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[McGillGrad]

I am not familiar with this "pimping" that you were doing. Would you care to elaborate.

And congrats on schooling a snob.

 

[AmericanIMG]

pimping is when you are questioned from an older collegue (doctor, MSIII, resident, intern, etc). happens all the time on scrubs during rounds when dr kelso asks the group what the ailments are

 

[BellKicker]

Is pimping negative by definition? I hate working with docs who never ever ask a single question.

Then again, we have lecturers who'll point their little laser pen at someone at the back of the auditorium and shout out questions like "what's a normal ferritin value?". I hate that stuff.

 

[meanderson]

I don't understand the point of an M1 shadowing an M3 at all. In my opinion the "clinical experience" during the M1 year should consist of classes on practical technical skills. These can be done on site and taught by clinical skills instructors in small groups. I just don't see the point of a 1st year "shadowing" an m3.

 

[Finally M3]

Wow...you were pimping a MSI. You must be very happy as an almost 4th year finishing most of your core clinical rotations pimping a first year with no clinical experience at all.

Are you going to start picking fights outside of elementary schools as well?

 

[tkim]

Originally posted by McGillGrad
I am not familiar with this "pimping" that you were doing. Would you care to elaborate.

And congrats on schooling a snob.

http://www.neonatology.org/pearls/pimping.html

The Art of Pimping
by Frederick L. Brancati, MD, Department of Medicine, University of Pittsburgh.
From JAMA 262(1):89, July 7, 1989.

--------------------------------------------------------------------------------

[...] Pimping occurs whenever an attending poses a series of very difficult questions to an intern or student. The earliest reference to pimping is attributed to Harvey in London in 1628. He laments his students' lack of enthusiasm for learning the circulation of the blood: "They know nothing of Natural Philosophy, these pin-heads. Drunkards, sloths, their bellies filled with Mead and Ale. O that I might see them pimped!"

In 1889, Koch recorded a series of "Puempfrage" or "pimp questions" he would later use on his rounds in Heidelberg. Unpublished notes made by Abraham Flexner on his visit to Johns Hopkins in 1916 yield the first American reference: "Rounded with Osler today. Riddles house officers with questions. Like a Gatling gun. Welch says students call it 'pimping.' Delightful."

On the surface, the aim of pimping appears to be Socratic instruction. The deeper motivation, however, is political. Proper pimping inculcates the intern with a profound and abiding respect for his attending physician while ridding the intern of needless self-esteem. Furthermore, after being pimped, he is drained of the desire to ask new questions -- questions that his attending may be unable to answer. In the heat of the pimp, the young intern is hammered and wrought into the framework of the ward team. Pimping welds the hierarchy of academics in place, so the edifice of medicine may be erected securely, generation upon generation. Of course, being hammered, wrought, and welded may, at times, be somewhat unpleasant for the intern. Still, he enjoys the attention and comes to equate his initial anguish with the aches and pains an athlete suffers during a period of intense conditioning.

Despite its long history and crucial importance in training, pimping as a medical art has received little attention from the educational establishment. A recent survey reveals that fewer than 1 in 20 attending physicians have had any formal training in pimping. In most American medical schools, pimping is covered haphazardly during the third-year medical clerkship or is relegated to a fourth-year elective. In a 1985 poll, over 95% of program directors admitted that the pimping skills of their trainees were "seriously inadequate." It comes as no surprise, then, that the newly appointed attending must teach himself how to pimp. It is to this most junior of attendings, therefore, that I offer the following brief guide to the art of pimping.

Pimp questions should come in rapid succession and should be essentially unanswerable. They may be grouped into five categories:

1. Arcane points of history. These facts are not taught in medical school and are irrelevant to patient care -- perfect for pimping. For example, who performed the first lumbar puncture? Or, how was syphilis named?

2. Teleology and metaphysics. These questions lie outside the realm of conventional scientific inquiry and have traditionally been addressed only by medieval philosophers and the editors of the National Enquirer. For instance, why are some organs paired?

3. Exceedingly broad questions. For example, what role do prostaglandins play in homeostasis? Or, what is the differential diagnosis of a fever of unknown origin? Even if the intern begins making good points, after 4 or 5 minutes he can be cut off and criticized for missing points he was about to mention. These questions are ideally posed in the final minutes of rounds while the team is charging down a noisy stairwell.

4. Eponyms. These questions are favored by many oldtimers who have assiduously avoided learning any new developments in medicine since the germ theory. For instance, where does one find the semilunar space of Traube? Or, whose name is given to the dancing uvula of aortic regurgitation?

5. Technical points of laboratory research. Even when general medical practice has become a dim and distant memory, the attending physician-investigator still knows the details of his research inside and out. For instance, how active are leukocyte-activated killer cells with or without interleukin 2 against sarcoma in the mouse model? Or, what base sequence does the restriction endonuclease EcoRI recognize?

Such pimping should do for the third-year student what the Senate hearings did for Robert Bork. The intern, in contrast, is a seasoned veteran and not so easily rattled. Years of relentless pimping have taught him two defenses: the dodge and the bluff.

Dodging avoids the question, wasting time as well as a valuable pimp question. The two most common forms of dodging are (1) to answer the question with a question and (2) to answer a different question. For example, the intern is asked to explain the pathophysiology of thrombosis secondary to the lupus anticoagulant. He first recites the clotting cascade, then recalls the details of a lupus case he admitted last month, and closes by asking whether pulse-dose steroids are indicated for lupus nephritis. The experienced attending immediately diagnoses this outpouring as a dodge, grabs the intern by the scruff of the neck, and rubs his nose back in the original pimp.

A bluff, unfortunately, is much more damaging than a dodge. Allowed to stand, a bluff promulgates a lie while undermining the academic hierarchy by suggesting that the intern has nothing more to learn from his attending. Bluffs weaken the very fabric of American medicine, threatening our livelihood and our way of life. Like outlaws in a Clint Eastwood movie, bluffs must be shot on sight -- no due process, no Miranda Act, no starry-eyed liberal notions of openness or dialogue -- just righteous retribution.

[...]

Clearly, pimping -- good pimping -- is an art. There are styles, approaches, and a few loose rules to guide the novice, but pimping is learned in practice, not theory. Despite its long and glorious history, pimping is in danger of becoming a lost art. Increased specialization, the rise of the HMO, and DRG-based financing are probably to blame, as they are for most problems. The burgeoning budget deficit, the changing demographic profile of the United States, the Carter Administration, inefficiency at the Pentagon, and intense competition from Japan have each played a role, though less directly. Against this mighty array of historical forces stands the beleaguered junior attending armed only with training, wit, and the determination to pimp. It won't be easy to turn back the clock and restore the art of pimping to its former grandeur. I only hope my guide will help.

 

[McGillGrad]

AmericanIMG,

Thanks for the summary.

tkim6599,

Excellent article! I appreciate it.

 

[Stinky Tofu]

Originally posted by Skip Intro
The kid (and, yes, he was a kid) was getting what they call "early immersion" (or some crap like that) at the hospital I'm currently rotating at. I surmised that he was one of those egg-head, third generation types who had both parents who were doctors, basically always did well in school, and essentially went into medicine more as an inevitability rather than a choice. Anyway, he'd spent most of the afternoon standing there with his thumb jammed up his butt doing nothing, so my attending said, "Follow Skip around," [NB: my real name omitted], "he's been here for a while. You can ask him any questions."

So, the kid followed me around, nice enough guy and all that, but you could just tell that his passion for medicine was close to zero. (Honestly, I don't know why such people pursue medical careers - oh, that's not to say that he didn't get have like a 3.95 undergrad GPA and a 36-37 on the MCAT (don't know for sure... didn't ask... really don't care).) But, the point was his school, Cornell-Weill, put him in this rotation to learn. And, in medicine, you don't absorb by osmosis.

Well, this is more an embryo question if you ask me, but I let it slide. Then I asked him, "Okay, so what's this part of the bone called."

Was this a big deal? No. But, I share this story to prove one thing: it doesn't matter where you go to school. You will come across Caribbean grads at various stages of their training and career and, yes, they too can teach you something.

Do you think it's fair that you formed all these opinions about this student without really getting a chance to know him and his background? Isn't this akin to what you hate about the AMGs who already have opinions about the type of doctor you will be without knowing anything about you?

How do you know that he wasn't up the last three nights studying for exams? Also, it's hard to maintain interest as a first year medical student when you don't know what the hell is going on. Is the lack of interest a failure on the part of the student or the teacher? Instead of finding a way to acclimate him, you decided to pimp him instead. Do you think you've helped improve his view of Ross students? I'm sure he does have a lot to learn from an MS-III from Ross, but keep an open mind because I think in the future you might find that an MS-III from Cornell might have a couple of things to teach you too.

 

[Purifyer]

Originally posted by Skip Intro
I'm an MSIII from Ross University, and today an MSI from Cornell-Weill was shadowing me. That's absolutely the truth. Just thought you all might like to know that. Another tid-bit for you: I was pimping him.



-Skip

You knew more about medicine than a 20 year old who was accepted into class a few months ago? I don't know about anyone else, but I'm amazed.

I think you might have some serious self image problems.

 

[Andrew_Doan]

Originally posted by Stinky Tofu
Do you think it's fair that you formed all these opinions about this student without really getting a chance to know him and his background? Isn't this akin to what you hate about the AMGs who already have opinions about the type of doctor you will be without knowing anything about you?

How do you know that he wasn't up the last three nights studying for exams? Also, it's hard to maintain interest as a first year medical student when you don't know what the hell is going on. Is the lack of interest a failure on the part of the student or the teacher? Instead of finding a way to acclimate him, you decided to pimp him instead. Do you think you've helped improve his view of Ross students? I'm sure he does have a lot to learn from an MS-III from Ross, but keep an open mind because I think in the future you might find that an MS-III from Cornell might have a couple of things to teach you too.

Nice post Tofu!

 

[McGillGrad]

To the people who are criticizing Skip Intro, you are taking his post the wrong way.

He is merely pointing out it is the person behind the medical education that makes a good doctor, not the medical school.

Plus, if you are in a hospital doing rounds with an older peer and you have no real enthusiasm, then no amount of top tier medical education can change that.

Yes, maybe the Cornell kid had a bad day, maybe he was extremely tired, maybe lost a loved one (etc. etc., ad nauseum), but the fact is that the impression that a person gives off is all we can judge from (until we get to know them better).

In conclusion, if you cannot understand why an IMG was somewhat amused to teach something to a student from a posh US med school, then you are apparently a spoiled brat that knows nothing of being looked down on for something totally arbitrary. Because I'll, tell you what. It is a great feeling to prove those people wrong.

 

[smf]

Andrew Doan, M.D., Ph.D.
"Reed College-1993; Johns Hopkins-2001; U of Iowa, Medicine Internship-2002; U of Iowa, Ophthalmology-PGY-3"




No doubt you are a smart person. Why then are you not in the Bascom Palmer Optho Program? Is it not rated number 1 or close to it?

I think the original poster was trying to say there is no magic in being enrolled in a US medical school or in being a graduate of the same.

Perhaps you will be fortunate enough to rotate in Colombia to learn a thing or two about anterior lamellar. Those FMG witch doctors might know something about that topic.

Contrary to what some may believe, it is physiologically unhealthy for their feces NOT to stink.

 

[Andrew_Doan]

Originally posted by smf

No doubt you are a smart person. Why then are you not in the Bascom Palmer Optho Program? Is it not rated number 1 or close to it?

First, I'm not making judgements about FMGs. I was supporting Tofu's comment about giving a first year medical student a chance in the clinic. It's not a great surprise that a MS III knows more than the MS I. The learning curve is logarithmic! I also know that if you come from a FMG program and work hard, then you can do anything you want.

Second, just because a program is rated number one by surveys and US News does not mean it's number one on my list.

I didn't apply to Miami because I have a family and didn't want to raise two children in Miami.

The rankings for residency programs, however, places Iowa at #3, which was my first choice because of the program's dedication to residency training, surgical volume, and being affordable for a young family.

Based on the rankings by Ophthalmology Times, Wilmer is #1, Bascom is #2, and Iowa is #3. I've already been at Hopkins for 8 years, so it was time to move on.

I don't quite understand your question SMF, is number #3 not good enough?

http://www.ophthalmologytimes.com/ophthalmologytimes/article/articleDetail.jsp?id=76764&pageID=1

In regards to your question about anterior lamellar, I don't need to be in Colombia to learn about that. It's a simple plastics operation for trachoma. As a physician and military officer, I plan on volunteering my skills in Third World Countries.

 

[tofurious]

I'm glad there are people who feel good about themselves by pimping first year med students who have not even finished leg anatomy classes yet.

The OP's point was not it's the person not the school that mattered. His tone was suggesting that he could have just done as well at Cornell had he gotten in if he had 3 generations of doctoring in his family. This kid (MS1) probably came from some PS### in NYC, paid his own way through college, and never had a doctor or even college grad in his family. Having to take this type of s**t from a Carribean grad is sure to make a positive impression on him about USIMGs and FMGs.

Andrew: are you surprised that the FMGs who think numbers matter most are now berating you for going to a #3 program in the country? My god, the sky must be falling in Iowa for being rated #3. How could you bear to be at the #3 place in the country? Will you have a job when you get out?

 

[tofurious]

Originally posted by Stinky Tofu
in the future you might find that an MS-III from Cornell might have a couple of things to teach you too.

Is Ross 4 or 6 years? Either way, maybe a MS-II or just an MS-I who has finished anatomy... because I distinctly remember learning about growth plates in the leg anatomy class.

 

[Finally M3]

Originally posted by McGillGrad
To the people who are criticizing Skip Intro, you are taking his post the wrong way.

He is merely pointing out it is the person behind the medical education that makes a good doctor, not the medical school.

Yes, maybe the Cornell kid had a bad day, maybe he was extremely tired, maybe lost a loved one (etc. etc., ad nauseum), but the fact is that the impression that a person gives off is all we can judge from (until we get to know them better).

In conclusion, if you cannot understand why an IMG was somewhat amused to teach something to a student from a posh US med school, then you are apparently a spoiled brat that knows nothing of being looked down on for something totally arbitrary. Because I'll, tell you what. It is a great feeling to prove those people wrong.

Lol, I'm a spoiled brat for not condoning the pimping of a MSI, not in an effort to teach, but to let a MSIII with self-image problems get his rocks off?

Oh, as a minority growing up in Detroit, I've NEVER experienced 'being looked down on for something totally arbitrary'. Stop being so melodramatic. Your posts just make me care less about the 'plight' of IMGs, if that's what all of y'all are thinking.

 

[andwhat]

I will definitely agree that this post makes USIMGs look bad, and FMGs bad in general, and I am a USIMG - its embarrasing that someone thinks in this manner. Medical school rotations are about learning how to interact in the medical environment, improving history and physical taking abilities, and oral presentation skills, I think that pimping should be left for the attendings. I cant believe that someone could get a cheap thrill like this. I learned from US med students, and they learned from me. In no way or manner would I ever try and impose my knowledge onto someone just because I happened to be on a certain rotation (or medical school experience for that manner) for a longer duration of time, thats just stupid. Not saying that you are stupid of course dont get me wrong! but it is a little immature. I mean think how you would feel if you were on the opposite spectrum of that..

 

[McGillGrad]

Originally posted by Finally M3
Lol, I'm a spoiled brat for not condoning the pimping of a MSI, not in an effort to teach, but to let a MSIII with self-image problems get his rocks off?

I chose my words carefully in order to avoid pointing fingers. You assumed that I was talking to you. That says more about what you think of your reply than what I think. You volunteered yourself as a person who does not understand "why an IMG was somewhat amused to teach something to a student from a posh US med school."

In reality, you are grappling with your own demons with your post, because this has nothing to do with my post. I am talking about teaching and you are talking about ulterior motives. Maybe they should have taught more reading comprehension in that Detroit school of yours.

 

[smf]

Originally posted by tofurious
I'm glad there are people who feel good about themselves by pimping first year med students who have not even finished leg anatomy classes yet.

The OP's point was not it's the person not the school that mattered. His tone was suggesting that he could have just done as well at Cornell had he gotten in if he had 3 generations of doctoring in his family. This kid (MS1) probably came from some PS### in NYC, paid his own way through college, and never had a doctor or even college grad in his family. Having to take this type of s**t from a Carribean grad is sure to make a positive impression on him about USIMGs and FMGs.

Andrew: are you surprised that the FMGs who think numbers matter most are now berating you for going to a #3 program in the country? My god, the sky must be falling in Iowa for being rated #3. How could you bear to be at the #3 place in the country? Will you have a job when you get out?

Some might read it as berating, others, sarcastic humour.

What skip intro felt is directly related to the pervasive attitude by usa organized medicine that has tried overtly and covertly to stop non lcme school graduates for decades.
Despite these obstacles, graduates from every region of the world have trained in all specialties in the usa. yes, there are caribe grads in optho, derm, ortho, etc etc.

The reason the % accepted nowadays into those programs is low is political and unrelated to capability and intelligence. Perhaps similar to obtaining a position as a longshoreman.
Lets not forget the original surgeons were barbers. So if you graduate from a school in political disfavour, you will NOT be accepted into certain specialties regardless of your iq, aptitude, or humanity. Case in point with a surprise ending; A friend of mine was FRCS orthopaedics, passed the US exams with high scores, had excellent references but could barely get an ortho interview. Got rejected for 2 years. Went to do a year of research at an Ivy league school. Applied again, rejected again. Hired an attorney to communicate with the program he wanted to train in.
The argument was quite simple; explain how ANY fresh graduate can be more qualified than an already board certified ortho professor. The program decided not to reject him again.
I actually worked in the same hospital he did ortho in. All of the residents were amg's except him. Some of his fellow residents liked him and made comments along the lines of him knowing more than the program director, others resented him. There does indeed exist an attitude from the old boys club (lcme) that for some unknown reason no one can be as good if from abroad.

Granted it is not everyone that feels this way but certainly enough to spread feelings of educational apartheid.

I have known great people that were graduates of lcme schools so don't get me wrong. but there is no shortage of arrogant, condascending, elitist lcme byproducts that are legends in their own minds. And yes there are also egotistical non lcme grads but the difference I have noticed is the non lcme folks do not make it their goal in life to discredit an entire world of education outside of their own
Studying in the usa does not cure emotional issues that linger on throughout ones career.

I vividly recall being "pimped" at an interview for pgy training many years ago. The guy interviewing me chose questions that only a pgy2 or higher could have been likely to know the answer to. Basicly his plan was to ask me the unanswerable then feel so superior. I got the feeling he did all but refuse to interview me and he was forced into it.

Then there are the state licensure boards tactics to deny licensure to non lcme graduates. They have been "slammed" in court and congress for decades.

All this after having to learn another language, then study like there is no tomorrow, living in another country, leaving family and friends behind.

Nowadays I experience the ultimate paradox, I get called to bail out the lcme upper level residents to do procedures they should be capable of doing, but are not. I try to let them do procedures with supervision but even that has met with resistance from some. Some have the attitude that learning a procedure is not important since I can just do it and they don't need to be bothered anymore than they already are.

Then there a "classic" of many that stands out in my memory. I had worked up a cc;dizzyness= severely dehydrated, tachycardic patient with borderline acceptable bp. The pmd was a harvard school graduate surgeon who actually told me on the telephone to write an order for meclizine as he stated meclizine is used to treat dizzyness. I argued for volume replacement and refused to write mecilzine. A nurse took his phone order.
Who am I but a lowly fmg, what could I know?


The guys and gals that studied abroad did by no means take any shortcut and in fact have worked very hard often in a new language. In actuality amg's (including those with honours) did significantly worse on the CSA than those from abroad. Go figure!


In essence a system of educational apartheid has existed in the usa. Decades of political and legal action have made some inroads. At least the usmle is taken by everyone these days, instead of seperate examinations as in the past. And at least us non lcme grads do not have to sit in the back of the bus.

 

[smf]

"Originally posted by Andrew_Doan [/i]
First, I'm not making judgements about FMGs. I was supporting Tofu's comment about giving a first year medical student a chance in the clinic. It's not a great surprise that a MS III knows more than the MS I. The learning curve is logarithmic! I also know that if you come from a FMG program and work hard, then you can do anything you want. "

Some would have us believe that if you come from a non lcme school you are therefore unqualified, inferior, or just no damn good. If you succumb to the cold war tactics you might actually believe you are no good. Thus, in accordance with this mode of thinking the caribe school graduate has to be terrible and the Cornell grad though in an earlier year of training is therefore more knowledgeable by virtue of being a "golden child"

It is not surprising that after enduring the above atmosphere that skip-intro felt the way he did.

"The oppressor becomes the oppressed"
"If only the hunter were hunted"

What skip-intro should not do is condescend onto the ms1. Better to vent on an Internet forum than take it out on a person.

I elaborated in more detail about some of my feelings on another post on this thread.





"I don't quite understand your question SMF, is number #3 not good enough? "



No, of course not. We know you are the best and shouldn't settle for #3.



"In regards to your question about anterior lamellar, I don't need to be in Colombia to learn about that. It's a simple plastics operation for trachoma. As a physician and military officer, I plan on volunteering my skills in Third World Countries."


Actually I was referring to anterior lamellar refractive , and it was Colombia that volunteered to teach these procedures to US and Canadian surgeons as well as to the rest of the world.
You might ask one of your attendings if the names Jose Barraquer or Luis Ruiz mean anything.




Ciao y un fuerte abrazo

 

[Andrew_Doan]

Originally posted by smf
Some might read it as berating, others, sarcastic humour.

What skip intro felt is directly related to the pervasive attitude by usa organized medicine that has tried overtly and covertly to stop non lcme school graduates for decades.
Despite these obstacles, graduates from every region of the world have trained in all specialties in the usa. yes, there are caribe grads in optho, derm, ortho, etc etc.

US Tax dollars in the form of Medicare pays for graduate medical education. It has nothing to do with FMGs being inferior or less intelligent. If the American people are paying for residency education, then it should be US citizens who receive the opportunity to train in the US before a non-resident/non-citizen. Is it wrong that our system is about economics and who pays the bill?

As for non-LCME grads and residency, there's plenty of DO's and USIMGs doing residency in the US. I don't see this as a problem considering that all the Caribbean medical schools send their students for clinical rotations and residency training in the US.

 

[tofurious]

Originally posted by smf
What skip intro felt is directly related to the pervasive attitude by usa organized medicine that has tried overtly and covertly to stop non lcme school graduates for decades.
Despite these obstacles, graduates from every region of the world have trained in all specialties in the usa. yes, there are caribe grads in optho, derm, ortho, etc etc.

The reason the % accepted nowadays into those programs is low is political and unrelated to capability and intelligence.

The man is keeping you down. Damn the man!

Who are these incompetent seniors you speak of? If you truly believe that your seniors - who must have trained in the US to be so disfavored by you quoting your terminology - are so inept, why don't you share with us who they are so we can ask them directly how they dare to use their arrogance to keep you down when they should be learning from you?

What I don't understand is, if you don't like the way this country's medical system works, why did you come back? Why don't you work in the ideal medical system in which you received your excellent training?

 

[orthoguy]

I love the---"US Medical students always stereotype USIMG's" followed by the post "The cornell student probably went to a prep school/had 8 generations of doctors in his family etc etc"


Yes---all of us who are in medical school in the US have political connections that you poor working-class/blue collared true americans who are forced to train outside of the US due the old boy's club repression don't have.

Give me a break.

Maybe some of us (who have gone to STATE schools or have no doctor's in our family) simply got higher grades.


Seems like a much more rational explanation to me.


Truth hurts huh.

But continue you conspiracy theories if it makes you sleep better at night.

 

[smf]

Originally posted by orthoguy
I love the---"US Medical students always stereotype USIMG's" followed by the post "The cornell student probably went to a prep school/had 8 generations of doctors in his family etc etc"


Yes---all of us who are in medical school in the US have political connections that you poor working-class/blue collared true americans who are forced to train outside of the US due the old boy's club repression don't have.

Give me a break.

Maybe some of us (who have gone to STATE schools or have no doctor's in our family) simply got higher grades.


Seems like a much more rational explanation to me.


Truth hurts huh.

But continue you conspiracy theories if it makes you sleep better at night.

I wouldn't expect you to be knowledgeable about an area that you have little or no exposure to. Speaking out of ignorance does not become you either when you speak of a conspiracy theory.

FACTUALLY, very much in the way NRMP and other codefendants of www.residentcase.com have conspired(allegedly of course since you know such altruistic organizations would never do such a thing) organized medicine has indeed conspired to stop fmg's and also conspired to smear DO's. Seems any viable competition must be smeared and discredited. The below information is factual and represents BUT a single case of what you call paranoia/conspiracy. There have been a multitude of similar cases won in court and or congress.
Mr. Bernard Ferguson, an attorney, is probably the singe most instrumental litigator in these issues over the past decades.

Some who are rejected from us schools no doubt may feel bad. I had never applied in the USA so I don't know that awful feeling, nor do I know the feeling of my organic lab work being sabotaged.

All of our sh-t stinks, even yours.

Yep, you can keep this suit of lights.



Michael C. Ritota Jr., MD, F.C.C.P., F.A.C.A., First President of N.A.S.A., Founder of U.A.G. North American
Alumni Association

The first large wave of North American students to begin studying medicine at the U.A.G. began in the year of 1968. This demand for medical education abroad was largely due to the fact that the United States was in the midst of a very unpopular war with Vietnam and the Selective Service Act of 1966 stated that any student studying medicine would be deferred from the draft. This new regulation, immediately provoked an increase in applications for the 8,800 existing medical school spots in the U.S. from a previous of 18,000 to 88,000 applications, many of which were really not premedical students but students studying a bachelor of science with good averages and what we called "draft dodgers".

Naturally, this avalanche of applications with better grade-averages that that of the traditional premed student, displaced spots for many highly qualified students into the mainstream of American medical schools. This situation forced many dedicated students to look abroad for their education accepting the hardship of learning new cultures and languages to fulfill their dream of becoming physicians.

The Autonomous University of Guadalajara became the leader by accepting the greater number of these ambitious students. Later in years, a "secret" study by the AMA realized that an error of judgment was made by admitting a whole generation of students into American medical schools who were really not dedicated to the profession but, as previously stated, only taking advantage of the draft status granted by studying medicine. The really dedicated premed student went abroad and studied at the U.A.G.!

On Thanksgiving weekend of 1969, a small group of U.A.G. students met with Dr. Michael C. Ritota Sr. who flew to Guadalajara from New Jersey to discuss recent new rules dictated by the AMA and applied to foreign medical students studying abroad (FMGS) imposing drastic limitations upon their return to practice medicine in the United States.

Immediately following this meeting, a more important strategical meeting was called with the direction of Lic. Antonio Lea?o ?lvarez del Castillo and Lic.Carlos P?rez Vizca?no at the site of the new U.A.G. campus then under construction. At that meeting, a committee was formed to investigate these new requirements and coordinate as much information as possible with parents, students, and the administration of the U.A.G. - N.A.S.A. was not yet formed.

Upon return to the United States, Dr. Michael C. Ritota Sr.'s worst nightmare became a reality -- The American Medical Association had set into place rules at the state-level through the State Medical Associations virtually barring all FMGS from Guadalajara. Dr. Michael C. Ritota Sr. immediately formed the CPA (Concerned Parents Association) with chapters in 31 different states to initiate coordinated activity at the level of Senators, Congressman, and media to reconsider and change these "laws".

In essence, the AMA (a private institution) was dictating State Law in the same manner Shell Oil or Exxon might negotiate laws requiring their credit cards to drive in a state.

1969 was a year of dialogue with politicians, the AMA, and state committees. Parents groups were organized and the U.A.G. gave the students full backing and moral support. UNAM would not give a degree that stated M.D. nor grant a "T?tulo" upon graduation. These were the catch "22" 's imposed by the AMA.

Remember these were the years when FAX's, E-mail, LADA 001, Federal Express and many other means of rapid communication did not exist. Nevertheless, it was remarkable and astounding how organized we were in 1969.

1970 became the year of frustration before the intransient eyes and ears of the AMA in Chicago. After, countless and fruitless meetings in Chicago and with the State Medical Boards, the student board decided it was time for a more energetic action, and "war" was declared. Plans were drawn up for a two pronged attack. One on the State level, with Concerned Parents Associations initiating legislation for changes in State laws and the other prong was on a nationwide law suit filed in the Southern District Court of New York -- North American Student Association (N.A.S.A.) versus The American Medical Association (A.M.A.). Thus was born NASA in early 1972.

Fund raising from the students proved helpless under the enormous expenses to be incurred by the legal action, then somewhere and somehow an anonymous benefactor flew into our lives and provided us with all expense for our war chest. Whoever he is, may God bless him for helping to make so many fine doctors.

One of our most difficult problems was that we had no graduate of the U.A.G. practicing in the Unite States as an example of the quality that would soon come out of the U.A.G. and surprise the medical world. We were helpless against all arguments that a strong desire to achieve a goal could make a young student surpass any obstacles. Today, there exists literally, thousands of graduates from the U.A.G. as excellent examples of this argument.

Like lightning, states changed their laws through the United States. Governor Ronald Reagan being among the first to sign into law changes allowing students to return to California without obstacles. I remember him saying at the signing of the law in Sacramento, California "I am doing this because it is the right thing to do".

As a result of losing so much territory to the parent's committees and risking utter chaos among the State Medical Societies, the AMA collapsed, and decided to come up to an agreement with our attorneys which would create a "happy medium". Thus, born the Fifth Pathway program. The rest is history -- a long line of fine graduates who have entered the mainstream of American Medicine.

However, we must never forget the brilliant and enormous effort by the literally thousands of parents who gave their time and influences to promote legislative changes at state levels, who spent their own money to go to state capitols and promote these laws, to have parties for politicians, to send letters, etc., etc., etc. We must never forget those students who campaigned on their own time and nickel for this cause. Those that took from their studies to promote these changes. And, least of all, never, never, to forget the tremendous moral support by the direction of the U.A.G. to resolve this problem and give us the opportunity o become doctors serving in the long roll of fine physicians of Time's most honored profession -- MEDICINE.

http://www.fifthpathway.com/index2.html

 

[smf]

Originally posted by tofurious
The man is keeping you down. Damn the man!

Who are these incompetent seniors you speak of? If you truly believe that your seniors - who must have trained in the US to be so disfavored by you quoting your terminology - are so inept, why don't you share with us who they are so we can ask them directly how they dare to use their arrogance to keep you down when they should be learning from you?

What I don't understand is, if you don't like the way this country's medical system works, why did you come back? Why don't you work in the ideal medical system in which you received your excellent training?

Sorry your question is too late. Already on attending staff at multiple instutions both in US and Latin America.

Say hello to God for me.

 

[tofurious]

Originally posted by smf
Say hello to God for me.

On behalves of all your patients and all the possible US students who may have had the honor of working under you, I guess we should thank you?

Last time I checked, there hasn't been a draft since the 1970s, and people who were draft dodgers would be in their 50s now - and hopefully not applying for residency still. Things have changed drastically since then, as have people's reasons for going abroad. "Not cutting it" is the main reason nowadays.

 

[Finally M3]

Originally posted by McGillGrad
I chose my words carefully in order to avoid pointing fingers. You assumed that I was talking to you. That says more about what you think of your reply than what I think. You volunteered yourself as a person who does not understand "why an IMG was somewhat amused to teach something to a student from a posh US med school."

In reality, you are grappling with your own demons with your post, because this has nothing to do with my post. I am talking about teaching and you are talking about ulterior motives. Maybe they should have taught more reading comprehension in that Detroit school of yours.

Lol, you're freaking hilarious. In reality, you should learn how to comprehend what you yourself wrote;

"In conclusion, if you cannot understand why an IMG was somewhat amused to teach something to a student from a posh US med school, then you are apparently a spoiled brat that knows nothing of being looked down on for something totally arbitrary. "

You WERE writing to me, because I can't understand why ANY MSIII would get a sense of superiority by knowing more than a MSI, whether he is bored, interested, etc. It is EXPECTED for you to know more at the stage of game you are in.

I can fling personal insults with you to pass time (Montreal, frogs, etc.) but I'd rather not.

 

[smf]

The American Medical Association had set into place rules at the state-level through the State Medical Associations virtually barring all FMGS from Guadalajara

In essence, the AMA (a private institution) was dictating State Law in the same manner Shell Oil or Exxon might negotiate laws requiring their credit cards to drive in a state."
================================================================================================

The posted information was to counter allegations of paranoia as in conspiracy imagined. I posted the article in its entirety and it is up to the reader to extract the pertinent stuff, in this case I did above.

This is but a singe episode in which a so called honorable organization(s) acted together(conspired) like thugs and scoundrels would.

The reason Ross, SGU, etc have clinical rotations for their students in the usa is largely due to ever present legal surveillance and action and probably parents writing their congressmen.

State medical boards have denied licensure for things tantamount to the question used to qualify blacks for voting in our proud nations history; How many bubbles are in a bar of soap?

Sadly






"On behalves of all your patients and all the possible US students who may have had the honor of working under you, I guess we should thank you?"


Why would it be an honour for patients and or students to work with me? Thank me for what?


Honoured was I in having the opportunity to meet certain people in my life.



Should you not focus on studying during this part of your education?
==========================================================================================================================

"Not cutting it" is the main reason nowadays.





US medical college admission committees have said they could fill a second entering class(if they had one) with equally as qualified students, yet you like to say "not cutting it"

You remind me of the horse with eye blinds, only able to see in one direction. How do you feel when the Harvard MS/grad waves their snooty degree in front of you and says you are inferior, you are no good? Are ther right?



---------------------------------------------------------------------------------------------------------------------------






Ciao

 

[Andrew_Doan]

Originally posted by smf
The posted information was to counter allegations of paranoia as in conspiracy imagined. I posted the article in its entirety and it is up to the reader to extract the pertinent stuff, in this case I did above.

This is but a singe episode in which a so called honorable organization(s) acted together(conspired) like thugs and scoundrels would.

The reason Ross, SGU, etc have clinical rotations for their students in the usa is largely due to ever present legal surveillance and action and probably parents writing their congressmen.

State medical boards have denied licensure for things tantamount to the question used to qualify blacks for voting in our proud nations history; How many bubbles are in a bar of soap?

SMF,

I feel that there is a huge difference between a USIMG vs a FMG (non-citizen or non-resident) training in the US. Medical schools have a limited number of spots because there are a limited number of residency training slots. We don't have the funding to double the training capacity.

Where does this funding come from?

US Tax dollars in the form of Medicare pays for graduate medical education. If the American people are paying for residency education, then it should be US citizens who receive the opportunity to train in the US before a non-resident/non-citizen. Is it wrong that our system is about economics and who pays the bill?

This is not about racism or conspiracy theory as you have implied. The issue of FMGs not being able to train in the US and receive licensure has to do with basic economics. There are plenty of countries that exclude non-citizens from government funded programs. Why should the US be any different?

 

[McGillGrad]

Originally posted by Finally M3
Lol, you're freaking hilarious. In reality, you should learn how to comprehend what you yourself wrote;

"In conclusion, if you cannot understand why an IMG was somewhat amused to teach something to a student from a posh US med school, then you are apparently a spoiled brat that knows nothing of being looked down on for something totally arbitrary. "

You WERE writing to me, because I can't understand why ANY MSIII would get a sense of superiority by knowing more than a MSI, whether he is bored, interested, etc. It is EXPECTED for you to know more at the stage of game you are in.

Let us review your argument. I said "...if you cannot understand why an IMG was somewhat amused to teach something to a student from a posh US med school...," and your reply with "I can't understand why ANY MSIII would get a sense of superiority by knowing more than a MSI, whether he is bored, interested, etc. It is EXPECTED for you to know more at the stage of game you are in."

I am talking about teaching and you are talking about an unsubstantiated pop-psychology evaluation of a person that you have never met or interacted with.

Here is the definition of a straw-man: The straw-man rhetorical technique is the practice of refuting weaker arguments than your opponents actually offer. It is not a logical fallacy to disprove a weak argument. Rather, the fallacy is declaring one argument's conclusion wrong because of flaws in another argument.

That is what you are trying to use. You and I are not arguing the same thing. That is why you are utterly and completely wrong.

I can fling personal insults with you to pass time (Montreal, frogs, etc.) but I'd rather not.

Actually your examples are of stereotypes and not personal insults, but I am sure that you knew that...

 

[smf]

Originally posted by Andrew_Doan
SMF,

I feel that there is a huge difference between a USIMG vs a FMG (non-citizen or non-resident) training in the US. Medical schools have a limited number of spots because there are a limited number of residency training slots. We don't have the funding to double the training capacity.

Where does this funding come from?

US Tax dollars in the form of Medicare pays for graduate medical education. If the American people are paying for residency education, then it should be US citizens who receive the opportunity to train in the US before a non-resident/non-citizen. Is it wrong that our system is about economics and who pays the bill?

This is not about racism or conspiracy theory as you have implied. The issue of FMGs not being able to train in the US and receive licensure has to do with basic economics. There are plenty of countries that exclude non-citizens from government funded programs. Why should the US be any different?

Andrew,

I am speaking as a USIMG and what my classmates, friends, and colleagues have been through over the last 20 years or so.

A close friend of mine from India once said to me he couldn't understand how US citizens (many by birth) can study hard for many years often in a different language, pass the applicable exams, even complete post graduate training then be hassled to no end to get licensed. Or, in the alternate, pass the exams and not be able to get a residency.
He said as an Indian he came to the US and took a chance not knowing what the future would hold. Today he is a radiologist, a damn good one and a hell of a nice guy.

Myself and many others BORN in the usa have felt like 2nd class citizens in having to put up with orchestrated efforts to stop those who do not study within the ordained geography.

It is much easier to forget about what I have been through than to debate on this forum. Hopefully part of success is not forgetting your roots.

Even my close friends in Colombia have commented on the aire of superiority they have perceived from US refractive/opthos providers. We have asked each other why in the world would people so educated and from the wealthiest most powerful country in the world have the need to condescend. Keep in mind I have discussed this with some of the greatest contributors the world has known in anterior segment.

Again, don't get me wrong, it is not everyone that has this attitude but it seems to be a substantial enough %.
Anyway as I have some projects to work on I don't know how much time I will have to hang out on net forums.

I wish both the usimg's and non usimg's all the best of luck in their futures.

 

[smf]

Originally posted by Andrew_Doan
US Tax dollars in the form of Medicare pays for graduate medical education. It has nothing to do with FMGs being inferior or less intelligent. If the American people are paying for residency education, then it should be US citizens who receive the opportunity to train in the US before a non-resident/non-citizen. Is it wrong that our system is about economics and who pays the bill?

As for non-LCME grads and residency, there's plenty of DO's and USIMGs doing residency in the US. I don't see this as a problem considering that all the Caribbean medical schools send their students for clinical rotations and residency training in the US.

OK, since you mentioned US taxpayer dollars and how taxpayer dollars should go to provide US citizens with opportunity, in this instance the opportunity being PG medical training, then by the same token is it wrong for US taxpayers to foot the bill to pay for many facets of non US resident/citizens who immigrate to the US?

 

[Andrew_Doan]

Originally posted by smf
OK, since you mentioned US taxpayer dollars and how taxpayer dollars should go to provide US citizens with opportunity, in this instance the opportunity being PG medical training, then by the same token is it wrong for US taxpayers to foot the bill to pay for many facets of non US resident/citizens who immigrate to the US?

As long as US citizens and US residents have a chance to do GME training first, I see nothing wrong with supporting the training of non-US residents and non-citizens. Likewise, we try to feed our citizens first before funding programs for immigrants. There's nothing wrong with this. As I stated before, few countries are as generous as the US.

I'm sorry you have had bad experiences as an USIMG; however, there are many success stories for USIMGs for every story like yours. I don't know your history nor do I know your struggles. As a USIMG, if you match in a residency program and pass all three steps of the USMLE, then you will be able practice as a physician.

In regards to setting standards and requiring physicians to graduate from certain medical schools, what is wrong with that? The US has one of the best medical systems evidenced, in part, by millions of people who travel to the US for their diagnosis and treatment. Only if we can also care for the uninsured, then we would have a very nice system.

 

[smf]

Originally posted by Andrew_Doan
As long as US citizens and US residents have a chance to do GME training first, I see nothing wrong with supporting the training of non-US residents and non-citizens. Likewise, we try to feed our citizens first before funding programs for immigrants. There's nothing wrong with this. As I stated before, few countries are as generous as the US.

I'm sorry you have had bad experiences as an USIMG; however, there are many success stories for USIMGs for everyone story like yours. I don't know your history nor do I know your struggles. As a USIMG, if you match in a residency program and pass all three steps of the USMLE, then you will be able practice as a physician.

In regards to setting standards and requiring physicians to graduate from certain medical schools, what is wrong with that? The US has one of the best medical systems evidenced, in part, by millions of people who travel to the US for their diagnosis and treatment. Only if we can also care for the uninsured, then we would have a very nice system.

Certain states have began to demand that a medical school be involved in research and Texas for instance can reject licensure to a graduate of a school they deem not substantially equivalent to a US school(whatever that means)
Usually they target schools that attract a lot of US citizens, however lets say a very bright person coming from medical school in Vietnam, who has passed the usmle, csa with high scores, can arbitrarily and easily be rejected should they assert that school is not substantially equivalent. Other states are following the lead of Texas and California.
Then it up to school to pay a lot of money for a team from the usa to visit them and do an evaluation including a mountain of paperwork and from what I have heard, can be rejected regardless of compliance in the absence of us counsel.

Show me an objective valid scientific study that proves certain schools graduate inferior doctors. Yes there was a recent newspaper story about malpractice suits and schools graduated from the problem was that some lcme schools in the usa made the list. Should those lcme schools be put on the disapproved list?
I have a colleague who shared with me his story of fleeing se asia on a boat, staying in different refugee camps in se asia then finally getting to the usa.
In this country called America there are those who say forget about the rest of the world, we have enough problems therefore don't spend any money on anyone not a citizen/resident.

Am I incorrect in wondering if US taxpayer dollars somehow helped your family to come to america or live in america?

I believe fancy degrees are ok but people cannot forget their roots nor suddenly be immune to other issues affecting humanity not excluding the struggle of those dealing with a group of people telling them they are inferior because they read Guyton or Jawetz outside the geography of n america.

I was not so politically or philosophically concerned in medical college. I studied with great passion and enjoyed the experience thoroughly. I recall great friends and teachers. Some of the best years of my life. Passed the exams in the usa only to discover the arrogance and superiority complexes and resentment. How dare someone become a doctor if its not in the usa?
Certainly if a student/school is clearly inferior, its grads would not pass applicable examinations thus the school/grads would certainly pose no threat to us medicine.

No one doubts those in us schools did not/do not study hard. Those abroad study equally as hard sometimes harder if in a new language.

Anyway I appreciate your kindness in feeling sorry for what we have been through.

Nowadays I like to think of myself as an advocate for those wearing the shoes I wore. I've already been licensed for MANY years in multiple states (USA) and also am on staff at one of those inferior fmg witch doctor hospitals that helped develop the hyperopic algorithms for the 217 zyoptix. (and using such technology years before the usa)

Anyway, take care.

 

[tofurious]

So what is your point with all this justification? Life isn't fair. Someone took your spot in a US med school you think you deserved, someone took your spot in a US residency program you think you deserved, and someone took your spot in _________ you think you deserved.

By going abroad for med school, you took a spot from someone from that country who thought he/she could become a doctor by doing well in that country, WITHOUT having to compete with someone with a US college education. By becoming an attending at a foreign country, you took away one attending job from the natives.

Is anything you have done any fairer to the countrymen and women whose homeland you have clearly benefited from? If you call what you do to others free competition, the same free competition did you in and you should have no complaints. If you argue that you went to an island whose medical education system's objective is to train doctors, by returning to the US you are robbing a 3rd world country of an opportunity to have one more doctor who would not spend a single minute complaining that he/she could not train in a US med school.

The biggest fallacy in most FMGs and USIMGs arguments is that they think they have something USMGs do not have and the USMGs were simply lucky. While exceptions do exist, I highly doubt that there is a systemic shortcoming in the USMGs that the FMGs and USIMGs are immune from. You can quote all the qualities you claim to have, and I am sure any US med student, resident, and faculty can name someone who went through the US medical education with identical qualities PLUS some.

 

[redshifteffect]

Originally posted by tofurious
So what is your point with all this justification? Life isn't fair. Someone took your spot in a US med school you think you deserved, someone took your spot in a US residency program you think you deserved, and someone took your spot in _________ you think you deserved.

By going abroad for med school, you took a spot from someone from that country who thought he/she could become a doctor by doing well in that country, WITHOUT having to compete with someone with a US college education. By becoming an attending at a foreign country, you took away one attending job from the natives.

Is anything you have done any fairer to the countrymen and women whose homeland you have clearly benefited from? If you call what you do to others free competition, the same free competition did you in and you should have no complaints. If you argue that you went to an island whose medical education system's objective is to train doctors, by returning to the US you are robbing a 3rd world country of an opportunity to have one more doctor who would not spend a single minute complaining that he/she could not train in a US med school.

The biggest fallacy in most FMGs and USIMGs arguments is that they think they have something USMGs do not have and the USMGs were simply lucky. While exceptions do exist, I highly doubt that there is a systemic shortcoming in the USMGs that the FMGs and USIMGs are immune from. You can quote all the qualities you claim to have, and I am sure any US med student, resident, and faculty can name someone who went through the US medical education with identical qualities PLUS some.

I would like to thank you for a mature and well thought out post.

 

[smf]

Originally posted by tofurious
So what is your point with all this justification? Life isn't fair. Someone took your spot in a US med school you think you deserved, someone took your spot in a US residency program you think you deserved, and someone took your spot in _________ you think you deserved.

By going abroad for med school, you took a spot from someone from that country who thought he/she could become a doctor by doing well in that country, WITHOUT having to compete with someone with a US college education. By becoming an attending at a foreign country, you took away one attending job from the natives.

Is anything you have done any fairer to the countrymen and women whose homeland you have clearly benefited from? If you call what you do to others free competition, the same free competition did you in and you should have no complaints. If you argue that you went to an island whose medical education system's objective is to train doctors, by returning to the US you are robbing a 3rd world country of an opportunity to have one more doctor who would not spend a single minute complaining that he/she could not train in a US med school.

The biggest fallacy in most FMGs and USIMGs arguments is that they think they have something USMGs do not have and the USMGs were simply lucky. While exceptions do exist, I highly doubt that there is a systemic shortcoming in the USMGs that the FMGs and USIMGs are immune from. You can quote all the qualities you claim to have, and I am sure any US med student, resident, and faculty can name someone who went through the US medical education with identical qualities PLUS some.

IN the US you need to study hard and keep your fingers crossed and hope you get accepted. Once accepted chances are you wont be kicked out, though exceptions exist.

In many other countries, when you enroll in university, you choose what you want to study vs them choosing you. If you want biology you check off biology, law-law, medicine-medicine, etc etc.

Then comes the "sink or swim" part. Attrition is fairly steep as students realize it isn't for them, or it is too demanding, etc etc.

Classical anatomy is but one pretty good filter. Anatomy1, 2 and neuro, each taking an entire semester. The % that actually graduate the program is a far cry far the total students that start (medicine).

The ones that leave usually change their course of study or take a break. Some quit all together. The other filter when I began studying was a different language. Lectures and exams in a new language, textbooks and a dictionary, both medical and english-spanish in both hands.

I don't believe I took someone elses spot since the system is different from what you believe it is. Everything in the world believe it or not is not based on what you know within a single country.

By the way as sad as this may seem, I never applied to US schools so despite your analysis, I do not feel bad that someone took the spot I never wanted.

On staff at a medical center in latin america I have never encountered the arrogant, condescending, full of oneself attitude I have seen in the country I was born in. Again not 100% as I have known some superb grads from the usa and canada-, both academically smart, able to put it together, and actually having personalities)

As far as qualities present between AMG's and IMG's and your above argument I would tend to agree with you, I would venture to guess there may be just as many incompetent img's as there are amg's.

There are other threads on the forum with posts from students/grads from other countries. The posts are very good and should you open yourself up for introspection you too may find them enlightening.

http://forums.studentdoctor.net/showthread.php?s=&threadid=88975

is one such thread



Don't fret, I am not trying to change you.

I wish you the best for the future.

 

[Andrew_Doan]

Originally posted by smf

In many other countries, when you enroll in university, you choose what you want to study vs them choosing you. If you want biology you check off biology, law-law, medicine-medicine, etc etc.

Then comes the "sink or swim" part. Attrition is fairly steep as students realize it isn't for them, or it is too demanding, etc etc.

I think it is unfair to generalize about the general attitudes of US physicians.

Second, the system in other countries is not so different than in the US. In the US, the weeding is done after college during the medical admissions process.

In other countries, while students start as medical majors in college, the weeding is done in the midst of training. Keep in mind that most other countries have a combined undergraduate-medical education curriculum. This system is similar in regards to cutting down the class size, so if one can't make the grade, then they are out of luck. You also state that the "attrition is fairly steep". In US medical school admissions, there's about 3 applicants per position. Is the attrition rate overseas similar to this ratio?

Truthfully, I'd rather be in the US knowing if I needed to think about an alternative career at the transition point between college and medical school.

Another thing that needs to be considered is financial compensation. US physicians are paid significantly more than most physicians in other countries. This drives the competition upwards for medical school admissions in the US. If physicians were paid more, in let's say India, then I guarantee you that the competition would be much higher for Indian medical schools.

In regards to your point about me being an immigrant, yes, I am a Vietnamese immigrant and US Tax dollars paid for my entry into the US after the Fall of Saigon in 1975. US Tax dollars also paid for my MD-PhD degree via the MSTP and likewise, US Tax dollars is paying for my residency training.

I never stated that I didn't support the US helping non-citizens/non-residents. My point is that opportunities should be given to US Citizens/Residents first before offering the same opportunity to others. My departure from Vietnam resulted in the loss of numerous American lives and money. Things of this nature I cannot change. I am grateful for the generous contributions that the soldiers and American people sacrificed. However, my immigration was an American policy regarding SE Asia.

Our discussion is really about GME positions in the US. My point is that these positions should be reserved for US Citizens/Residents first, and then offered to non-citizens/residents after.

For your information, I didn't receive any special treatments in high school or college. My father worked at a $12/hour job until he became disabled by rapid cycling bipolar disorder, and my mother worked on an assembly line for $8/hour all of her life. I worked hard in high school and college. I felt that I was lucky at multiple crossroads in my life; however, I never felt that I was given special treatment because I was simply a Vietnamese immigrant. Also, major US programs weren't shut down because of our arrival to the US. Contrary to your post, I have not forgotten my roots and my past experiences. FYI, this is why I've picked a career in academic medicine and a career in the military. I'm going to pay society back for my good fortune.

For the record, I believe the US should help their own citizens and residents before helping people in other countries. If you can name one country that helps other countries before providing for their own citizens/residents , then I will reconsider my position. In particular, I don't understand why you insist that GME residency spots should be freely given to FMGs. I don't care if FMGs are more qualified, there are plenty of US grads who deserve these positions, which are funded by American tax dollars. It would be horrific to turn away US medical graduates because FMGs want to train and practice in the US. Residency training in the US is not a welfare program.

I wish you the best of luck in your career.

 

[smf]

In actuality the quality of residency programs is rated by the percentage of USMG's in any given program.

Personally, I believe GME's goal is to serve the patients as best as possible and if there is an FMG whether they be US citizen or not, if that person is more qualified be it via prior training (ie; a FRCS orthopod seeking GME) or a person with better board scores and/or rotation evaluations, that person should ultimately provide care.

I will let some of the other participants cover for me so I can take a break.

Not easy being old you know.

 

[BellKicker]

Originally posted by Andrew_Doan
Residency training in the US is not a welfare program.

Andrew, I think 40K a year for an MD is a good deal for America, when you think of it that way.

Other countries relying heavily on IMGs, like my own, have dead-end positions called "junior doctors" (or other names, I'm sure). These positions lead nowhere and IMGs spend years in these positions before they land a real residency.

The way the US system propels you straight into "real" residency is where the real "IMG-friendliness" or welfare lies.

That's my humble opinion, anyway.

 

[Andrew_Doan]

Originally posted by Skip Intro
Agreed. The majority of the supposed "stigma" I've been exposed to has been in this forum.

Three questions, then:

(1) Would you include U.S. citizens who train abroad in this category? If so, why?

(2) Last time I checked, there were about 22,500 residency positions for about 16,500 U.S. graduates. Should we cut the number of residency spots?

(3) Are you aware that COGME, completely reversing its previous and long-held position, has recently predicted a 150,000-200,000 physician shortage by the year 2020? Should we open more U.S. medical schools, or encourage more IMGs to come to the U.S. to practice?

Skip,

I'll answer your questions in order:

1) I don't include US citizens who train abroad in the category of FMGs. I strongly believe US IMGs should have access to residency training before FMGs. US IMGs are citizens, their families pay taxes, and therefore, US IMGs have a right to train in the US. Hence, most US IMGs obtain residency training in the US.

2) Clearly, we don't need to cut back on residency spots. If there is indeed a true shortage of physicians, then the US should increase the number of medical school slots.

3) I'm not sure if the physician shortage is an accurate estimate. We must accept the report as simply a projection. Interestingly, the shortage is mainly in primary care specialties, and the shortages are located in rural America. I'll come back to this point later.

Originally posted by Skip Intro
First off, the fact that GME is funded almost solely by Medicaid in the U.S. kind of goes directly against your point about it not being a welfare program. Secondly, I don't know of a single instance, especially given the numbers stated above, where your foundless, scaremongering and what you called "horrific" scenario of any US medical school graduate being turned away from a U.S. GME program has occurred - this is not what we are talking about. We're talking about what is tantamount to the "country club" mentality, where certain extremely qualified (and in many cases more qualified than their U.S.-trained counterparts) are turned away from competitive programs simply because they are not the right "breed", for lack of a better term. Is that right?

Please respond. I'm curious.

-Skip [/B]

GME is mainly funded by Medicare (not Medicaid), and you're correct that Medicare is a welfare program for the elderly. I believe that US residency training is not a welfare program for training physicians. US residency training programs are more of an investment in America's future. Thus, Medicare is a welfare program for the elderly, but its funding of GME is an investment in America's future.

Second, you state: "We're talking about what is tantamount to the "country club" mentality, where certain extremely qualified (and in many cases more qualified than their U.S.-trained counterparts) are turned away from competitive programs simply because they are not the right "breed", for lack of a better term."

How are you making the assessment about these extremely qualified FMGs? Most FMGs who are applying for residency training, for instance in ophthalmology, are already trained ophthalmologists in their home countries. The FMGs may be more experienced, but this does not make them more qualified for a training program. Take an American medical graduate with the same number of years of experience, then you can make an accurate comparison about the qualifications of the USMG vs FMG. This is similar to making the comparison between a PGY III vs PGY I.

In addition, you also make the point of being turned away from "competitive programs". It turns out that most competitive programs have more than enough qualified US medical graduate applicants. Why should competitive programs turn down highly qualified USMGs for FMGs? BTW, the most competitive FMGs do get competitive residency positions. In ophthalmology, there are 35 matched-FMGs this year. That's almost 8% of the total incoming class for 2005.

There are ways for FMGs to practice here. FMGs can apply for the less competitive fields and work in rural America where there is a shortage of physicians. I'm not against FMGs training here. If FMGs train in the US, then they should work in fields that have physician shortages and work in areas that need more physicians. Otherwise, FMGs can obtain training here and then return to their home country where their medical services are needed more.

http://www.ctsnet.org/doc/5761

http://www.unmc.edu/Community/ruralmeded/RMEPost/j1_visa.htm

 

[Andrew_Doan]

Originally posted by Skip Intro
Point is, U.S. IMGs and straight IMGs qualitatively are not necessarily treated differently - there is still a "no access" sentiment at many programs.

Actually Skip, you should be grateful that you don't have to worry about the J-1 Visa issue as a US IMG. You can actually match, complete residency, and practice medicine in the US without a problem. While it is difficult to obtain a competitive residency as a US IMG, it is not impossible if you're a good candidate. You have more options open to you than just primary care. For instance, look at stephew in rad onc:

Johns Hopkins Kimmel Cancer Center
PGY-5
Chief Resident
Radiation Oncology

SGUSOM '99

Seems like stephew is doing great.

BTW, it is a waste of talent if an ophthalmolgist from another country tries to match for residency in the US and fails to match. They have denied their home country of their skills and expertise where it's needed more.

 

[Andrew_Doan]

Originally posted by Skip Intro

Again, only comment in the form of questions and barring the comment on those IMGs whose intent is to return to their native country: why, as a default position, is this acceptable and/or fair? Why? Whose needs are ultimately being served by such a policy? Certainly not necessarily the patient's, right?

With all the claims that FMGs are superior to their US-counterparts, patients will be well served by these talented individuals. Hence this policy serves the needs of patients in rural America.

 

[Andrew_Doan]

Originally posted by Skip Intro
Again, I can't argue with this. But, I will take this still as a concession, since you didn't address my primary point, that you agree with the fact that many programs are "off limits" to my ilk. Right or wrong?

Skip, I know it angers you that there is a bias against Caribbean medical schools; however, US medical graduates face similar judgements when applying for residency. For instance, a graduate from a less competitve medical school may be greatly disadvantaged when applying for competitive fields, even with high board scores. When the field has numerous competitive applicants with high board scores, it's going to be tough. At Iowa, for instance, we interview about 60 applicants for 5 ophthalmology spots. We usually receive close to 500 applications and 100 applicants are sporting 250+ Step I scores. With this level of competition, it's the nature of the residency application process to favor applicants from well-known medical schools.

Originally posted by Skip Intro

On the other hand, if they are talented and qualified, why shouldn't the U.S. public benefit? Why shouldn't the physician benefit financially as well?

With so many talented and intelligent US medical graduates applying for residencies, competitive programs have not had to depend on FMGs. However, as I mentioned earlier, almost 8% of the incoming ophthalmology class for 2005 are FMGs, so I don't understand how you can claim that FMGs are completely prohibited from training in the US. Perhaps, the applicants who were rejected had weaknesses during the interview process or had holes in their applications. There's more to being a physician than raw numbers, grades, and research articles.

Second, this issue can be addressed by my point that GME is paid for by US Tax dollars and is an investment in America's future. If you consider the bang for each dollar spent on GME, then it's better to train a US grad who is 26 years old than a FMG with previous training and experience who is 35 or 40. The US grad will be able to work and contribute to society for more years than the FMGs who have already gone through residency, worked, and repeated a US residency.

The bottom line is that it does matter where you go to medical school when applying for competitive residencies. This is a reality that US medical graduates, US IMGs, and FMGs face.

 

[tofurious]

8% of FMGs in ophtho is quite impressive. Some of the AMGs who didn't match into any ophtho spots would say that's 8% too many.

There are many impressive FMGs. However, most of the impressive FMGs are not the ones crying foul on this board, and most of the FMGs on this board are not likely these impressive FMGs. Even the MGHs and Stanfords take FMGs (obviously not 50% as the FMGs would like it), but probably not someone from the Carribean schools as they have many star FMGs from Europe to pick from (who were not rejected by the evil American medical schools, and who have probably put in a couple to a few years of research work after graduation from their home country medical school). And again, like Andrew said, the MGHs and Stanfords probably don't pick often from mid to lower tier American medical schools either. Such effects could easily translate down to the mid-level residency programs, opening up many more spots for FMGs in the lower-tier residency programs. I highly doubt many people in the Carribean schools want to spend their careers in research, so I don't think why they should be complaining that they are not getting into these top academic residency programs when there are community programs taking them already.

 

[orthoguy]

OK, I am going to break down this issue really quickly and cut to the heart of the matter without the need for the plesant discourse occuring above.

To those in the Caribbean who are crying foul about the "unfair disadvantage" stacked against them I say---- .

1) Why did you go to a Caribbean Medical school? Was it because you applied around to a number of schools with your impressive pre-med credentials and decided that hey, though X American School wants me Ross just fits my personality and training style better? Was it b/c you wanted to learn Caribbean medicine and treat the illness of the islands? No, this is not why you went, its b/c you were weeded out with your low MCAT's and GPA. The rest of us did not have some kind of magical advantage over you/some free way into medical school/some mysterious connection/coem from a family of docs. We either out performed you or worked harder if we didn't get in on our first try to bulid up our resume before we applied again (b/c we knew the inferior outcome of the Caribbean route).

2) Be greateful that there is this system that still allows you to train and compete for US residency spots. What more do you want? The simple facts are YOU GO TO INFERIOR SCHOOLS. Anyone with $$$ and a bachelors can go to Ross/Mexico/etc etc and then YOU STILL HAVE THE ABILITY TO GET A US RESIDENCY!!!!!!!!! How can you possibly complain after you have been denied by any of the NUMEROUS US medical schools that are there for US students take a seondhand route and still have the ability to wind up where the rest of us who have gone to US medical schools are. We can and do wind up at the same end point. So why all of the crying above? Do you not see what is still available to you? Do you expect everything in this world to be available to everyone regardless of their credentials?

The point is that instead of complaining and sterotyping ever US grad as some "spoiled" and "privileged" individual as a cheap means of ego defense, be happy that you still have this amazing opportunity to work as an MD in the US in spite of your less than stellar undergrad performance and denial from US medical schools.



(Note: The above only refers to US FMG's not foreign born/foreign trained IMG's)

 

[McGillGrad]

Originally posted by orthoguy


The point is that instead of complaining and sterotyping ever US grad as some "spoiled" and "privileged" individual as a cheap means of ego defense, be happy that you still have this amazing opportunity to work as an MD in the US in spite of your less than stellar undergrad performance and denial from US medical schools.

I understand the message that you are trying to convey. Unfortunately, the way in which you represented your feelings actually confirm the OP's feelings about American med school graduates and their attitude toward Caribbean graduates.


BTW- I am not an American FMG, so I have no vested interest in defending American FMGs.

 

[smf]

Originally posted by orthoguy
OK, I am going to break down this issue really quickly and cut to the heart of the matter without the need for the plesant discourse occuring above.

To those in the Caribbean who are crying foul about the "unfair disadvantage" stacked against them I say---- .

1) Why did you go to a Caribbean Medical school? Was it because you applied around to a number of schools with your impressive pre-med credentials and decided that hey, though X American School wants me Ross just fits my personality and training style better? Was it b/c you wanted to learn Caribbean medicine and treat the illness of the islands? No, this is not why you went, its b/c you were weeded out with your low MCAT's and GPA. The rest of us did not have some kind of magical advantage over you/some free way into medical school/some mysterious connection/coem from a family of docs. We either out performed you or worked harder if we didn't get in on our first try to bulid up our resume before we applied again (b/c we knew the inferior outcome of the Caribbean route).

2) Be greateful that there is this system that still allows you to train and compete for US residency spots. What more do you want? The simple facts are YOU GO TO INFERIOR SCHOOLS. Anyone with $$$ and a bachelors can go to Ross/Mexico/etc etc and then YOU STILL HAVE THE ABILITY TO GET A US RESIDENCY!!!!!!!!! How can you possibly complain after you have been denied by any of the NUMEROUS US medical schools that are there for US students take a seondhand route and still have the ability to wind up where the rest of us who have gone to US medical schools are. We can and do wind up at the same end point. So why all of the crying above? Do you not see what is still available to you? Do you expect everything in this world to be available to everyone regardless of their credentials?

The point is that instead of complaining and sterotyping ever US grad as some "spoiled" and "privileged" individual as a cheap means of ego defense, be happy that you still have this amazing opportunity to work as an MD in the US in spite of your less than stellar undergrad performance and denial from US medical schools.



(Note: The above only refers to US FMG's not foreign born/foreign trained IMG's)

Herr Fuhrer,

What amazes me most is expending your precious time and energy to elaborate on those clearly inferior (as you have stated) to you. Surely they represent ZERO threat to you or your career.

How dare they study the same books that you use.

How dare they return to the country they were born in.

How dare they walk the same hallowed hallways as you.

How dare they pass the same exams as you.

Why do you waste your breath and words on THIS forum with us lowly inferior folks. Surely there is a single AMG you feel superior to and willing to engage in some constructive aires of superiority with.


On our knees before Thy.

 

[Andrew_Doan]

Originally posted by Skip Intro
However, some programs, not all, will not even send an application or accept an ERAS application from IMGs. That is a fact.

My point above was that this is also true for USMGs. For instance, some ophthalmology programs will not even consider an application from a USMG who graduated from a less competitive medical school. It matters where you go to school (at some programs more than others).

For instance, consider this program:

http://www.usc.edu/hsc/doheny/