some programs favor foreigners over US citizens and permanent residents. While doing my third year clerkships, I rotated through certain unnamed hospitals where the IM residency program consisted almost entirely of people from certain foreign countires, and I don't mean similar ethnic backgrounds, I mean citizens of certain countries. Makes me wonder.

 

[Orange Julius]

However, I think some programs favor foreigners over US citizens and permanent residents. While doing my third year clerkships, I rotated through certain unnamed hospitals where the IM residency program consisted almost entirely of people from certain foreign countires, and I don't mean similar ethnic backgrounds, I mean citizens of certain countries. Makes me wonder.

I've seen that too, in a few different places. Interestingly, I've heard rumors that those programs tend to regularly circumvent the regultions. Perhaps it's easier to get away with that if your employees aren't exactly free to up and leave.

 

[EctopicFetus]

I think we all rotated through places with FMGs the thing is they would be desireable in many ways. Most have been attendings elsewhere and therefore require less supervision, of course this can be a double edged sword cause many of them do things differently.

The biggest difference is cultural IMO, not all FMGs but many of them just dont understand our social interactions and they sometimes do things that we would copnsider rude. Of course this happens with USMGs but it is more common among FMGs IMO..

I believe 50% of IM docs are foreign.. truth is US docs often dont want to enter these fields.

The above is just my opinion. I am not trying to offend anyone!

 

[robotsonic]

I think it's racist for people to imply that doctors coming from third world countries are stupid. Many of them are absolutely brilliant and I feel quite small compared to them. (not you, Robotsonic - I'm adding to your comment)

Definitely. I think I was most offended by the title of the thread, saying that foreign doctors are "dangerous". Although in the post he says that they are possibly dangerous because their background isn't checked as thoroughly (is this true?) and I guess they might be terrorists( ), but the title seems to imply that they are dangerous to patients.

However, I think some programs favor foreigners over US citizens and permanent residents. While doing my third year clerkships, I rotated through certain unnamed hospitals where the IM residency program consisted almost entirely of people from certain foreign countires, and I don't mean similar ethnic backgrounds, I mean citizens of certain countries. Makes me wonder.

This is strange. I've actually never seen that, but I guess it is possible. From talking with my foreign doctor friends, though, it seems that the majority of residency programs would MUCH rather have Americans or Green Card holders than give out H1s.

 

[PatrickBateman]

I think it's racist for people to imply that doctors coming from third world countries are stupid. Many of them are absolutely brilliant and I feel quite small compared to them. (not you, Robotsonic - I'm adding to your comment)

No one's implying that third world doctors are stupid. The point is that training in a third world country isn't likely to aquaint you the knowledge of how to function in a first world hospital. Added to that, the significant culture gap between the first and third worlds can often be problematic. A first world candidate is generally just more suitable.

There's no point in taking offence to that. It's got nothing to do with intelligence.

 

[Orange Julius]

Definitely. I think I was most offended by the title of the thread, saying that foreign doctors are "dangerous".

Well if, because of their visa status, they essentially can't object to being pressured to ignore regulations, then that could definately be dangerous. The current work hour cap was brought about for patient safety reasons, after all.

 

[GoofyDoc]

The point is that training in a third world country isn't likely to aquaint you the knowledge of how to function in a first world hospital.

True, but do programs hire foreign doctors without any US clinical experience?

 

[PatrickBateman]

True, but do programs hire foreign doctors without any US clinical experience?

Yes, but for the most part, only for prelim positions. If they survive, they may be given a contract extension. The trial period and the "US clinical experience" are one and the same.

 

[raph91]

I think that most Americans (and I've lived here for 25 years and came here from Europe) aren't really qualified to make comments on anybody from anywhere else, so for those of you who are making comments about people from India, for example, I would probably shut up because it proves your own ignorance (as an example IIT in India is considered by many, including people at MIT and Caltech to be the best technology institute in the world). (this is a comment directly to Bateman who seems pretty stupid).

For one, IMG's definitely do have a harder time. And if you're talking about these certain schools that only take people from the same country, I would really want to know which places these are and the competition amongst American grads to obtain seats here because I have NEVER heard of such places and, if they honestly exist, then I would agree that there's something fishy. But these are often places that, if they didn't get these FMG's they wouldn't have ANY residents. Unless you prefer that? Or would you rather have the guy from your class who took 9 years to finish medical school, failed Step 1 twice, failed Step 2 once, and barely got through be the one getting the much needed seat filled in that program.

The fact is that the US would prefer to only have American grads. This is why there is also higher compensation to hospitals per each American resident than per each foreign resident. This is ALSO why if you go to places like MGH or Mayo (which I hope you won't say are bad programs), you WILL find foreign medical grads. They have so much money and are so well established, they don't really CARE about the government compensation per resident.

Furthermore, some of the absolute TOP physicians in this country and the world are foreign medical graduates. One example is Valentin Fuster, a graduate from Barcelona, did residency at Mayo, former president of AHA and president-elect of the World Heart Federation and an entire laundry list of other honors and achievements.

Many of these foreign medical grads come into this country having practiced in varying capacities in other countries. They come here for various reasons, mostly because of the great academic opportunities in medicine offered in the US, but not always. As another example, I know of one individual who ended up as a cardio fellow at Henry Ford in Michigan. Well, he is extraordinarily well-known throughout the world for work in his particular area of cardiology, but came to this country for his wife who lives here. This is the type of guy who belongs in training at any institution in the country, and the US would be an idiot for not taking him.

The fact is that foreign medical grads take the same exams as us, often score better than us, and yet have a FAR harder time getting into the same residencies as us. You can be an American medical grad with barely passing grades and have failed Step 1 once and barely passed the second time and still be considered by relatively good pediatric residencies, for example. You can be a foreign medical grad with average Step scores and be put at the bottom of the pile or outright rejected.

It isn't like somebody can walk into this country, announce "I WANT A RESIDENCY" and be assured one. They also have to take the appropriate exams, etc. in order to get there.

And if you want to complain about quality assurance, I say that I honestly would not trust more than half the people in my class with my health in a life or death situation. I know so many crappy doctors out there who graduated from American medical schools. However, if a foreign medical grad makes a mistake, it becomes a statement about all foreign medical grads. If an American grad makes a mistake, then it makes that person look bad, but apparently is not a commentary on American health education.

I hate absolutes and I would say that the percentage of lousy FMG doctors is probably equal to that of American medical grads, except they tend to be weeded out more. Also, MANY of these FMG's become doctors for their own people (not to sound racist or anything). Without them here, there are a lot of ethnic minorities (Indian, Chinese, etc.) who probably would never go to a doctor and thus cause increased pain on the American medical system when they show up to an ER for severe complications of medical problems that have been going on for decades but not been dealt with because of lack of care. Maybe these FMG's might not be used to the cultural norms of the US, but in the working world, white America doesn't often go to these doctors for care. Their practices tend to be overwhelmingly foreign.

 

[3dtp]

Well if, because of their visa status, they essentially can't object to being pressured to ignore regulations, then that could definately be dangerous. The current work hour cap was brought about for patient safety reasons, after all.

This does happen. I counseled one such individual who was an FMG at a community hospital. This resident was pressured to ignore certain regulations and when the resident protested, the resident was informed that the contract was being terminated. When this particular resident protested that and stated that there would be an appeal, the assistant PD, also a non-US national told him that since his contract had been terminated, he had no legal basis to be in the US and if an appeal was made, then they'd report to the INS and have him deported.

This resident did find another position, in another state at a less malignant program. The program has a reputation of firing several residents per year for unprofessional behavior.

Also, many programs do not go the H1B route, I think. I'm not sure, but most go the J-1 exchange visa route which is far easier and cheaper than the H1B. So, I'm not sure why this is a major concern to us. Anyone better informed? or has an H1B that can shed light on it?

 

[Stillorgan]

Also, MANY of these FMG's become doctors for their own people (not to sound racist or anything).

Eh, that's completely racist. You've been here 25 years and this is your level of cultural competency? Not very impressive.

Without them here, there are a lot of ethnic minorities (Indian, Chinese, etc.) who probably would never go to a doctor and thus cause increased pain on the American medical system when they show up to an ER for severe complications of medical problems that have been going on for decades but not been dealt with because of lack of care. Maybe these FMG's might not be used to the cultural norms of the US, but in the working world, white America doesn't often go to these doctors for care. Their practices tend to be overwhelmingly foreign.

Yes, that's all very nice and idealistic. Now do please come back down to earth.

 

[Orange Julius]

This does happen. I counseled one such individual who was an FMG at a community hospital. This resident was pressured to ignore certain regulations and when the resident protested, the resident was informed that the contract was being terminated. When this particular resident protested that and stated that there would be an appeal, the assistant PD, also a non-US national told him that since his contract had been terminated, he had no legal basis to be in the US and if an appeal was made, then they'd report to the INS and have him deported.

This resident did find another position, in another state at a less malignant program. The program has a reputation of firing several residents per year for unprofessional behavior.

Also, many programs do not go the H1B route, I think. I'm not sure, but most go the J-1 exchange visa route which is far easier and cheaper than the H1B. So, I'm not sure why this is a major concern to us. Anyone better informed? or has an H1B that can shed light on it?

That's a horrible story. I'm glad the resident you councelled found another spot. Really, that sort of situation is outright exploitation. If anyone sees this as a "foreigners getting a free ride" situation, then they're missing the point entirely. Residents who are pressured to flaut the law on pain of deportation must be enduring a living hell. The ordeal you describe here is one I wouldn't wish on anyone. It's not right for any program to maintain outdated malignant practices in that manner.

 

[Von Hohenheim]

J1 visas are often used my FMG residents. The drawback with a J1 visa is that in order to maintain one the holder has to spend a specified quota of days in their country of origen each year. Needless to say, the time quota is more than any residency program would offer in vacation leave. This problem can be sidestepped through a hardship clause whereby the holder can claim that the current political climate in their country would make it unsafe for them to return. This is in practice very difficult to verify or falsify. As such it is not unusual for J1 visas to suffice for purposes of residency.

 

[Poety]

Is the OP concerned that the residents on HB visas are dangerous because they aren't screened thoroughly or because they are pressured into not following protocols?

I'm confused by this thread

 

[Whodathunkit]

The fact is that foreign medical grads take the same exams as us, often score better than us,

Many times, those grads have been out into practice...and it's alot easier to take an exam when you have clinical applications to draw on. It was alot easier for me to remember which medications to use for patients when I actually had patients to describe them to. Prior to that...it was mainly rote memorization. A person who has been an FP or IM(in any industrialized country) for even a few years would(should) do exceptionally well on Step 2 and 3. Step 1 although more difficult makes a lot more sense to me now...after some years of practice.

And besides, sometimes, these applicants...prepare for a MUCH longer period of time that is usually allowed of us...Back in the day, I had to take a 2 day Step 1 exam on a certain standardized day...right after 2nd year medical school...no exceptions. Some schools require it before you can start 3rd year. Not all schools are like that though. I friend of mine at hopkins could take it anytime during her third year. Damn right she did well...she had PLENTY of time to study for it and took it when SHE was ready.

.....he said that his program, which is in no way desirable, tries to get as many American grads as possible, but many don't apply. ...Unfortunately, these tend to be programs that people are not fighting over, so they end up with foreigners.

Has your friend and the program director tried to figure out why their program doesn't seem to be attracting top applicants? Many times, AMG weed out programs on their list by how many FMGs are in the programs. It's a never ending cycle unfortunately. An applicant sees an FMG in the program, assumes(correctly or not) that their must be something malignant with program. Doesn't rank program. Program ends up with greater number of FMGs, cycle repeats the next year. Many times, because FMGs are desperate to gain access to ANY program that they will take a spot in even the most malignant program. I've seen some FMG boards where people will try to scramble into Psych, Surgery, FamPrac, Peds, IM, etc...pretty much any program that will have them. It's up to the programs themselves also to make themselves more attractive to everyone...including FMGs. It's a shame really with the FamPrac residencies that have problems fillings.

One idea I've thought about is if PAs, who seem to be filling the void for the lack of Primary Care Doctors in the US, want to be considered full physicians...why not streamline them into the same FP residencies(3 yrs and out) problems with filling solved. Most PA schools have to take some of the same classes we take in med school anyway.

 

[Waiting4Ganong]

I read the OP as an obvious spoof.

The guy is a comedy genius.

 

[Miklos]

This is why there is also higher compensation to hospitals per each American resident than per each foreign resident. This is ALSO why if you go to places like MGH or Mayo (which I hope you won't say are bad programs), you WILL find foreign medical grads. They have so much money and are so well established, they don't really CARE about the government compensation per resident.

I believe this to be a myth. If anyone can prove otherwise, please feel free to post.

 

[Waiting4Ganong]

Miklos - don't go start bringing facts into this rabble-rousing. This is about wealthy, academically mediocre, trustfund kids thinking they are better than others by right (accident of birth etc) rather than by effort.

It is a decidedly un-American attempt to stop residency directors recruiting the most qualified doctors to their programs. A merit based system (even the one as biased to home trained grads as the US one) has left some (like the OP one suspects) at the bottom of the pile and this is an attempt to make sure untalented+american trumps talented+foreign in US residency training selection. Funny how a country based on the principles of the free market, labor and trade freedoms and merit/hard worked-based success (aka: the american dream) could have spawned such protectionist sentiments....

You could make an argument (indeed I would) that all 16,000 US mainland medical graduates should have a residency place available to them (this is pretty much the way the system works now anyway). But they should compete for the type of place with the best of the doctors from the rest of the world. This only helps US interests and makes US medicine stronger than it otherwise would be.

As for does the slacker from New York with a trust fund who bombed college and scrapped through an offshore diploma mill (but with a US passport) serve US interests better than the almost fulltrained attending cardiologist from New Delhi who wishes to complete a US fellowship then take a low paid faculty job in a US teaching hospital? - well, no contest.

Part of the wonder of America is the idea that hard work and talent really does matter more than dirty deals, connections, and birthrights. When I hear rich American "med students" (I use the term loosely) from offshore or lowly ranked mainland schools whine about talented foreign-educated doctors taking opportunities they see as theirs by right off them- well, makes me want to get founding fathers on them....

For an non US citizen to convince a residency director that despite differences in training, culture and work patterns, he will be a better doctor and more of an asset to the residency program than a US born medical student must mean they are way above the standards of the other applicants. In my view, those Foreign born and trained doctors who have worked hard enough to reach such a standard deserve more than H1 visas - they deserve green cards! I'd swap them with every whining US trustafarian from a two-bit school who moans about their "birthright".


edited 7th Jan: Changed references to "middle class" (see later note). Translated labour into american spelling.

 

[FACS]

Funny how a country based on the principles of the free market, labour and trade freedoms and merit/hard worked-based success (aka: the american dream) could have spawned such protectionist sentiments....

Wa ha ha. Nothing like listening to an Englishman lecture about what it means to be American. Where else but SDN would you find this kind of bizzarreness?


BTW, is the OP a trust fund kid or is he middle class? Surely, he can't be both.

 

[robotsonic]

Thank you, raph91 and Waiting4Ganong. I'm glad that there are at least a few people on here who actually stop to think about the situation of FMGs before spouting off their uninformed complaints about immigrants.

 

[3dtp]

[

 

[3dtp]

Wa ha ha. Nothing like listening to an Englishman lecture about what it means to be American. Where else but SDN would you find this kind of bizzarreness?


BTW, is the OP a trust fund kid or is he middle class? Surely, he can't be both.

Yeah. We ain't done so bad for a bunch of reject convicts the Brits wanted to get rid of a couple a hundred years ago! (and Australia too for that matter).

Maybe in the interest of free trade and equity we should export our convicts to their home countries. Long live the Queen!

Of course the other alternative is for these docs to apply for a regular immigration visa like the rest of the world has to do and wait their turn.

I don't think in modern times, just anyone (non-EU) can hop a jet, fly to London, Frankfurt, Paris and say, here I am, ready to emmigrate. Why is it the US should be any different? Any Japanese nationals out there who can give us information on what it would take to emmigrate to Japan and be a doc there?

 

[DaBigDawg]

Yes, but for the most part, only for prelim positions. If they survive, they may be given a contract extension. The trial period and the "US clinical experience" are one and the same.

Patrick Bateman is a ******. No wonder people like to take docs from outside the US. If our medical schools are producing idiots like him I would leap at the chance to take FMGs.

 

[Waiting4Ganong]

Wa ha ha. Nothing like listening to an Englishman lecture about what it means to be American. Where else but SDN would you find this kind of bizzarreness? :

Spent 10yrs in States - all the paperwork, paid all the same taxes. Only the birth certificate (and my spelling) would give the game away. All the rest of my family are US citizens. Besides was just giving my personal take on it - not the "voice of all Americans"

BTW, is the OP a trust fund kid or is he middle class? Surely, he can't be both.

Middle class in the traditional (ie: rich but not nobility) rather than newer (everyone except the rich) usage. Again, probably a UK usage rather than a US one. Apologies for confusion.

 

[Waiting4Ganong]

Yeah. We ain't done so bad for a bunch of reject convicts the Brits wanted to get rid of a couple a hundred years ago! (and Australia too for that matter).

I thought the convicts went to Auss and the Religious nutters and gun nuts got sent to US ( JOKE!). But I take your point - American has done awesomely well in it's short history. I have to say I lot of that is, in my view, down to three of the best things about America:

1) On foundation a set of written, clear statements on common principles
2) The approach to Immigrants (Give us your tired, your poor, your huddled masses... )
3) The idea that Merit (hard work and talent) should be sufficient for success.

The OP seems to be whining against at least two of the things that have made America great...

I don't think in modern times, just anyone (non-EU) can hop a jet, fly to London, Frankfurt, Paris and say, here I am, ready to emmigrate. Why is it the US should be any different? Any Japanese nationals out there who can give us information on what it would take to emmigrate to Japan and be a doc there?

Too right. Just like when coming to the US - you have to take the same tests as home students first (USMLE I, II even IIcs) - until recently English (but not Canadians!) had to take a test of English language to come to the US for residency!!!! Even when you ace them you'll still only be considered at places where your American peers have lower scores (<20 pts) and less clinical experience. There are plenty of barriers set up as it is - I just don't approve of making it any harder for residency directors to pick the residents that they want!

Maybe the residency directors on SDN (BKN is one for example) could comment on how they'd view additional restrictions being placed on their ability to recruit the best resident classes.

 

[svaefinga]

Oh, thank you guys for making me laugh.
FMGs do not only take the same exams as you do, they also take in addition exams in their home countries. They should have learned their stuff by then I guess. I am licensed in two (western) European countries and wouldn't consider to go to the US if not for personal reasons. I haven't tried it yet but to get into a residency as a FMG doesn't seem to be a walk in the park to me. H1b-visa are pretty rare, usually you have to settle for a J1 if you are not a permanent resident.
BTW tell me more about programs prefering FMGs I am sure there are lot's of FMGs out there who would love to get to know these.

 

[wertyjoe]

I am from rural North Dakota and most of our rural clinics/hospitals are staffed by Indians (non native-americans) and eastern Europeans. Our rural hospital/clinics recruit them because US grads won't work in the middle of nowhere for such little pay.

First, I believe they provide an invaluable service to my state. Without them most people would have to drive 150+ miles for routine health checkups. Instead, many small town clinics are staffed by foreigners.

However, IMHO, they really suck! I had one give me a hearing test (for a DOT physicial) by standing in the corner while he stood on the other side of the room. He whispered quietly with his hand over his mouth, "Bill Clinton is president". I was like what the f**k! This is a hearing test?

I had this polish Dr. accuse me of being on steroids. He gave me a long lecture on steroid abuse and said that my problems were caused by this. I am a big boy, but I have never touched steroids before in my life. I couldn't convince him that I didn't do steroids. I had to make a new appointment with an american doc to get help.

I'll take a dumb american doc over a smart foreign doc any day. Atleast, I'll know what the h*ll he's saying.

Werty

 

[BKN]

Maybe the residency directors on SDN (BKN is one for example) could comment on how they'd view additional restrictions being placed on their ability to recruit the best resident classes.

Gee, thanks for offering me the opportunity to offend at minimum 1/2 of my fellow SDNers. Or if I'm not careful, ALL of you.

MUST. . .NOT. . .POST. . .oh well. . .


Yadda-Yadda-Yadda warning: Long winded and obvious introduction follows as I collect my thoughts, but you can skip ahead if you like. I'll mark the answer with a .

I think the situation is this:

1. It's much cheaper to start a GME program than an allopathic American medical school. It's also of more immediate and direct benefit to the originating institution. Thus, there are many more GME slots than American allopathic grads. Of note, the number of slots also has little to do with need, either. the numbers seem to increase slowly whether we have too many or too few Docs.

2. Americans pay much more of the GDP to health care than other developed countries. While much of the money goes to insane hospital charges and supporting most of the medical research (pharmaceutical and basic science) that gets done and benefits all of the world, a lot of it goes into to far better compensation for Docs.

3. Slots plus opportunities = If I am a foreign physician, I may want to come to the US, just as uneducated, poor Mexicans slip past my office on their way to better money and a better life.

4. The cost of starting an allopathic medical school, has led to few new private ones being started in at least 1/2 a century. I think the last one was Baylor in 1947, and that was actually a move from Dallas to Houston. You could argue that it was actually a creation of a public Medical School (Southwestern). Few public schools have been created since the feds offered incentives to increase class size or build anew in the late 60's and early 70's.

5. In the last 20 years people have built more DO schools and Carribean schools that depend on building classrooms only and using extant nonteaching allopathic institutions to provide the clinical experience.

6. The graduates of the schools in #5, mostly US citizens, are competing with the IMGs for the slots not grabbed up by the allopathic grads. Therefore the number of foreign citizen IMGs matching to GME is dropping while the number of slots are increasing.

My point is, it's always been hard to get American GME if you're a IMG. It's getting harder.

As to the original query, America's success has always been due to meritocracy and immigration. Even if you're a "Native American", you're ancestors came to the "New World" at some point. There's always been some xenophobia too. But what I'm reading in this thread has less to do with that than with pure competition and attempting to take advantage. Well, that's American too.

The point of licensure requirements is protection of the American public from quacks. In the post-911 paranoid era some of that xenophobia is creeping in as well. Of course, PDs will fight attempts to tell us who we will select. Will we succeed, while the Feds try to keep out the bad guys out? I don't know.

But you're job is to stop worrying about it and be the best Doc you can for your patients, whatever situation you end up in.

Warning: Long winded p.s.

A profession is defined as a business that:

1. Has a special knowledge base that government does not set
2. IS SELF-POLICING

 

[BKN]

Ooops. . posting error.

Warning: long winded p.s.

A profession is a business with special privileges:

1. Special knowledge base, not set by government

2. self policing powers

3. An obligation to put the client's (patient's) interests ahead of our own.

The State Boards and the GME PDs in those self-policing and patients' functions have to balance perceived doctor shortages versus perceived inadequate medical training. The 30 or so Carribean schools, clearly commercial enterprises with no benefit other than income to the countries (officials?) in which they sit, are the biggest challenge right now. Heck, in the '80s we even had the "medical school at the airport" in El Paso. There was a "school" out there, chartered in St Lucia. The "theory" was that because it was in the "free trade zone", they could have a foreign med school. Somehow, I doubt that any of the graduates practice in St Lucia today. I wonder if any practice in the US?

 

[3dtp]

Too right. Just like when coming to the US - you have to take the same tests as home students first (USMLE I, II even IIcs) - until recently English (but not Canadians!)

That's because Canada is bilingual. Except for Quebec, that is.

 

[Miklos]

6. The graduates of the schools in #5, mostly US citizens, are competing with the IMGs for the slots not grabbed up by the allopathic grads. Therefore the number of foreign citizen IMGs matching to GME is dropping while the number of slots are increasing.

My point is, it's always been hard to get American GME if you're a IMG. It's getting harder.

This maybe true, but is not supported by the NRMP statistics from 1999-2005.

Over that time period, USIMGs (excluding 5PW) that matched via the NRMP increased from 864 to 1,143. During the same time period, true FMGs also increased their number matching through the NRMP from 2,567 to 3,087.

We know from the yearly JAMA numbers that a large number of IMGs (both USIMGs and true IMGs) score positions outside the match. For 2004, which is the last year we have publicly available NRMP and JAMA statistics, we know that:

• 1,117 USIMGs matched via NRMP
• 62 5PW grads matched via NRMP
• 2,970 true FMGs matched via NRMP

This yields a total of 4,152 IMGs of "all colors" including some with previous US GME matching via the NRMP into PGY1 spots.

Interestingly, the JAMA survey for that year reports 6,122 IMGs of "all colors" however without prior US GME on duty as of August 1, 2004. This means an additional 1,970 IMGs of "all colors" gained positions outside the match.

Problem is, that the JAMA numbers poorly report citizenship status. According to their datatable of the 6,122 it breaks down as follows:

• US Citizen (thereby USIMG): 1,176
• US Permanent Resident (thereby FMG): 1,234
• Non-US Citizen (thereby FMG): 1,744
• Unknown Citizenship: 1,938

Curiously, the number of IMGs who score a position outside the match closely correlates to the unknown citizenship category.

Given this information, it is at best difficult to determine what share is taken by USIMGs versus FMGs. What is certain, is that applications this year are up.

 

[BKN]

This maybe true, but is not supported by the NRMP statistics from 1999-2005.

Given this information, it is at best difficult to determine what share is taken by USIMGs versus FMGs. What is certain, is that applications this year are up.

Thanks for the reply. I am a statistician as well as a Doc and I always appreciate details and corrections. Well almost always.

Having read through it and having thought about it, I'll stand by the intent of my comments while admitting that is difficult to be certain of the exact numbers. I believe that between more DO schools, more Carribean and other schools catering to US applicants who can not make it into DO or Allopathic schools and more "true" IMGs looking to ahieve USGME, it's harder for a "true" IMG to get USGME. I think this thread is all about competition and relative advantage, which is not pretty, but is as American as meritocracy and justice.

I have an acquaintance in the state legislature. He says that if there are only two guys in the same business in the state, eventually one of them will appear before him to try to convince him it's in the public interest to give the guy an advantage.

When the same thing happens in front of the State boards or the PDs, we are supposed to go back to the profession's adavantage: self policing in return for putting the patient's interest in front of our own.

 

[Miklos]

Having read through it and having thought about it, I'll stand by the intent of my comments while admitting that is difficult to be certain of the exact numbers. I believe that between more DO schools, more Carribean and other schools catering to US applicants who can not make it into DO or Allopathic schools and more "true" IMGs looking to ahieve USGME, it's harder for a "true" IMG to get USGME. I think this thread is all about competition and relative advantage, which is not pretty, but is as American as meritocracy and justice.

You may well be right, especially if we factor in DOs.

I'd be curious to know whether in your opinion, USIMGs have a leg up on FMGs? And if so, why?

I know it sounds like a trivial question.

We can point to factors such as US clinical experience, cultural and language fluency and a lack of visa issues, for instance. These could easily account for a relative advantage for USIMGs over FMGs in primary care and "less" competitive specialties.

However, from what I've seen and read about at the very competitive end, it seems that FMGs with additional qualifications (PhD, completed GME at home, publications) have significant advantages over USIMGs.

 

[BKN]

You may well be right, especially if we factor in DOs.

I'd be curious to know whether in your opinion, USIMGs have a leg up on FMGs? And if so, why?

QUOTE]


As a PD in a specialty with fewer FMGs, I'm not sure that I can give an expert answer.

Possible reaons to favor USIMGs that occur are:

1. Jingoism and the anti-immigrant hysteria (oh sorry, un-PC, strike that), pure and simple
2. The visa thing. As I understand it if a FMG is not ECFMG certified it can be a near thing to get it done after match and before July. And in these paranoid/cautious times, they might not get their visa at all. That's got to go through a PDs mind, particularly when looking at a candidate from the middle east.

Balance that against:

The "true FMGs" applying are usually among the verry top that their country has to offer. The USIMGs are usually folks that couldn't get into US schools.

But the whole thing boils down to the individual. I've seen very good and very bad apps from all schools from the Ivies down to the most obscure. I'm going to hire the best that I can.

Cheers, BKN

BTW as a kid, I was a military brat with tours in Germany, Morocco, Spain and Japan. I loved it. I got the idea in college that it would be nice to study abroad in medical school. I thought I would apply to English speaking medical schools in Europe. My favorite idea was Malta. Happily, my faculty talked me out of it. Life is easier for a USMG.

p.s. the cultural and language fluency issues, IMnotHO are minimal. You can train anybody with these credentials. In fact, you couldn't stop them from achieving if you tried.

 

[nitin_ps]

visit: http://new.petitiononline.com/Standish/petition.html

To all US citizens, permanent residents and GC holders

DOL (Department of Labor) has clear regulations that US citizens and permanent residents are to be considered for vacant positions before such vacancies are offered to applicants from abroad.

In most fields, obtaining an H1B visa is a very difficult process and stringent conditions apply before an H1B petition is approved. In medicine it is just the opposite.

Administrators of hospital residency programs, in contravention of DOL rules and regulations, are routinely offering vacant positions to foreign medical graduates (FMGs) not living in the US without first attempting to fill such vacancies with qualified candidates residing within US borders.

Hospital residency positions, including internships, are filled through a centralized electronic application system. Anyone, anywhere in the world with internet access can use this system to apply for hospital residency positions. This allows applicants from abroad to apply at the same time as US citizens and permanent residents.
Since the number of applicants from abroad far outnumber US citizens and permanent residents applying for each vacancy, qualified US citizens and permanent residents are frequently never interviewed for some positions which ultimately are given to non-resident foreign applicants who are then supplied with H1B visas enabling them to work as physicians in the US.

Hospitals are therefore determining who receive visas. Screening of these H1B recipients is minimal at best as hospitals are virtually unfettered in sponsoring H1B visas for candidates they hire from abroad.

Hospitals receive federal, city and state funds from tax dollars, yet citizens and permanent residents residing in the US who contribute these tax dollars are being outnumbered and ignored.

There are currently thousands of unemployed, qualified graduates of foreign medical schools; both US citizens and permanent residents; residing in the US capable of filling these vacancies.

Only after all US citizens and permanent residents who apply are found not suitable, should programs be free to hire non-resident applicants. To interview and subsequently employ non-resident applicants without first interviewing US citizens and permanent resident applicants in order to ascertain their suitability, is utter disregard for US labor laws.

This practice is dangerous in that doctors provided with H1B visas in this manner are not screened as thoroughly as other prospective immigrants are. This practice must be stopped outright.

Please sign this petition and help safeguard the health and safety of our communities.
I ask your help to ensure that:
1.Current laws are respected and enforced.
2.Applicants are appropriately screened before being provided with H1B visas.
3.Regulations stipulating that vacant positions be offered to qualified US citizens and permanent residents before attempting to fill such vacancies with applicants from abroad are complied with.

There are already thousands of qualified, unemployed foreign medical graduates residing in the USA capable of filling these vacancies. Why take this unnecessary risk?

Please sign and forward copies of this petition to your Congressmen, Senators, City and State representatives, newspapers, radio stations and civic organizations in your state.

visit: http://new.petitiononline.com/Standish/petition.html
and sign the petition.

There are similar postings (almost exact copy) in various other medical forums, and one thing could easily be recognized, that this campaign is started is "second or third generation americans" (whose parents or grandparents migrated to US). These are mostly USFMGs, who could not get into US medical school. Go to the petition link and look at the names and you will know what I am saying (although this "pattern" might change once this post is up).

Its not "US grads VS FMGs" thread, nor has this amything to do with who is given preference for GME. We all should be mature enough to understand that no PD would want a slack candidate (whether US grad or FMG) in their program. Also, IMO for every mediocre FMG there is a outstanding US grad and vice versa, and you certainly can not generalize.

Coming back to the "intent" of the thread, this campaign is started by a bunch of losers who want to take advantage of their US citizenship (even though their medical schooling was not done in the US). Parents (or grandparents) of these guys came to the US, struggled and worked hard to gain US citizenship. These losers (USFMGs) are now undermining the very reason that granted citizenship to their ancestors. If you visit the petition link, you can notice that some of them have graduated as early as 1983. Now these people have accumulated in substantial numbers and started a campaign to enter the US medical system, not based on merit, but on birth.
It is important to ask yourselves whether the US should really consider stopping H-1B visas in favor of these losers?

PS. Sorry for any spelling or gramatical errors.

 

[Miklos]

You may well be right, especially if we factor in DOs.

I'd be curious to know whether in your opinion, USIMGs have a leg up on FMGs? And if so, why?

As a PD in a specialty with fewer FMGs, I'm not sure that I can give an expert answer.

Possible reaons to favor USIMGs that occur are:

1. Jingoism and the anti-immigrant hysteria (oh sorry, un-PC, strike that), pure and simple
2. The visa thing. As I understand it if a FMG is not ECFMG certified it can be a near thing to get it done after match and before July. And in these paranoid/cautious times, they might not get their visa at all. That's got to go through a PDs mind, particularly when looking at a candidate from the middle east.

Balance that against:

The "true FMGs" applying are usually among the verry top that their country has to offer. The USIMGs are usually folks that couldn't get into US schools.

But the whole thing boils down to the individual. I've seen very good and very bad apps from all schools from the Ivies down to the most obscure. I'm going to hire the best that I can.

Cheers, BKN

BTW as a kid, I was a military brat with tours in Germany, Morocco, Spain and Japan. I loved it. I got the idea in college that it would be nice to study abroad in medical school. I thought I would apply to English speaking medical schools in Europe. My favorite idea was Malta. Happily, my faculty talked me out of it. Life is easier for a USMG.

p.s. the cultural and language fluency issues, IMnotHO are minimal. You can train anybody with these credentials. In fact, you couldn't stop them from achieving if you tried.

Thanks. Appreciate the reply.

 

[Waiting4Ganong]

Gee, thanks for offering me the opportunity to offend at minimum 1/2 of my fellow SDNers. Or if I'm not careful, ALL of you.

MUST. . .NOT. . .POST. . .oh well. . .

Thanks for taking the bait! Seriously, it is great to hear a residency director bring some much needed perspective to this topic.

Thanks for taking the time to share your comments - much appreciated.

 

[Apollyon]

Balance that against:

The "true FMGs" applying are usually among the verry top that their country has to offer. The USIMGs are usually folks that couldn't get into US schools.

Although the balance of your posts are excellent, this is the only point to which I take some exception.

When you have 1 spot and 2 people, someone doesn't get in. Some few years ago (I think it was 1999), about 40% of all applicants (not applications) to allopathic medical schools in the US were from California and New York. 40% of all med school spots in the US are not in California and NY.

My school in the Caribbean ("best of the worst") puts ~200 into the pool every year, whereas the "status quo" of US MD seniors is ~16K. We barely dilute it (or "pollute" it, as some have said). Our student body was about 50-60% US citizen, 30% permanent resident, and ~10% foreign national (who, believe it or not, did return to their countries to practice/train) - and, even among our student body, more than 50% were California or NY residents.

Brad Deal (when he was AMSA president) wrote in The New Physician that, "if someone has better grades, better recommendations, better board scores, and is a nicer guy, wouldn't you think he's a better candidate?" Not to some program directors (a very few of whom show a shocking lack of class, grace, and professionalism with the withering disrespect and invective strewn at those USFMGs that have the temerity to apply to those programs), who prefer a USMG with a Step I <200 to a USFMG with a Step I of >240 (which was supposed to be the "great equalizer", comparing apples to apples).

You are right by saying "people who couldn't get in" - although there were people that said they chose the Caribbean, I found that rather disingenuous as compared to those of us that were honest. My point is that not all Caribbean students are complete losers who belong on the garbage heap, begging for the leavings and drippings of the US GME feast - sometimes the best are the best, from US schools with US citizens, US citizens abroad, and foreign citizens from foreign schools. The incomplete success of US med school admissions committees to select the best students that will translate into the best doctors is evidenced by the introduction of the Step II-CS exam (anyone can take a written test, right?). To throw the baby out with the bathwater (rejecting an app because of where it's from, instead of who it's from) seems somewhat shortsighted.

 

[eejakyule8]

A profession is defined as a business that:

1. Has a special knowledge base that government does not set
2. IS SELF-POLICING
3. An obligation to put the client's (patient's) interests ahead of our own.

Thanks. I like this definition.

 

[NR117]

Coming back to the "intent" of the thread, this campaign is started by a bunch of losers who want to take advantage of their US citizenship (even though their medical schooling was not done in the US). Parents (or grandparents) of these guys came to the US, struggled and worked hard to gain US citizenship. These losers (USFMGs) are now undermining the very reason that granted citizenship to their ancestors. If you visit the petition link, you can notice that some of them have graduated as early as 1983. Now these people have accumulated in substantial numbers and started a campaign to enter the US medical system, not based on merit, but on birth.
It is important to ask yourselves whether the US should really consider stopping H-1B visas in favor of these losers?

PS. Sorry for any spelling or gramatical errors.

Hard to argue with the points you make, which are excellent BTW.

 

[BKN]

Thanks. I like this definition.

Well, it's not mine. It's all over the medical ethical literature and I think in some ways a matter of law.

It certainly helps me when I have an ethical dilemma to deal with. Happens a lot in EM.

 

[Poety]

I am from rural North Dakota and most of our rural clinics/hospitals are staffed by Indians (non native-americans) and eastern Europeans. Our rural hospital/clinics recruit them because US grads won't work in the middle of nowhere for such little pay.

First, I believe they provide an invaluable service to my state. Without them most people would have to drive 150+ miles for routine health checkups. Instead, many small town clinics are staffed by foreigners.

However, IMHO, they really suck! I had one give me a hearing test (for a DOT physicial) by standing in the corner while he stood on the other side of the room. He whispered quietly with his hand over his mouth, "Bill Clinton is president". I was like what the f**k! This is a hearing test?

I had this polish Dr. accuse me of being on steroids. He gave me a long lecture on steroid abuse and said that my problems were caused by this. I am a big boy, but I have never touched steroids before in my life. I couldn't convince him that I didn't do steroids. I had to make a new appointment with an american doc to get help.

I'll take a dumb american doc over a smart foreign doc any day. Atleast, I'll know what the h*ll he's saying.

Werty

Oh that made my day, that was hilarious!!!!

 

[eejakyule8]

It is important to ask yourselves whether the US should really consider stopping H-1B visas in favor of these losers?

Well, the US isn't going to stop giving H-1B or J1 visas. The visa issue is a much larger matter than this triffle within the medical world. Immigration, while not in the interests of those lower down on the food chain, is undeniably benificial to our economy as a whole. It's not going to go away as long as a nation are still prospering in the world. Even, if it were the case that visa policy were decided on the basis of petitions of this sort (which, of course, is not the case), this petition has a mere 67 signitures. 67! Any talk about visa reform is purely redundant. The matter of how medicine handles this increasingly delicate problem of US/USFMG/IMG/MD/DO applications for limited GME slots, on the other hand, is I suspect interesting to all of us regardless of where we stand.