FMGs dirty little secret

[evenflowcarter]

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[Farmacist2011]

It does matter which is why I always ask where someone graduated when I go a new doctor. Friendly conversation when we first meet. If those less qualified FMG can do that then I do not see why a D.O could not make the change. If D.O > MBBS, but MBBS = MD then D.O = MD

 

[kcin]

It does matter which is why I always ask where someone graduated when I go a new doctor. Friendly conversation when we first meet. If those less qualified FMG can do that then I do not see why a D.O could not make the change. If D.O > MBBS, but MBBS = MD then D.O = MD

DO > MBBS && MBBS = MD ===> DO > MD

Fix your logic!!!

 

[JaggerPlate]

1. It was my understanding that the equal conversion of MBBS -> MD in the US was coming to an end. In fact, I'm pretty sure certain states like NY now force all docs, MD, DO, or MBBS to state their degree EARNED for all official purposes.

2. It was also my understanding that a. These docs had to pass all 3 steps of USMLE in order to use the MD and not the MBBS, and b. that this still didn't have any real effect on residency training, meaning they would still essentially have to complete an ACGME accredited residency to practice legitimately. In my mind, passing all 3 aspects of step and completing a residency probably makes it legit.

3. I also think that most MBBS from other countries aren't in the league of US IMGs who are US citizens but got a degree from the Caribbean. Most of these people were top of their class/respective fields in their country, but decided to come over here and now have to essentially start all over again, but can still bring a ton of knowledge, experience, and definitely aptitude.

4. I do agree however that ACGME residency positions should be reserved/given preference to individuals graduating from US medical schools. Although, it does essentially seem to be how it is now.

 

[JaggerPlate]

DO > MBBS && MBBS = MD ===> DO > MD

Fix your logic!!!

LOL. Don't share your findings in pre-allo, they'll shank you for that kind of talk up there.

 

[Colbert]

1. It was my understanding that the equal conversion of MBBS -> MD in the US was coming to an end. In fact, I'm pretty sure certain states like NY now force all docs, MD, DO, or MBBS to state their degree EARNED for all official purposes.

2. It was also my understanding that a. These docs had to pass all 3 steps of USMLE in order to use the MD and not the MBBS, and b. that this still didn't have any real effect on residency training, meaning they would still essentially have to complete an ACGME accredited residency to practice legitimately. In my mind, passing all 3 aspects of step and completing a residency probably makes it legit.

3. I also think that most MBBS from other countries aren't in the league of US IMGs who are US citizens but got a degree from the Caribbean. Most of these people were top of their class/respective fields in their country, but decided to come over here and now have to essentially start all over again, but can still bring a ton of knowledge, experience, and definitely aptitude.

4. I do agree however that ACGME residency positions should be reserved/given preference to individuals graduating from US medical schools. Although, it does essentially seem to be how it is now.

Agree with the points above (although I don't know anything about point #1).

Most of these MBBS from India or Pakistan or where ever else they come from are the respective cream of their crop. A lot of them have functioned at the attending level in their countries yet they still come here and complete a full residency so that they can practice in America. It could even be argued that after all of this they are more trained than US MD/DO.

Any this is by no means a "dirty little secret." This is well known. I don't know where all the MD-envy has come from lately in this forum. You graduated from medical school. You're a physician. Be proud of yourself.

 

[Igor4sugry]

I agree with above post. FMGs are cream of the crop; and they know their stuff cold. Imagine, they are competing with the whole world to get into an American residency program. Who cares what their title is back home, their knowledge base is solid.

Most of them already completed an internship year to graduate from their home program.

 

[MedStudentWanna]

2. It was also my understanding that a. These docs had to pass all 3 steps of USMLE in order to use the MD and not the MBBS, and b. that this still didn't have any real effect on residency training, meaning they would still essentially have to complete an ACGME accredited residency to practice legitimately. In my mind, passing all 3 aspects of step and completing a residency probably makes it legit.

But using that logic, then DOs should be allowed to do the same. If they complete all three steps and an ACGME residency, they should be allowed the option of calling themselves an MD, the way an MBBS is (and I think that's the OP's point).

I've said before that if a DO really wants to do this, I think he/she would have a good legal argument to make.

 

[evenflowcarter]

heh.. obviously you have never worked with IMGs as residents. I won't spoil it for you.

 

[JaggerPlate]

But using that logic, then DOs should be allowed to do the same. If they complete all three steps and an ACGME residency, they should be allowed the option of calling themselves an MD, the way an MBBS is (and I think that's the OP's point).

I've said before that if a DO really wants to do this, I think he/she would have a good legal argument to make.

I could be wrong, but wouldn't it have more to do with the MBBS not being recognized in the states, but the ACGME understanding what it means and giving the MBBS the opportunity to take all 3 steps and complete a residency with a legitimized degree (in this case, the MD)?

Since the DO is recognized in all 50 states as the complete equivalent, it seems like changing the designation by completing ACGME would be kind of pointless. I dunno though, I guess if you really wanted to make that argument, you could.

I guess at this point in my career, I just don't see the point. It's pretty crucial that DOs are able to sit for the USMLE and complete ACGME residencies as is (we'd be SOL if they closed this up as there are only about 1/3 AOA spots per students), so being BC by an AMBS board after completing an ACGME residency as a DO seems like a pretty good deal all around, and I don't know if going by 'MD' as well is really necessary in this case.

Keep in mind though that I'm a 1st year medical student, and don't pretend, by any means, to know how I'll feel about it in four years, the way it all works, etc.

 

[JaggerPlate]

heh.. obviously you have never worked with IMGs as residents. I won't spoil it for you.

IMG =/= FMG

IMG is an American citizen who went to a foreign medical school (Caribbean)

FMG is a citizen from a different country who went to medical school there, and went through the steps of essentially completing residency again here in the US to practice in America.

Sorry if I misunderstood what you were getting at.

 

[DrWBD]

heh.. obviously you have never worked with IMGs as residents. I won't spoil it for you.

I have. (Both American and foreign). I have worked with FMGs in residency who were some of the best physicians I have ever encountered, and I have no issue referring my patients to them now. Others, on the other hand, were terrible. But generalizing that all FMGs are inferior physicians is incorrect IMHO. I've seen just as much mediocrity, if not more, among many of the osteopathic physicians in my community.

 

[evenflowcarter]

IMG =/= FMG

IMG is an American citizen who went to a foreign medical school (Caribbean)

FMG is a citizen from a different country who went to medical school there, and went through the steps of essentially completing residency again here in the US to practice in America.

Sorry if I misunderstood what you were getting at.

yes i meant fmg, and the img are far superior to the fmg. in my experience (university setting) the language, cultural, and patient management barriers are extremely frustrating to deal with as a fellow resident (especially cleaning up patient messes.) granted my experience could merely be a stereotype, i challenge you to regard all fmg as amazing and superior (a vast number of fmg are fresh out of medical school with no formal specialty training.) Would love to hear back about that. however, the specialty trained fmgs i have dealt with, have also disappointed me while some have dazzled me.

using the reasoning described in previous posts, if DO's have taken all the usmle steps (as I have), they should be eligible to have an MD equivalent.

that said, i still have the same opportunities as md's, just do in part to being at an allopathic university residency

appreciate your thoughts

 

[DocEspana]

yes i meant fmg, and the img are far superior to the fmg.

nooooo I think you misunderstood Jagger. I believe he was stating (and i will agree with him) that foreign born foreign trained FMGs tend to be much more proficient doctors than american born foreign trained IMGs.

I've heard this anecdote from classmates in their clinical years (since at bronx lebanon the residents are half IMGs and half FMGs at most basic departments). Heard it from doctors (again, most explicitly from the staff we have from bronx lebanon, but also from a few other docs). And have seen studies that say the same thing. Health Affairs journal recently (august 2010) published a huge study on the negative outcome rates of doctors of different trainings in emergency medicine.

US-MDs and DOs finished basically identically. FMGs finished identically as well (without even needing any of that "within margin of error" garbage) The IMGs (american citizens trained overseas) had a significantly higher rate of negative outcomes when compared to any other group though and fell well outside of the other three groups on performance in the ER.

 

[tkim]

I could be wrong, but wouldn't it have more to do with the MBBS not being recognized in the states, but the ACGME understanding what it means and giving the MBBS the opportunity to take all 3 steps and complete a residency with a legitimized degree (in this case, the MD)?

All of the foreign degrees that are vetted through the ECFMG and allowed to take the USMLE are then allowed to apply for unrestricted medical licenses. It does not award you the MD degree. You can absolutely obtain a medical license to practice using your foreign degree so long as it is ECFMG certified and you pass the USMLE and complete a ACGME residency.

People practice using the foreign degree on a regular basis.

What some people with foreign degrees tend to do is 'tack' on the MD after their MBBS, for better recognition, although they have not earned an MD - in the US or back in their home country.

 

[JaggerPlate]

nooooo I think you misunderstood Jagger. I believe he was stating (and i will agree with him) that foreign born foreign trained FMGs tend to be much more proficient doctors than american born foreign trained IMGs.

Yeah, that's essentially what I was trying to get at. However, I think flow is saying that he understands, but disagrees and in his experience (working with IMGs and FMGs) there are some definite issues with simply defining FMGs as all great doctors who were top of the field in their country and simply came here to practice. I think he's saying he sees issues with language barriers, individuals who didn't really complete a formal residency in their home country, etc.

Again, like you said, I've always heard the opposite (FMG >> IMG), but I really don't have the clinical experience to make blanket statements, so I'll just soak up experienced opinions on the matter.

All of the foreign degrees that are vetted through the ECFMG and allowed to take the USMLE are then allowed to apply for unrestricted medical licenses. It does not award you the MD degree. You can absolutely obtain a medical license to practice using your foreign degree so long as it is ECFMG certified and you pass the USMLE and complete a ACGME residency.

People practice using the foreign degree on a regular basis.

What some people with foreign degrees tend to do is 'tack' on the MD after their MBBS, for better recognition, although they have not earned an MD - in the US or back in their home country.

So, if they can become licensed and still use the MBBS, why do they even have the option to use the MD?

 

[tkim]

So, if they can become licensed and still use the MBBS, why do they even have the option to use the MD?

I don't know if such an option really exists, and that most MBBS simply list themselves as "MD" on their yellow pages listing and advertising signs as to increase recognition, though they technically they were never awarded that degree.

I know in NY where I trained, a foreign medical degree holder who had a NY license could apply to be awarded the NY Regents MD degree, which would allow them to legally call themselves 'MD'. It involved paperwork and a fee, but if it increased your visibility, I'd do it as the cost of increasing your business. But then again, plenty of people using their MBBS alone.

 

[JaggerPlate]

I don't know if such an option really exists, and that most MBBS simply list themselves as "MD" on their yellow pages listing and advertising signs as to increase recognition, though they technically they were never awarded that degree.

I know in NY where I trained, a foreign medical degree holder who had a NY license could apply to be awarded the NY Regents MD degree, which would allow them to legally call themselves 'MD'. It involved paperwork and a fee, but if it increased your visibility, I'd do it as the cost of increasing your business. But then again, plenty of people using their MBBS alone.

If this is true, then I think flowcarter actually has a bit of a point with regard to DOs not having the same luxury. Granted, I still don't think it's necessary, but it seems odd that the MBBS would be able to earn one degree and technically use another, but not DOs?

 

[tkim]

If this is true, then I think flowcarter actually has a bit of a point with regard to DOs not having the same luxury. Granted, I still don't think it's necessary, but it seems odd that the MBBS would be able to earn one degree and technically use another, but not DOs?

Actually, no, he doesn't. People with foreign medical degrees who use the 'MD' without being awarded one, and without the blessing of their state's medical licensing board are giving themselves a degree that they didn't earn and legally cannot use. It may not be right, but no one's going to go after those people and make them change their business cards and signage.

The USDO is a US degree, not foreign, so the comparison fails. A closer comparison is a dentist wanting to change from DDS to DMD (osteopathic purists, spare me arguments that blossom in your tiny bossums regarding the comparison). Both US degrees, no practice advantage.

Where the argument stands is whether a foreign medical holder is justified in using the 'MD' title in order to clear confusion and increase business. If so, then shouldn't the DO also be allowed to advertise that way as well? Again, unless there is a specific allowance by state licensing board for people to call themselves MD with a foreign MBBS then they do so illegally, as would any DO who puts MD on business cards or signage.

I don't know of any instance where a MBBS is legally allowed to call themselves MD. In NY it it illegal to do so. I would love to see other states laws regarding this - specifically one where a non-MD foreign degree holder can legally call themselves MD in that state. I have a feeling there won't be.

 

[Lokhtar]

Um, MBBS = MD. If you transported your medical school to India, and had the same curriculum, you'd get a MBBS at the end of your four years + an internship year. The US simply decided to award a doctoral degree at the end instead of the traditional bachelor's of medicine and surgery. That's why it's still called 'undergraduate medical education'.

In the US, you don't get another degree when you complete residency, so that's the difference but it's still called 'Graduate Medical Education'.

If you graduate with MBBS and move to America (and pass the USMLE, ECFMG requirements), it's the same as earning the MD. Also, good luck getting into an Indian medical school. If you think competition here is bad, for All India Institute of Medical Science, this is the acceptance rate:

The acceptance rate for admission to the undergraduate course (medical school) is thus 72/90000 i.e. 0.08%

Good luck and have fun trying. It's not inferior by any sense of the imagination.

USMD = USDO = MBBS. Get over it - it only matters if you're a pre-med who cares about prestige.


EDIT: Assuming they've paid the state licences and whatever that's needed to make it legal for them to advertise as such. The reason USDO cannot advertise as USMD is because the AOA (American Osteopathic Association) is the one who says that the degrees are different and want to maintain their uniqueness. There are no MBBS granting schools in the US, so it makes sense that they can advertise based on their skillset rather than a degree no one recognizes.

 

[MedStudentWanna]

Um, MBBS = MD. If you transported your medical school to India, and had the same curriculum, you'd get a MBBS at the end of your four years + an internship year. The US simply decided to award a doctoral degree at the end instead of the traditional bachelor's of medicine and surgery. That's why it's still called 'undergraduate medical education'.

I could easily argue that if you transported your DO school to an MD one, you'd get an MD and vice versa. DO schools simply decided to add a component heavy in musculoskeletal manipulation. That's why it's called a DO degree. Your point fails.

In the US, you don't get another degree when you complete residency, so that's the difference but it's still called 'Graduate Medical Education'.

You don't get a different degree when you complete residency in the UK either, so what's your point?

If you graduate with MBBS and move to America (and pass the USMLE, ECFMG requirements), it's the same as earning the MD.

Again, I could argue that if you graduate med school, pass the USMLE, and do an ACGME residency, it's the same as earning an MD.

USMD = USDO = MBBS. Get over it - it only matters if you're a pre-med who cares about prestige.

No one on this thread is a pre-med, so don't annoint yourself arbiter of what matters and allow people the discussion.

EDIT: Assuming they've paid the state licences and whatever that's needed to make it legal for them to advertise as such. The reason USDO cannot advertise as USMD is because the AOA (American Osteopathic Association) is the one who says that the degrees are different and want to maintain their uniqueness.

The same logic that goes into requiring TRI years in some states. The AOA is the fall of the DO degree.

 

[Lokhtar]

I could easily argue that if you transported your DO school to an MD one, you'd get an MD and vice versa. DO schools simply decided to add a component heavy in musculoskeletal manipulation. That's why it's called a DO degree. Your point fails.

I'm not a DO student. And you certainly could get an MD degree. There is no difference in the basic sciences. The DO degree exists as a separate entity because they choose it, and they choose to add on OMM. The AOA is the one against a degree change. I have no issue with people taking the USMLE's, going into ACGME residencies, and graduating with a 'MD' if thats what the schools start granting.

You don't get a different degree when you complete residency in the UK either, so what's your point?

The point is that the education is the same, and since there are no MBBS granting schools in the US - it makes sense for them to advertise as an equivalent degree to avoid patient confusion.

Again, I could argue that if you graduate med school, pass the USMLE, and do an ACGME residency, it's the same as earning an MD.

And I don't disagree with you. I would have no problems with that if the AOA decided that. I don't consider the degree as inferior. I do have some issues with things like cranial, but virtually no DO graduate practices those things so for all practical purposes, it's identical.

 

[Pansit]

I learned something new today.

Most foreign medical colleges overseas (india, china, UK) award MBBS or MchBch as their medical degree title.

In india, in order to be designated as MD you must do a 3 year residency excluding internship, however, nearly all medical students applying have not done a formal residency in order to earn that title and simply have their MBBS.

However...

When they come to the US for residency, they change their title from MBBS to MD because it is argued that since they passed all the steps they their degree equals the american equivalent -MD (you may see an occasional MBBS.)

As a DO, I have a problem with this. Their training is certainly not on par with and American medical grad MD or DO for that matter, and they haven't truely earned MD, however, this new title grants them the same esteem as an AMG, while us DO's are left with discrimination.

This is on top of the fact that medical tuition is rougly 5 percent of what we pay here.

What are you thoughts? Does it even matter? Sorry for random rant.

I am down for letting FMG's designate themselves as DO's if they want to. They definitely deserve whatever title they want with their 99% percentile step 1 and step 2 scores, on top of being the top students at their respective medical schools...I mean...some of the FMG's I have worked with can quote chapter, page, and paragraph from Harrisons...

 

[RetinaTazer]

I am down for letting FMG's designate themselves as DO's if they want to. They definitely deserve whatever title they want with their 99% percentile step 1 and step 2 scores, on top of being the top students at their respective medical schools...I mean...some of the FMG's I have worked with can quote chapter, page, and paragraph from Harrisons...

MOST FMGs are in the top of their countries and thus able to pass rigourous medical licensing. I did open a discussion to open OGME doors to MDs and FMGs in some of my publications.

 

[dozitgetchahi]

All of the foreign degrees that are vetted through the ECFMG and allowed to take the USMLE are then allowed to apply for unrestricted medical licenses. It does not award you the MD degree. You can absolutely obtain a medical license to practice using your foreign degree so long as it is ECFMG certified and you pass the USMLE and complete a ACGME residency.

People practice using the foreign degree on a regular basis.

What some people with foreign degrees tend to do is 'tack' on the MD after their MBBS, for better recognition, although they have not earned an MD - in the US or back in their home country.

No. In at least some states (for example PA), a foreign MBBS really does earn an "MD" degree that is issued by the state board post-American residency completion. I saw this "MD" diploma (and a set of ancillary certifications) hanging in the office of an Egyptian-trained doc in PA once. This guy's MBBS was nowhere to be found, but his "MD" was proudly displayed, and all of his signage, documents, etc refer to him as "Doc X, MD". I also know some other people who decided to go to the University of Guadalajara for medical school, and they are all making sure they precisely follow the steps for their MBBS to be converted to an MD for American practice.

I understand this is changing in some other states (NY), but it still is this way elsewhere.

 

[DD214_DOC]

No. In at least some states (for example PA), a foreign MBBS really does earn an "MD" degree that is issued by the state board post-American residency completion. I saw this "MD" diploma (and a set of ancillary certifications) hanging in the office of an Egyptian-trained doc in PA once. This guy's MBBS was nowhere to be found, but his "MD" was proudly displayed, and all of his signage, documents, etc refer to him as "Doc X, MD". I also know some other people who decided to go to the University of Guadalajara for medical school, and they are all making sure they precisely follow the steps for their MBBS to be converted to an MD for American practice.

I understand this is changing in some other states (NY), but it still is this way elsewhere.

I'm not sure how this is possible since state medical boards don't award degrees.

 

[dozitgetchahi]

I'm not sure how this is possible since state medical boards don't award degrees.

http://www.op.nysed.gov/prof/med/med-mdconferral.htm

"The Board of Regents is empowered to confer the M.D. degree on New York licensees who meet specific requirements.

To be eligible, you must:

1) have completed a medical education program in a foreign medical school, satisfactory to the department, which does not grant the degree doctor of medicine (M.D.) and in which the philosophy and curriculum were equivalent, as determined by the department, in accordance with the policy of the Board of Regents, to those in programs leading to the degree of doctor of medicine (M.D.) at medical schools in the United States satisfactory to or registered by the Board of Regents and the department;"

 

[tkim]

http://www.op.nysed.gov/prof/med/med-mdconferral.htm

"The Board of Regents is empowered to confer the M.D. degree on New York licensees who meet specific requirements.

To be eligible, you must:

1) have completed a medical education program in a foreign medical school, satisfactory to the department, which does not grant the degree doctor of medicine (M.D.) and in which the philosophy and curriculum were equivalent, as determined by the department, in accordance with the policy of the Board of Regents, to those in programs leading to the degree of doctor of medicine (M.D.) at medical schools in the United States satisfactory to or registered by the Board of Regents and the department;"

The NYS State Board of Regents is not the state medical board. I should know this, since I am licensed in NY.

 

[tkim]

No. In at least some states (for example PA), a foreign MBBS really does earn an "MD" degree that is issued by the state board post-American residency completion. I saw this "MD" diploma (and a set of ancillary certifications) hanging in the office of an Egyptian-trained doc in PA once. This guy's MBBS was nowhere to be found, but his "MD" was proudly displayed, and all of his signage, documents, etc refer to him as "Doc X, MD". I also know some other people who decided to go to the University of Guadalajara for medical school, and they are all making sure they precisely follow the steps for their MBBS to be converted to an MD for American practice.

I understand this is changing in some other states (NY), but it still is this way elsewhere.

I'd really like to see something in writing that backs this up.

 

[dozitgetchahi]

The NYS State Board of Regents is not the state medical board. I should know this, since I am licensed in NY.

Ok, so perhaps it isn't the "state medical board". I may have misunderstood the Egyptian doc I spoke of earlier when I discussed this with him. However, the general point I made - that there is a governmental entity in at least one state that is capable of conferring MD degrees on graduates of foreign medical schools - still stands. Did you even read the link I posted above?

 

[tkim]

Ok, so perhaps it isn't the "state medical board". I may have misunderstood the Egyptian doc I spoke of earlier when I discussed this with him. However, the general point I made - that there is a governmental entity in at least one state that is capable of conferring MD degrees on graduates of foreign medical schools - still stands. Did you even read the link I posted above?

You mean:

http://forums.studentdoctor.net/showthread.php?p=10558590&post10558590

http://forums.studentdoctor.net/showpost.php?p=9966091&postcount=31

http://forums.studentdoctor.net/showpost.php?p=8670210&postcount=12

http://forums.studentdoctor.net/showpost.php?p=8922845&postcount=116

http://forums.studentdoctor.net/showpost.php?p=7718727&postcount=37

and, not to mention post #17 in this very thread:

http://forums.studentdoctor.net/showpost.php?p=10608258&postcount=17

You are missing the point, and that is, that people with the MBBS do not automatically get 'MD' to throw on their name, like the OP suggested. In the case of NY, you have to be licensed in that state and apply and pay a fee. And in order to get a license, in NY you have to complete residency in the US.

This is vastly different from someone automatically changing their MBBS to MD as soon as they hit US soil. NY is the only state I've heard that you can apply for another degree to be awarded. You say PA does too, I'd love to see a link to that.

 

[MSmentor018]

Health Affairs journal recently (august 2010) published a huge study on the negative outcome rates of doctors of different trainings in emergency medicine.

US-MDs and DOs finished basically identically. FMGs finished identically as well (without even needing any of that "within margin of error" garbage) The IMGs (american citizens trained overseas) had a significantly higher rate of negative outcomes when compared to any other group though and fell well outside of the other three groups on performance in the ER.

can you send/attach the PDF for this? I don't have access to health affairs journal at the library. I did a retrospective analysis on a similar subject in the ER. I would love to read this review esp since it's rank list time and I am doing a part 2 to the study

 

[MSmentor018]

University of Guadalajara for medical school, and they are all making sure they precisely follow the steps for their MBBS to be converted to an MD for American practice.

I can assure you, because it's hanging on my wall, you don't get a MBBS from guad. it's an MD degree of medicine and surgery on dark brown leather parchment, then you do the 5th pathway program and then they award you the title "completion of 5th pathway from NY medical college" but it's always been MD

 

[JaggerPlate]

it's an MD degree of medicine and surgery on dark brown leather parchment

Sounds epic.

 

[MSmentor018]

Sounds epic.

I think it's pigskin but I didn't want PETA to get into this discussion!