Doctors on H-1B visas are dangerous

[Poety]

Can someone please tell me if this thread is about the dangers of not screening these H1b applicants or if its about residents on these visas being dangerous in practice?

BKN? someone?

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[eejakyule8]

Can someone please tell me if this thread is about the dangers of not screening these H1b applicants or if its about residents on these visas being dangerous in practice?

BKN? someone?

Yes, both of these claims serve as pretext for the dispute. What the dispute is "about" is a whole nother matter entirely.

 

[Poety]

Thanks eej, Im just trying to follow along here, guess Im a bit slow I'll just assume - its about both

 

[BKN]

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.

Well, I knew I would offend somebody if I answered. I always feel that I have to be more careful in reacting on this forum than others.

It seems to me though, that you have agreed that the students at the Carribean schools mostly couldn't get into US ones.

You know I would never say that "all Caribbean students are complete losers who belong on the garbage heap . . .etc". In fact, I'm proud to call almost everyone I ever met that made it through medical school brother or sister.

It is entirely different to say that the schools themselves make me uncomfortable. One thing that gives pause is the ancient history of this phenomenon (read the late 80's). One or two schools were found to be selling degrees. My memory is that approximately 100 "physicians" were in training in New York who had never in fact attended. Secondly, it is my impression that the owners of such schools have established them solely to make money and that most provide no service to the public around them, which is the norm and the ethos in medical education. Finally, I think you realize that the fact that these schools' clinical experiences are not really reviewed by anybody is a big problem for the medical boards and the PDs. In fact, when the subject is brought up, the local authoritieis say "not our problem". The LCME sets strict standards for both basic science and clinical training and reviews each allopathic school every 7 years. D.O. schools have a similar mechanism. State boards have the problem of deciding whether the medical training of all foreign graduates is acceptable. It's considerably easier when the medical profession of the country involved has passed on the school. That's the self-policing thing I mentioned in earlier posts. Perhaps you've noticed on other sub-fora the "off-shore" schools in London that the UK Medical Council is having to deal with.

I've not had to deal with the Carribean phenomenon before this year. The Texas State Board of ME was very proud to tell the legislature that they had succeeded where New York had failed. There was not a single graduate with a fraudulent degree in training or practice. They celebrated by making it tougher. Since, until this year, the TSBME refused training permits to Carribean graduates, I didn't have to think about it. This year, since the policy changed, I looked at the few Carribean apps that came in. Some appeared to be excellent, others not. I offered some interviews. We'll see what comes of it.

And finally a little inspirational story. Remember the medical school at the airport? I think it was Spartan University of the Health Sciences, St Lucia. Fifteen years later, we got an application from a graduate! Apparently the degree didn't help. So he attended UTEP to get an MS in Biology, did medical school all over again at UT Houston and did a family medicine residency there. He then practiced for 6 years and decided he wanted to change to EM. It was the most fascinating application we had ever seen, so we ranked him and he matched. He was one of the very best residents we ever trained and he's one of the nicest humans beings I've ever met. He makes us proud.

That's why "Carribean graduates aren't all garbage". I believe it's the individual, not the school. So I'm sorry if you felt I was dissing you, I was trying to answer a question the best way that I knew how. Apollyon, you've refused to take no for the answer to your aspirations. That's admirable. I hope you succeed in your endeavors. But if the answer to US training and licensure is no, I hope you'll go on. Somebody will need you somewhere, perhaps far more than I am needed in the US.

 

[BKN]

Thanks eej, Im just trying to follow along here, guess Im a bit slow I'll just assume - its about both

Actually P, I think he was telling you it's about neither one. Originally it was about:

Resolved: The federal government should ensure that USIMGs take precedence over foreign citizen IMGs in USGME programs and,

Resolved: It's ok to use whatever post-911 hysteria you can muster you can to achieve this.(oops, not PC strike that)

Actually because the pro side has been remarkably absent after the OP and eej is right about the very small likelihood of there being a successful campaign to change immigration policy, we highjacked it to argue with ourselves about the relative merits of IMGs by citizenship and school. So the OP has sowed dissension, not a complete loss for him.

No wonder you were

P.S. nitin_ps, I've gone to the website. These guys have a right to petition. But I think I agree with your conclusions, even if your language is a little florid. However, it might be fair for us to know a little bit about your interest in this. You are a new member (<10 posts). If you don't mind answering, are you a foreign IMG or just a concerned citizen?

 

[Apollyon]

Well, I knew I would offend somebody if I answered.

Not offended in the least, and I interview for an attending job tomorrow morning (I'm EM3 at a program in the east - I KNOW my PD knows you).

Keep fighting until the fight is done. But at the same time, that leads to two complexes.

The first is, once you beat the man (get in), you become the man (forget the people after you from your school). The second is, take an FMG, expect EVERY SINGLE PERSON applying to EM to apply to your program, like a swarming mentality.

 

[BKN]

Not offended in the least, and I interview for an attending job tomorrow morning (I'm EM3 at a program in the east - I KNOW my PD knows you).

Keep fighting until the fight is done. But at the same time, that leads to two complexes.

The first is, once you beat the man (get in), you become the man (forget the people after you from your school). The second is, take an FMG, expect EVERY SINGLE PERSON applying to EM to apply to your program, like a swarming mentality.

Well, congratulations. I don't know why I assumed you were still at the "best of the worst".

We have matched a few FMGs in the past, mostly people we knew personally from other residencies on our campus. The Carribean thing will be a new experience, if it happens. As for the swarm, I'm not looking forward to it. As long as we're small, I can look at every app myself and make interview offer decisions. If I'm seeing a 1000, it will be impossible and we'll have to go to a formula, which will be hard to write and will make it harder to look at interesting variants.

 

[svaefinga]

The second is, take an FMG, expect EVERY SINGLE PERSON applying to EM to apply to your program, like a swarming mentality.

Is it that bad? Is this actually keeping programs from accepting FMGs?

 

[Poety]

Unfortunately I think people feel that if a program has a lot of FMG/IMG they are not strong, not competitive, and not "good" <sigh> part of the whole "discrimination thing" which never ends. Pick a reason to ostracize someone, and watch the rest follow.

Ofcourse there is some validity to some of the claims in some programs, but unfortunately it seems to bear this stereotype even if the FMG's are strong candidates, or the program is actually strong.

Its a vicious cycle as someone else eluded to.

 

[Miklos]

Is it that bad? Is this actually keeping programs from accepting FMGs?

Take a look at the ERAS statistics for an idea of how many IMGs apply to programs. On the prelimary stats right upper corner, year to date for December (download the Excel Spreadsheet, click on Avg. Apps per Program), you'll see for instance that;

IM (C) programs got (until Dec 10th) an average of 1,078.5 applications from IMGs, in addition to 207.7 from USMDs and DOs.

 

[BKN]

Take a look at the ERAS statistics for an idea of how many IMGs apply to programs. On the prelimary stats right upper corner, year to date for December (download the Excel Spreadsheet, click on Avg. Apps per Program), you'll see for instance that;

IM (C) programs got (until Dec 10th) an average of 1,078.5 applications from IMGs, in addition to 207.7 from USMDs and DOs.

Thanks, Miklos. Very useful.

 

[Standish-holmes]

Please note: I received many emails about difficulty signing the petition, almost all are from AOL-users.

Petitiononline has informed me that they “are having compatibility issues with the AOL browser."

PLEASE USE ANY non-AOL BROWSER AND YOU WILL BE ABLE TO VIEW AND SIGN THE PETITION.

 

[Waiting4Ganong]

Please note: I received many emails about difficulty signing the petition,

I have huge difficulty signing your grubby little scam - but that has nothing to do with my aol account!



P.S: If someone wants to throw up another petition proposing that US residency directors be free to recruit the very best and brightest doctors from around the world and that such activity strengthens American Medicine* - I'd be more than happy to sign that one!


*and that imposing quotas of crappy doctors (just because they have US passports) on residency programs certainly isn't a smart move!!

 

[hzma]

Ever hear of xenophobia? (sarcastic)

 

[hzma]

I just wanna put my 2 cents in, scams like this make me sick- and I agree with you WaitingforG- we should make our own petition.

My dad recieved his training overseas, came here, was certified, and has been a highly respected physician since- he has his name on over 90 publications and research on especially NHL and HL, that has added to the changes in patient care and treatment till today. I use him as a personal example of FMG, yes, you heard me, FMG who has made a difference to medicine, albeit small. (and when he finally got the citizenship- it was the happiest day of his life, because it meant Hope, for the whole family).

And if it sounds strange to mention family, well there are numerous other examples of FMG's and visa holders/GC holders who have made a difference in this country, not just in the medical field, and all add to make this country the beautiful land i know.

What makes America beautiful is the equal opportunity for everyone.
The system here, attempts to place all doctors in an EQUAL footing, and you can't practice unless you are a certain level, and you can't succeed unless you are a certain level (or face malpractice charges). We should try to uphold the spirit of this "attempt," and not destroy it, even if the "real world" is different, and FMGs are not on equal footing with AMGs.

To all the xenophobes in the world: All people are equal, and no, some people are NOT more equal than others.
"You may say I'm a dreamer, but I'm not the only one, I hope someday you'll join us, and the world will live as one."

 

[Hitch]

I just wanna put my 2 cents in, scams like this make me sick- and I agree with you WaitingforG- we should make our own petition.

My dad recieved his training overseas, came here, was certified, and has been a highly respected physician since- he has his name on over 90 publications and research on especially NHL and HL, that has added to the changes in patient care and treatment till today. I use him as a personal example of FMG, yes, you heard me, FMG who has made a difference to medicine, albeit small. (and when he finally got the citizenship- it was the happiest day of his life, because it meant Hope, for the whole family).

And if it sounds strange to mention family, well there are numerous other examples of FMG's and visa holders/GC holders who have made a difference in this country, not just in the medical field, and all add to make this country the beautiful land i know.

What makes America beautiful is the equal opportunity for everyone.
The system here, attempts to place all doctors in an EQUAL footing, and you can't practice unless you are a certain level, and you can't succeed unless you are a certain level (or face malpractice charges). We should try to uphold the spirit of this "attempt," and not destroy it, even if the "real world" is different, and FMGs are not on equal footing with AMGs.

To all the xenophobes in the world: All people are equal, and no, some people are NOT more equal than others.
"You may say I'm a dreamer, but I'm not the only one, I hope someday you'll join us, and the world will live as one."

All together now. cumbaiya me lord, cumbaiya.....

 

[matakanan]

All together now. cumbaiya me lord, cumbaiya.....

Now boy, u sing ...
"In Birmingham they love the governor
Now we all did what we could do
Now Watergate does not bother me
Does your conscience bother you?
Tell the truth
Sweet home Alabama.."

 

[toughlife]

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

yup

 

[MedWiz]

I just wanna put my 2 cents in, scams like this make me sick- and I agree with you WaitingforG- we should make our own petition.

Using services such as www.petitiononline.com, anybody is free to make up his/her own petitions easily and very quickly (indeed, that's exactly the reason why such services are frequently abused to make up buII*** petitions).
Given the fact that not an insignificant number of people here seems to be arguing against this very petition, it would indeed be interesting to see the reponse for some sort of "counter-petition"

http://www.petitiononline.com/create_petition.html

 

[penguins]

I went to the carib for med school and... I was really niave. I went because my friends from college who had higher GPAs and higher MCAT scores and had volunteered since they were infants weren't getting in to med school. In retrospect, I might have gotten in now that I have observed how random the process can sometimes be.
I didn't apply to US schools and thought going off-shore would be fun and an adventure. If I hadn't had that option, it would have made me apply to the US. There were people in grad school with me who had been wait-listed for the 3rd year. The carib school says that all you have to do is pass an extra test (at the time the language test)... simple, right?
There are people who graduated from my carib school who have never passed the USMLEs and are out there still sending former classmates petitions for things like the above. Carib schools are like 2nd chances for people and some fail even with that. I think that once a carib grad takes their steps and completes clinicals in the US they have a right to compete for US residency spots. I am realistic and totally acknowledge that compared to a US grad I am a second class citizen. I met lots of fantastic US med students in clincals and some real idiots that I don't know how they got in or managed to pass the USMLE. But... I still take a backseat to them for interviews and spots.
I was at a psych conference once (during psych rotation) and I was sitting next to this psychiatrist and he was really nice to me and had 2 DO students with him. The pleasant conversation continues and he finds out that I went to the caribbean and he FLIPS out and goes into this tiraid about how it is a sham and then he screams..."couldn't you even get into a DO school?" I told him I didn't want to go to a DO school (just not for me) and I get this loud lecture. There are "foreign" docs all around us from other countries and I was just dying for them because this guys very loudly proceeded to tell me how terrible the system that lets in FMGs.
...people like that guy will never give USIMGS or FMG a chance, his mind is already made up. However, I don't mind taking 2nd place to the US grads as long as I get judged on the merits after that.
I went to school in the carib with some amazingly bright people, I also went to school with some really dim bulbs. The dim bulbs never finished and just have a great big debt to pay which is really sad. Just because one wants to be a doctor, doesn't mean one should. In a rotation that I did at Emory with a prestigious doc, he told me that I was a lot brighter than some of their own med students. I loved that man!

I have no doubts that the original petition was from some disgruntled carib grad who didn't excel after his/her second chance. If it isn't then there is one out there somewhere else.
Do I think we should be in line ahead of the FMG? That is a hard question, I agree with BKN about the pros and cons of each. I have to admit, some of us suck. Some of us, however, have already excelled and have great potential.

I have a residency spot so the US system accepted me. Now I just need Texas, my real homeland, to accept me.

 

[matakanan]

Do I think we should be in line ahead of the FMG?

Well if the USIMG was comparable to an IMG in regards to his scores, research, general behaviour etc. then i guess the USIMG should get preference... purely for the fact that he is a citizen of that country.

 

[suntoucher]

plz dont take all that bs so personally

look at the last names of ppl who signed that petition
most of them are the same IMG/FMG who recently got their green cards and now they're pretending to be above ppl who needs visas

stupid-jealous-asskissing loosers are everywhere around the world
even penguins in Arctica have them

 

[m221915]

I dont know whether to laugh at your stupidity or pity you for going through this petition process. Presuming that you are too stupid to understand legalese let me explain to you in plain english.
READ THE FOLLOWING SLOWLY:

1. YOU ARE CONFUSING THE H1-B VISA PROCESS WITH THE GREEN CARD APPLICATION PROCESS.

2. H1 VISA PROCESS REQUIRES A LABOR CONDITION APPLICATION (LCA) WHILE GREEN CARD PROCESS REQUIRES A LABOR CERTIFICATION. ( different things)

3. LABOR CERTIFICATION FOR GREEN CARD REQUIRES THAT QUALIFIED AMERICAN CITIZENS / TRANSVAGINAL GREEN CARD HOLDERS OR TRANSPENILE GREEN CARD HOLDERS MUST BE CONSIDERED FOR VACANT POSITIONS BEFORE SUCH VACANCIES ARE OFFERED TO APPLICANTS FROM ABROAD.

4. LCA FOR H1 VISA DOES NOT...I REPEAT...DOES NOT REQUIRE THIS. IT ONLY REQUIRES THAT APPLICANTS FROM ABROAD ARE PAID THE SAME PREVAILING WAGES AND AMERICAN WORKERS ARE INFORMED OF THE INTENT TO HIRE A FOREIGN WORKER AT THE SPECIFIED WAGE.

5. THIS IS FROM THE OFFICIAL GOVERNMENT SITE :

workforcesecurity.doleta.gov/foreign/h-1b.asp

AND NOWHERE DO THEY REQUIRE LABOR CERTIFICATION FOR H1 VISAS

6. BTW THIS HAS NOTHING TO DO WITH GENUINE US/CANADIAN TRAINED MEDICAL GRADUATES WHO I ADMIT ARE BETTER TRAINED THAN IMGs IN MOST CASES AND HAVE NO COMPETITION FROM IMGs ANYWAY.

7. THIS IS FOR THOSE IMG LOSERS WHO WANT TO UNFAIRLY FORCE THEIR UNDESERVING @SSES INTO PROGRAMS OVER MORE QUALIFIED NON CITIZENS BASED ON GC.


IF YOU WANT TO REFUTE THE ABOVE STATEMENTS, HAVE THE COURTESY TO QUOTE OFFICIAL GOVERNMENT WEBSITES AS I HAVE.

M2

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.

 

[yaah]

I want to sign a petition that supports the opinion that doctors with a sense of entitlement and who want to skate by on their pedigree without having to work hard be banned from residency.

 

[suntoucher]

deleted

 

[AspiringPath]

Well put Waiting4Ganong!

It is utter nonsense that IMGs get H1bs easily. You have to file all kinds of paperwork. Several top hospitals now do not offer H1bs as a policy because of the paperwork headache.

I studied medicine in a rural medical college in India. I went on to get a masters and a Phd from an ivy league school here. I am commencing a residency this July in the US on an H1b. For an international medical graduate to tell me that he should be given preference to me just because he is a US citizen is plain nonsense. I reallly believe people like me have more to offer than mediocre US citizen grads who ship to one of them carribean countries with a fat wallet and get their medical degrees there. Close to 50% of IMGs, both US citizens and foreigners do not get matched. Some of the losers like the one who started this thread can whine forever........

 

[suntoucher]

I reallly believe people like me have more to offer than mediocre US citizen grads who ship to one of them carribean countries with a fat wallet and get their medical degrees there. Close to 50% of IMGs, both US citizens and foreigners do not get matched. Some of the losers like the one who started this thread can whine forever........

another side
may be i didn't get something but who did decide that? your indian friends? or may be your "humble" opinion?

AMGs should get residency at first. Period. They paid money for education and most of them are citizens of the country which would give you a job [in perspective]. You can not get position with H1 in top rated programs because AMGs will be there (look for the official link before), but not because there's a lot of papework for that kind of visa. The fact that you studied in rural Indian area doesn't give you any benefits. You should deserve the spot in program by hardworking, studing, LORs etc. You should prove you will be useful for this community. If you can not get H1 go and ask for GC if you think you are the smartest person in the world. Yes, it could be wrong from your side. But I'm sure that things work the same everywhere. For example, in India.

Wrong part in this thread is petition which isn't ethical at all. Ppl blame FMG/IMG who were more competetive than them. That's it.

BTW I'm IMG from Russia

 

[AspiringPath]

You need to read my post carefully: I said "US citizen grads who ship to one of them carribean countries...." I was not refering to AMGs.

 

[AspiringPath]

Oh and I didnt comment on the rest of your message because it made absolutely no sense. BTW my residency is in an ivyleague program, so much for your comment about "you did not get into top programs..." and talking about getting to know the culture, skills and the language of this country, I think you should start with lessons in english grammar.

 

[suntoucher]

Oh and I didnt comment on the rest of your message because it made absolutely no sense. BTW my residency is in an ivyleague program, so much for your comment about "you did not get into top programs..." and talking about getting to know the culture, skills and the language of this country, I think you should start with lessons in english grammar.

nooo, you did

so what's wrong with carribean countries? all FMGs have fat wallets there? and why do you complain on carribean countries if you are "commencing a residency this July in the US on an H1b"???

grammar courses... ok, i'm going to take one in rural india. please give me an address of the perfect indian english school aka "ivyleague"

the last thing
i put my non-grammar posts here because i can't understand why do people, who got their diplomas outside US, blame their colleagues which are in the same boat. I could understand AMGs who have xenophobic feelings, but I don't do FMG/IMG... And a post about "ivyleague" doesn't have too much difference than petition above..

 

[penguins]

....I reallly believe people like me have more to offer than mediocre US citizen grads who ship to one of them carribean countries with a fat wallet and get their medical degrees there.

We don't all have fat wallets
What happens when an AMG tries to go to India to be a doc?

 

[yaah]

There is an argument to be made for preferential treatment of american graduates - our tax dollars support the educational system and the patient population, and people accrue large debts to get into med school and succeed in it. Now, this doesn't mean it is our duty as a society to support everyone who decides to go into debt to pay for med school if their skills are not at the level we would expect.

In general though, it is hard to argue that residency programs do not give preferential treatment to american grads. There are reasons and it is not limited to "taking care of our own." They know what they are getting - american med schools have strict standards and protocols for teaching.

The way it is though, there is a shortage of american trained doctors, particularly in primary care. US institutions simply don't turn out enough graduates to fill all the spots that are needed.

The message, I think, in short is that if you are a qualified, intelligent, hard working graduate of a US medical school, you will not have trouble matching to a residency. And if you do, it is not because "a foreigner took my spot." That's naive.

 

[penguins]

There is an argument to be made for preferential treatment of american graduates - our tax dollars support the educational system and the patient population, and people accrue large debts to get into med school and succeed in it. Now, this doesn't mean it is our duty as a society to support everyone who decides to go into debt to pay for med school if their skills are not at the level we would expect.

In general though, it is hard to argue that residency programs do not give preferential treatment to american grads. There are reasons and it is not limited to "taking care of our own." They know what they are getting - american med schools have strict standards and protocols for teaching.

The way it is though, there is a shortage of american trained doctors, particularly in primary care. US institutions simply don't turn out enough graduates to fill all the spots that are needed.

The message, I think, in short is that if you are a qualified, intelligent, hard working graduate of a US medical school, you will not have trouble matching to a residency. And if you do, it is not because "a foreigner took my spot." That's naive.

Amen!

 

[matakanan]

I think you should start with lessons in english grammar.

I agree with u regarding the difficulty in H1 paperwork. But if an USIMG is 'equally qualified' as an IMG such as urself, then the seat should go to a US citizen... why? cause the country should give priority over its own citizens without compromising on quality.
ps.. pointing out errors in one's grammar, is childish and just plain rude.. it gives one the impression that u feel superior because u have a better grasp of the language.. or simply put, it shows that u r a f**king prick.

grammar courses... ok, i'm going to take one in rural india. please give me an address of the perfect indian english school aka "ivyleague"

There are quite a few actually... teach perfect Queen's English (RP pronunciation), although if u r lookng to study a language which some in the US refer to as 'American' , then sorry not even rural Indian schools can help u there.

What happens when an AMG tries to go to India to be a doc?

1) He can pay for his seat at a private college... here money talks, no one cares if u are a foreigner as long as u can shell out the dough.

2) He can get admission into a government college via 'foreign student quota'. A very small percentage of the seats at a govt. college is reserved for foreign students, but if no foreign student claims the seat, the seat is usually handed over to an Indian grad.

 

[Waiting4Ganong]

Some people seem to be suggesting that US-born offshore grads should always be given advantage over IMGs on the basis of extra taxes paid.

What Taxes have US FMGs paid exactly? On the profits from their paper-round when 10yrs old? From tips delivering pizzas in high school? From the 10 dollars an hour they made as an EMT or lab rat after college? Even if they worked a job for 10yrs after college (extreme example) at 40K/yr - the taxes they have paid will be a drop into the ocean compared to the taxes the IMG in Cardiology from India will pay into the system after his/her first few years as an attending in US earning 300-500K/yr.

What we are actually talking about here, is the taxes Mummy and Daddy have paid into the system aren't we? Let's at least be honest about it. Just as Mummy and Daddy let you have a second chance when you didn't get into ANY medical school in your own country - you now want them to give you a third chance - helping you get into a residency over those with better grades, work ethic and natural ability than you.

That is fine. As BKN so rightly said, trying to get one up on people ("never give a sucker an even break" etc) is also part of the rich heritage of America - but at least be honest with yourselves!

People also seem to be suggesting that if you ain't USMD (US born, US medical school) then you are all in the same boat (ie: second class). This just isn't true.

There are AT LEAST four main points on a spectrum worth pointing out:

US born but offshore educated (US FMG)- Strong Background:
Pros: No visa hassle. No cultural barrier. May have done most/all rotations in US hospitals (ie: used to the system). They are at, or almost at, the level of USMDs. Will make fine doctors.
Cons: There is a reason they didn't get into US MD. This reason is trival.

US born but offshore educated (US FMG)- Weak Background:
Pros: No visa hassle. No cultural barrier. May have done most/all rotations in US hospitals (ie: used to the system).
Cons: There is a reason they didn't get into US MD. This reason is not trival. Problems persist.

Non-US born and Non-US educated (IMG) - Strong Background
Pros: May represent some of best doctors in the world (yes - even better than USMDs - can such a thing be true??)
Cons: Visa hassle (require H1s). May not take kindly to being considered second choices. Language/Cultural issues. Racism.

Non-US born and Non-US educated (IMG) - Weak Background*
Pros: Willing to work in Newark/Camden/Detroit etc. Will take J1.
Cons: May find it harder to adapt to new systems than above. Language/Cultural issues. Racism.


*This includes those who didn't get into medical school in their own country.

 

[Waiting4Ganong]

What happens when an AMG tries to go to India to be a doc?

Don't know because it never happens. But as the US system starts to take more people based on merit rather than nationality then hopefully the weaker of the US FMGs will be able to give us an answer to this...

 

[suntoucher]

Non-US born and Non-US educated (IMG) - Weak Background*
Pros: Willing to work in Newark/Camden/Detroit etc. Will take J1.
Cons: May find it harder to adapt to new systems than above. Language/Cultural issues. Racism.

*This includes those who didn't get into medical school in their own country.

how did they get their medical diplomas?
lets say indian person didn't get into medical school in india and then went to i.e. germany?

and where is paragraph for persons who are not US born but got into US medical school?

 

[Waiting4Ganong]

how did they get their medical diplomas?

"Good enough to get Medicine degree" is not = "good doctor" in many places....

lets say indian person didn't get into medical school in india and then went to i.e. germany?

Could happen. Maybe not so often. I don't see your point though. Always exceptions/individuals. Are all German schools > Indian Schools (I doubt it).

and where is paragraph for persons who are not US born but got into US medical school?

I said AT LEAST four groups. You have quite rightly pointed out a (small) 5th group (<<1% of residency applicant pool). I'm not sure what the significance/impact of this group is. US training but potential visa issues. I imagine slightly less "desirable" than USborn and trained MDs because of this. All other things being equal of course.

MY point was just that not all IMG/FMGs are created equal. These terms cover a multitude of sins - from world experts to lazy spoilt rich kids. Thought it might be helpful to point out some of the possible subgroups. If these don't work for you feel free to ignore them.

 

[AspiringPath]

I think that the average AMG is far better trained than IMGs from many other countries. As an IMG, I do not dispute that. I also recognize that every country including the US favors its own citizens and permanent residents in employment. But I do have a problem with US citizens/GC holder IMGs who treat non-US citizen/GC IMGs like me as second class and suggest that those on H1b visas are "dangerous". We perform an important service to several underserved areas and also in leading academic centers that are involved in cutting edge medical/surgical research.

 

[penguins]

My question, what happens when an AMG wants to go to India to be a doc was highly sarcastic.
The US is the only country in the world that is expected to bend over backwards to accept people from other countries. What would happen if I moved to another country and expected a visa, expected everyone to learn my language, expected everyone to make exceptions for my culture and my religion. What would happen if I wanted a medical liscense in your country and complained about the racism.

The commentary about the taxes are ignorant. You bet it matters that our parents paid taxes, you bet it matters that I had taxes taken out of my paycheck when I started working at 16 and of course it matters that it is my home country.
I am not asking for any special treatment because I did pay taxes but for the person who made those crazy comments about how we didn't pay any doesn't understand the system. Everytime we buy a textbook or a carton of milk we are paying taxes.

The OP is an idiot. We can all agree on that.

 

[penguins]

And... I meant going there to set up shop. I know how one gets a seat. Either they earn it or they pay for it.
A very influencial and rich man in India offered to buy me a seat in an Indian med school. I wouldn't have had to pay a dime for tuition or anything. I am sure that something similar happens here as well in US med schools it is just done more undercover.
Admission to US med school can be very political. I am not going to whine about how it is unfair though. I didn't apply.

 

[Waiting4Ganong]

The US is the only country in the world that is expected to bend over backwards to accept people from other countries.

Really? Any evidence base for that statement? At all?

What would happen if I moved to another country and expected a visa,

You'd apply for one - Just like in the US

...expected everyone to learn my language,

Really? If French people come to do US residency does everyone have to speak French to them? That's cool. Also complete make-believe.

Until a year or so ago the US was even making English, New Zealanders and Australian people take a test of English to do a Residency!!!

...expected everyone to make exceptions for my culture and my religion.

Do you have a show on Fox news? How is this relevant to a discussion on selection for medicine residency training places?

What would happen if I wanted a medical liscense in your country and complained about the racism.

Could be true. People in UK often dislike Americans on principle and based on crude stereotypes.

The commentary about the taxes are ignorant.

Really how so. Bear in mind the 100K+ US taxes I've paid so far undoubtedly exceeds what you paid in from your high school 7-11 shifts or whatever. But continue...

You bet it matters that our parents paid taxes,

It matters. It makes them good citizens. Does it matter for residency selection? I really hope not. I hope I never get to the stage where I'm using arguments like this to justify my place in a residency training program. I hope I'd always have a) more pride and b) faith in my ability.

you bet it matters that I had taxes taken out of my paycheck when I started working at 16

Compared to the future taxes a hard working go-getter international graduate will pay in from his 300-500K salary? Not so much.

and of course it matters that it is my home country.

Yes - it gives you an advantage in that you don't need a visa. Helps your case. Anything beyond that you are making the same argument as the OP.

I am not asking for any special treatment because I did pay taxes but for the person who made those crazy comments about how we didn't pay any doesn't understand the system.

Who said you didn't pay any? I just said they were peanuts compared to the amount that hardworking IMG cardiologist is going to pay in.

Everytime we buy a textbook or a carton of milk we are paying taxes.

I paid 6% sales tax and all I got was this residency....

The OP is an idiot. We can all agree on that.

Yep.

 

[penguins]

Really? Any evidence base for that statement? At all?



You'd apply for one - Just like in the US



Really? If French people come to do US residency does everyone have to speak French to them? That's cool. Also complete make-believe.

Until a year or so ago the US was even making English, New Zealanders and Australian people take a test of English to do a Residency!!!



Do you have a show on Fox news? How is this relevant to a discussion on selection for medicine residency training places?



Could be true. People in UK often dislike Americans on principle and based on crude stereotypes.



Really how so. Bear in mind the 100K+ US taxes I've paid so far undoubtedly exceeds what you paid in from your high school 7-11 shifts or whatever. But continue...



It matters. It makes them good citizens. Does it matter for residency selection? I really hope not. I hope I never get to the stage where I'm using arguments like this to justify my place in a residency training program. I hope I'd always have a) more pride and b) faith in my ability.



Compared to the future taxes a hard working go-getter international graduate will pay in from his 300-500K salary? Not so much.



Yes - it gives you an advantage in that you don't need a visa. Helps your case. Anything beyond that you are making the same argument as the OP.



Who said you didn't pay any? I just said they were peanuts compared to the amount that hardworking IMG cardiologist is going to pay in.



I paid 6% sales tax and all I got was this residency....



Yep.

Good job picking things apart line by line. I don't even know where to start. I don't think paying taxes should get you a residency - never said that. And if you understood how the tax system works, you would know that it isn't just about the 6% added on at the end at the register.
And the hardworking US IMG cardiologist would be paying just as much as the IMG cardiologist and not sending a large part of it home every month so they would actually be putting more money into the economy. You can't think about that when given out residency spots obviously because you never know what people's situation is. But to make this about taxes is stupid. I would never make an arguement that paying taxes should get me a residency. Someone else on this forum did that.

When you say "americans" you should realize that you are then referring to everyone in north and south america and I don't think people abroad have the same distain for the rest of the continents as they do for those of us from the US of A. I don't care what they think, it is primarily out of jealousy that they think this anyway so it doesn't mean much. I have extensively travelled all over the world and for the most part, it is true. People from the US are generally louder and more obnoxious in public as well while those from other cultures are usually more well-mannered.

If it is so unfair and there is so much discrimination, then don't come here. Stay in your own country if things are so rough. When my people came to this country they kissed the ground in thankfulness for having the opportunity to come here and never took it for granted. They were discriminated against all the time and took the jobs the dogs wouldn't take. They paid their dues and didn't whine about it.

You know exactly what I mean about the language. The french people know english anyway, they just pretend not to.

I also never said that US-IMGs should have preference over IMGs. I can understand from a program's perspective that it might sometimes be easier to not have to worry about visas, language and cuture but I also know that the more qualified candidate should get the spot.

It would be easy (and was easy) to get a visa to go to India because there aren't that many people applying for one. I just paid my money and got it. I am curious how the locals would treat me if I wanted to do a residency there though.

I fail to see what Fox News has to do with it.

 

[3dtp]

We don't all have fat wallets
What happens when an AMG tries to go to India to be a doc?

I don't know about India, but I do know about Kazakhstan. You have to have a US Medical License. But that is not enough to practice in Kazakhstan. You also have to take a test of Russian and Kazakh. Then you have to take a written exam in Kazakh (sort of like the USMLE). Then you have to travel to Almaty to take an oral exam in Kazakh. Then, depending on the mood of the examiners you may or may not have to take a year of residency/equivalent in a Kazakh hospital. You also have to get permission from the territorial director of health where you want to work, which of course is highly political as well. The pay is about US$100-200/month in practice, subject of course to the national VAT.

Most people in Kazakhstan are bilingual, Russian is the primary language, but many speak German as a second language (or at least before the German reunification) or Kazakh in the more rural communities away from Almaty, Astana and Karaganda. Since Russian is the language of commerce, knowledge of Kazakh is not particularly useful except in smaller communities, but there is a political movement on the part of Kazakhstan to recapture its traditional pre-Czarist language and traditions. So, if you want to take the tests, you have to learn Kazakh. Kazakh is harder to learn for a native English speaker than Russian or German.

Concerning taxes. I think they matter, a lot. Those taxes are what helped build America, and British taxes are what convinced Americans that British tea is better off in Boston Harbor, than in our teacups.

I have, in my lifetime, paid far more taxes than my parents did, since my parents were rural, not wealthy, and did not have large incomes. Yes, I paid taxes from my paper route as a kid, then as a scientist for years before med school, and those taxes built up the infrastructure which is our heritage. And in the year before med school, I paid more income tax, than my entire first two year's salary. Not to mention real estate, sales, excise and road taxes. Same in England, Canda and Europe and to lessor extents in many countries. These taxes, whether they be in England, or Mexico or Kazakhstan or India, or whereever, went to build their respective countries' infrastructures or whatever their political leadership decided to do with the money, sometimes, perhaps frequently, to the dismay of their citizens.

While it would be nice to have no borders, our competing economic structures and policies do not support this at the present. Therefore, our first obligation is to our own. To some extent, this must be the case, here, just as elsewhere. We have a system that does allow for controlled immigration, which is rife with loopholes and escape clauses, so one might say that only the truely brightest immigrants can navigate it, but then some just walk across the borders in the dead of night in the desert, learn the system and expect America to take care of their every need, which, to a large extent, we do.

The issue was touched on by another poster. There is a perceived or real demand for services, and a shortage or surplus of supply for those services, depending on who's survey one choses to believe this week. The issue is not isolated to medicine, but medicine, science and engineering are the most significant and visible exceptions to the normal visa quotas.

So, I think that cultural and national "memory" as emphasized by our nation, education and heritage is important to consider in awarding jobs, training positions and prospects for future employment. We have a system that even Waiting4 acknowledges has worked very well, and has made us both the envy and the target of the world. So, we tread a fine balance, and we daren't dilute this national memory too much or we will lose it.

What is the best solution? I truely don't know, and don't think the answer will be apparent as long as there are economic and societal inequities in the world. And those will probably continue for as long as we inhabit the world.

So, US nationals fear competition and rightly so, which should motivate us to enhance our skills. But, it is precisely that competition which has helped make this a great nation. Foreign nationals want to come here for the reasons Waiting4 so articulately elucidated early in this thread. I think there's room for both. I also think we need to be balanced, lest we follow the path of the Roman Empire into oblivion.

 

[Waiting4Ganong]

3dtp, That was an awesome post!

If everyone on SDN was a thoughtful as this I think we'd have a real resource here...

I don't know about India, but I do know about Kazakhstan. You have to have a US Medical License. But that is not enough to practice in Kazakhstan. You also have to take a test of Russian and Kazakh. Then you have to take a written exam in Kazakh (sort of like the USMLE). Then you have to travel to Almaty to take an oral exam in Kazakh. Then, depending on the mood of the examiners you may or may not have to take a year of residency/equivalent in a Kazakh hospital. You also have to get permission from the territorial director of health where you want to work, which of course is highly political as well. The pay is about US$100-200/month in practice, subject of course to the national VAT.

Most people in Kazakhstan are bilingual, Russian is the primary language, but many speak German as a second language (or at least before the German reunification) or Kazakh in the more rural communities away from Almaty, Astana and Karaganda. Since Russian is the language of commerce, knowledge of Kazakh is not particularly useful except in smaller communities, but there is a political movement on the part of Kazakhstan to recapture its traditional pre-Czarist language and traditions. So, if you want to take the tests, you have to learn Kazakh. Kazakh is harder to learn for a native English speaker than Russian or German.

Concerning taxes. I think they matter, a lot. Those taxes are what helped build America, and British taxes are what convinced Americans that British tea is better off in Boston Harbor, than in our teacups.

I have, in my lifetime, paid far more taxes than my parents did, since my parents were rural, not wealthy, and did not have large incomes. Yes, I paid taxes from my paper route as a kid, then as a scientist for years before med school, and those taxes built up the infrastructure which is our heritage. And in the year before med school, I paid more income tax, than my entire first two year's salary. Not to mention real estate, sales, excise and road taxes. Same in England, Canda and Europe and to lessor extents in many countries. These taxes, whether they be in England, or Mexico or Kazakhstan or India, or whereever, went to build their respective countries' infrastructures or whatever their political leadership decided to do with the money, sometimes, perhaps frequently, to the dismay of their citizens.

While it would be nice to have no borders, our competing economic structures and policies do not support this at the present. Therefore, our first obligation is to our own. To some extent, this must be the case, here, just as elsewhere. We have a system that does allow for controlled immigration, which is rife with loopholes and escape clauses, so one might say that only the truely brightest immigrants can navigate it, but then some just walk across the borders in the dead of night in the desert, learn the system and expect America to take care of their every need, which, to a large extent, we do.

The issue was touched on by another poster. There is a perceived or real demand for services, and a shortage or surplus of supply for those services, depending on who's survey one choses to believe this week. The issue is not isolated to medicine, but medicine, science and engineering are the most significant and visible exceptions to the normal visa quotas.

So, I think that cultural and national "memory" as emphasized by our nation, education and heritage is important to consider in awarding jobs, training positions and prospects for future employment. We have a system that even Waiting4 acknowledges has worked very well, and has made us both the envy and the target of the world. So, we tread a fine balance, and we daren't dilute this national memory too much or we will lose it.

What is the best solution? I truely don't know, and don't think the answer will be apparent as long as there are economic and societal inequities in the world. And those will probably continue for as long as we inhabit the world.

So, US nationals fear competition and rightly so, which should motivate us to enhance our skills. But, it is precisely that competition which has helped make this a great nation. Foreign nationals want to come here for the reasons Waiting4 so articulately elucidated early in this thread. I think there's room for both. I also think we need to be balanced, lest we follow the path of the Roman Empire into oblivion.

 

[Waiting4Ganong]

I, of course(!), still disagree however and think that you can't have the benefits of globalization, open markets for US goods and services and the benefits of talented immigrant influx while also imposing restrictions on entry into specific areas of the labor market or other protectionist practices.

I'd consider that "both trying to have your cake and eat it" to use an English phrase.

You suggest a good point - net US immigration is massively inwards (both unofficial and official). While there is competition for finite resources (16,000 residency places in this case, top jobs etc etc) there is no realistic secondary market for those medical graduates in US who don't make the cut when compared to these talented IMG newcomers (hence the whine of the OP etc). I personally feel this is due to excessive tuition fees (and hence loans) and inflated salary expectations for all "locked" (in reality or perception, ie: by AMG education or birth) into the US physician labor market.

Firstly, Medical students can't very well going into nursing work say the way that lawyers who don't make the grade may go into banking or industry.

Secondly, those with US birth or medical training face many difficulties in training practicing in non-US countries (Loans, Salary Expectations, and the mismatch between training systems in other countries).

This lack of a "secondary market" leaves those who believe themselves "locked into" the US system but unable to get a residency against a talented pool of IMGs basically between a rock and a hard place.

Given US undergraduate medical training is such big business and that most providers also offer residency training - there is a vested interest to make sure their 300,000 dollar customers (AMGs) are shielded from competition from those who bought the other guy's product (US FMGs, IMGs etc).

One way to do this is to make US education better than elsewhere, test those standards nationally, and make all those from elsewhere also meet those high standards before being allowed to join the labor pool. This drives quality upwards and I hope all would agree is a good thing.

The second way to do this is to put additional barriers in the way of those from outside. This doesn't raise standards but instead creates an "us and them" bunker mentality (that can be seen so often in SDN!). I think this is cheap and it devalues the system in the eyes of many.

Sorry if jibberish - written in fits and starts between work....

W4G.

 

[penguins]

Great post 3dtp!
So the US isn't the only place that makes people go through a red tape to get a residency.

Excuse me, Waiting4Gong, “protectionist practices” ????? We should just let anybody in no matter what – is this what you think we should do? This is already happening in Europe because of their rapidly dwindling population and that policy has not been beneficial to them.

US Med school graduates getting the first dibs on spots isn't really an issue, I can't imagine anyone arguing that they shouldn't be first in line. It is their system and their country, HELLO! Diversity and immigration is part of what made this country great... sorry to break it to you but their grandparents did get here first.

IMGs take a risk, an admirable risk, by sitting for the exams and going through the application process. It is still a money and opportunity issue. I know that many of them really scrape together the money and time, etc but there may have been an even better applicant out there who wasn't able to do so. I don't know that I would be up to that kind of sacrifice and I admire those who did. I still think they should be very thankful for the opportunity, however.

US IMGs take a risk as well, just a different kind of risk.

There already are options for those that don't make it as a physician. They couldn't and shouldn't be a nurse instead as you suggest because that requires a different kind of training and a different type of licensing. There are crappy doctors out there just as there are bad apples in every field. Taking a set of exams doesn't mean you will be great in your field. I fail to see how “opening up” the market would make any difference. Just as I have encountered a few poor US grads in residencies/practice I have also encountered some crappy IMGs. Did they get into the system because they were the best of the best? Obviously not. Most of the IMGs I know are steller, absolutely steller, but many others can hardly speak the language, have many cultural barrier issues and don’t know much of the basic things a 3rd year med student should know.

This “bunker mentality” that you speak of is generated more by people like you than the AMGs themselves. A little bit of gratitude rather than this holier-than-thou attitude would go a long way.

 

[Waiting4Ganong]

HELLO! Diversity and immigration is part of what made this country great... sorry to break it to you but their grandparents did get here first.

This is the best line I've ever heard on SDN!

A little bit of gratitude rather than this holier-than-thou attitude would go a long way.

Gratitude? For what exactly? And from whom? As you seem to be directing this at me I should point out that I'm certainly not considering the US for residency training. I do have a conflict of interest however in that I want the doctors treating my family (who all live in US these days) in times of need to have earned their positions from being the best of the best rather than simply having been born with the right passport.

Anyway. I think I've said all I want to on this matter.




The Summary for those keeping score:

The IMG (W4G) thinks all should be judged solely on merit.

The US FMG (Penguins) thinks US nationals should get preference.

The AMG (3dtp) gives a balanced and realistic assessment.

And back in post 82 Yaah summed all the above up nicely.


Oh, and the OP is an idiot.

 

[penguins]

No.... I think the US medical school graduates should get preference!!!

 

[penguins]

Oh, Yaah posted #82, and I agree with him.
Waiting4Gong, I don't like you. But thanks for the compliment, I thought it was a good line too.