For anyone who is interested in knowing...

[Skip Intro]

OBJECTIVE: The authors sought to determine whether there is a selection bias against international medical graduate applicants for U.S. residency training positions in psychiatry. METHOD: Identical requests for a program application were sent by two resident applicants--one international medical graduate and one graduate of a U.S. medical school--to 193 residency training programs, and the rate and character of responses were compared. RESULTS: The response rate to requests for an application form was significantly higher for the U.S. medical school graduate (159 responses) than the international medical graduate (87 responses). The quality of responses was also different in some cases. CONCLUSIONS: Some residency programs in psychiatry are attempting to limit the influx of international medical graduate applicants at the very first level: the request for an application form. The reasons for this practice are not known, but discrimination could be a possible explanation.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9356575

BACKGROUND AND OBJECTIVES: The purpose of the study was to test the hypothesis that discrimination exists against international medical graduates (IMGs) applying to US family practice residency programs. METHODS: Two sets of letters were sent to 146 family practice residency programs randomly selected from the Directory of Graduate Medical Education Programs. The letters requested information and an application. All letters were identical except that the author of the first set was described as "a foreign medical graduate." The author of the second set was described as "a fourth-year medical student at the University of Nebraska Medical Center." Replies were monitored for 6 weeks after the second mailing. Response rates to each "candidate" were measured. In addition, responses were evaluated for the presence of a brochure describing the residency program, an application, cover letter, invitation for interview, eligibility criteria, and other material. RESULTS: A total of 113 programs (79%) responded. Of these, 102 responded to the fourth-year medical student and 57 responded to the IMG. Of the 46 programs replying to both candidates, only 20 provided identical mailings. Nine of the 46 programs required IMGs to meet standards that exceeded requirements set by the Educational Commission for Foreign Medical Graduates for residency training in the United States. CONCLUSIONS: A pattern of dissimilarity exists in the way family practice residency programs respond to requests for application materials, and the differences appear to depend on whether the candidate is a US medical graduate or an IMG. These results raise questions about the fairness of current methods of resident selection.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7859953

We're not just talking about opthamology here, Andrew.

-Skip

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[Andrew_Doan]

Those studies don't prove that there is an active policy to keep out IMGs.

This is similar to applicant A going to a good medical school vs applicant B going to a lower tier medical school.

If both applicants are equal in stats, then applicant A usually gets a better response.

However, if an IMG applicant graduated from a well-known medical school, such as Oxford (which I've seen this past application cycle), then that applicant is a highly competitive applicant.

The studies you cited only confirm that where you graduate matters in the residency selection process.

 

[smf]

Originally posted by Andrew_Doan
Those studies don't prove that there is an active policy to keep out IMGs.

This is similar to applicant A going to a good medical school vs applicant B going to a lower tier medical school.

If both applicants are equal in stats, then applicant A usually gets a better response.

However, if an IMG applicant graduated from a well-known medical school, such as Oxford (which I've seen this past application cycle), then that applicant is a highly competitive applicant.

The studies you cited only confirm that where you graduate matters in the residency selection process.

The studies quoted DID NOT specify which school(s) were attended.

Reminds me of the tv commercial for the dept of housing in which the same guy calls to inquire about a rental apartment each time imitating a different ethnicity.
Each time he is told the apartment is NO longer available until he calls using a wasp name and surname at which time the apartment becomes available.
Do you need a double blind placebo study or a weatherman to know which way the wind is blowing?

My family also came as immigrants. If a relative of yours lacking an anglo accent called to rent an apartment and met the same fate as the guy above would you also say it doesn't prove anything?

You can make the argument there is no law against discriminating against fmg's but there is in housing, however both involve similar principles.

 

[Andrew_Doan]

I respect your views and positions. Clearly, we're going around in circles here, and I have plenty to do with my time than discuss this circular argument with FMGs. Thanks for the new insights, however, and good luck with your future!

 

[odoreater]

Originally posted by Skip Intro
I happen to think it's wrong and akin to the previous exclusion that women in medicine used to face, or (to be more dramatic) making "non-whites" sit at the back of the bus.


Certainly, we no longer accept such a policy where minorities are excluded from even receiving applications to certain programs based on the color of their skin. Why should we accept this in the medical milieu based on educational background?

-Skip

As an American Medical Student I have been reading this debate thread back and forth with a hope to gleen something from it. I have tried to with hold judgement of the other side of this debate (in this case the IMG's) in spite of the obviously self effacing intentions of the "schooling the snob" original post but the above has gone entirely too far.

That you would have the audactiy to compare your stuggle as an american student who has gone internationally to the women's right's movement/the civil right's movements/or to the plight of ANY minority in this country is offensive/illogical/and outrageosuly histrionic.

1) As Dr. Doan has astutely pointed out again and again there are many American medical students who go to lesser ranked schools who have great struggles entering into competitive residencies. Should they then cry "double standard" or espouse conspiracy theories or should it be understood that people want to recruit from what are clasically considered top tiered schools to increase the prestige of their respecitve residency programs?

2) Internationally Caribbean medical schools are considered to be inferior schools. Your argument that IMG's are unfairly discriminated against does not hold water. For example---US spots go to US grads 1st---the rest are filled with IMG's and American IMG's. IF a student from Ross were to apply to the same program as a student from Oxford the Oxford graduate would be looked upon with more esteem than the student from Ross and therefore more likely to obtain a spot.
It is the presitgie of the school/the impressions that the residency selection committee has of the resident's alma matta that determines whether an application is interviewed or not.

3) Capitalism demands competition, in our profession we are selling ourselves, our background, our training to our future educators/employers. Further, our profession is a highly competitive one b/c of the job security, social presitige, income, and limited spots. By attending a school that is not held in high esteem in the resident market you have not set yourself up as a desireable commoditiy. It is a simple as that, no other explanation/randomized trail necessary for an explanation. (The following is not meant to be mean spirited---it is an honest assesment)---Caribbean schools are felt to attract lesser candidates who could not hack the college grades for US medical schools, train in second rate instutions, are taught by poor basic scientists, and train at poor hospitals (ie Jamacia hospital for Ross----though affiliated with Sinai---this is in name only). This is known throughout medicine---and makes your wares less likely to be purchased. Its as simple as that.

4) Finally, the horrible analogy above. Please, this is histrionic, offesnive, illogical, and poorly worded and here is why it simply is fallicious. 2 individuals apply for the same job with the same qualifications---one gets the job b/c of the color of his skin the other is turned away. The previous story is exactly what does not happen with IMG's. Change the story above to be one of a Caribbean IMG and as US medical student (no difference in race) applying for the same residency position. The above would be disrimination were it not for 1 assumption---that the candidates are equally qualified. All of the above arguments of double-standards etc have assumed a priori that the US grad and the Caribben grad are both equally qualified. However, most US residencies would not agree with this position. Again, as above it is felt that the US grad is a more attractive candidate, has better training, and has greater potential b/c of where he/she has trained than the Caribbean IMG. You cannot equate what a caribbean grad goes through to what any minority has gone through in this country (aside from being offensive) simply b/c it makes fallicious assumptions.

I agree with orthoguy above. By virtue of enetring a Caribbean medical school as a US citizen you have allowed yourself to still obtain an MD through a sort of educational loop-hole. Be happy that you will still get to be a Doctor, and though you may have to struggle harder to PROVE YOURSELF, you cannot demand that everyone embrace your alternate path.

 

[smf]

Reading some of the actual comments by FMG's (apparently and clearly mainly pertaining to non USIMG Caribbean graduates; see ethnicity) Comments including a Germany graduate/immigrant

"still feel gender discrimination. I have learned to keep my mouth shut! I came from Germany and felt like I stepped into the last century."

"For some reason, hospitals and clinics feel very comfortable discriminating against FMG such as: informing the recruiters do not send them FMG or bluntly telling recruiters that we don't consider anyone from certain countries or medical colleges. Bluntly state and write ads for recruiting physicians with special religious affiliation. I have even received letters from residency programs stating that "we have never and will never accept FMG". There are large clinics in WI that have policies of not hiring FMG i.e. Mayo Affiliated Clinics in Wisconsin and other large clinics. It seems that the medical profession in Wisconsin is very narrow minded and ignorant. Recently, past president of Family Practice Academy wrote an ad for a good Christian doctor in the Christian provider journal classified."

"As a result of discriminatory activities at various levels, I no longer practice medicine in my original fully trained specialty. I have gone back into training in the hopes that one day this hellacious nightmare will be over for my family and I. We have never known anything other than discrimination since the time that we became a family actually. I have traveled and lived in other parts of the world, and I better than others can say that you would not find a more perfidious, more insidious, more vindictive, more vile, more subtle, more well organized, more treasonous, more outrageous, more sordid form of discrimination anywhere I the so called "free world". I could write a book about this some day. Believe me, as a three-time former SMS delegate, successful practitioner with malpractice history, and former executive committee member at a hospital, uniquely having lived the life of an FMG and growing up in a doctor family even as a child myself, I've seen it all through the years? please God, may this terrible problem go away. Antidiscriminatory efforts in America must continue, let physicians present an example for the rest of society to see and be humbled by."







http://www.wisconsinmedicalsociety.org/physician_resources/membership/imgsurvey.cfm#yes


International Medical Graduate Survey


In the latter half of 2001, a survey on discrimination was distributed to all Wisconsin International Medical Graduates. The results were complied and made available in January of 2002. The survey was intended to determine whether IMG physicians experienced problems dues to where they attended medical school. At the request of the IMG Section, these results are being made available on-line.


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snipped due to message length restrictions

 

[smf]

Furthermore you should write and call program directors of desirable residencies and urge them to expell all the Caribe US citizen graduates currently enrolled so that they may be replaced with your superior brethren.

You may start with a certain Hopkins Onc Rad chief resident.

I think her name is Stephew and she is a moderator on one of these forums.

 

[tofurious]

I like how every IMG is calling the United States the most discriminatory country in the world when there is no control/comparison data from any other country. Why you ask? Because there aren't enough US doctors practicing in these other countries as there are FMGs practicing in the US.

Do you see the holes in your arguments now? Based on your data, US is the MOST and LEAST discriminatory country in the world.

As for why USIMGs are seen as inferior, consider two points: 1) USMLE and other tests are minimum competency tests, not a true reflection of how well you are trained as a physician. Having to pass it within 3 tries in 2 years is not that hard considering many/most US medical schools have 95+% first-time pass rates. 2) You are often a reflection of your instructors, and the faculty at the Carribean schools are nowhere near the caliber of US medical school faculty. You WILL argue that wait, many Carribean medical students do their rotations in great NYC hospitals where they show first year Cornell students who the boss is. I will point out that on any NBA team, there are starters and there are bench warmers. Yes, a bench warmer on the Lakers is probably better than a starter in some European minor league, but just because you're on the Lakers does not put you in the same league as Shaq and Kobe.

As I have said somewhere else before, you went to Carribean medical schools KNOWING that they are inferior schools and they are accurately seen as such. No one forced you to shell out the dough, and no one made you study in an area where the poor local residents do not like rich doctors' kids buying their way to a degree and a life of prosperity back in the US. You signed up for such a life, and you should stay quiet and cherish in your opportunity to return to this country to practice. Had Clinton had his way, you would have been forced to stay in the Carribeans.

And allow me to make an observation: FMGs are extremely discriminatory towards women in their countries, as the sampling of Wisconsin IMGs were overwhelmingly male (over 75%). I think this conclusion has as much statistical validity as your conclusions, and perhaps more truth associated with it.

 

[tofurious]

Here's published data (rather than skewed interpretation of incomplete data):

Fam Med. 2003 Feb;35(2):100-4.
The relationship of residency performance to match status and US versus international graduate status

"Although a large majority of the residents studied here performed well, somewhat less-favorable performance was seen among residents accepted after the Match and among those with international medical degrees."

****************************************************
JAMA. 2002 Sep 4;288(9):1079-84.
The changing pool of international medical graduates seeking certification training in US graduate medical education programs

"Total IMG first-time Step 1 takers went from a pass rate of 57.5% in 1997 to 65.7% in 2001 while non-USIMGs showed similar gains, increasing from a 57.6% pass rate in 1997 to 68.3% in 2001. USIMG performance showed some improvement from 1997 to 1999 but has worsened since 1999; the 55.4% pass rate in 2001 was the lowest in the study period. "

"A similar pattern of improvement is seen in both groups of IMGs. The pass rates for total IMGs and non-USIMGs improved by more than 25%, from 53% in 1997 to 79% to 80% in 2001. USIMGs also had an almost 20% gain in pass rates, increasing from 56.9% in 1997 to 76.1% in 2001."

"In match year 2002, it is evident the USIMGs had a significantly higher overall pass rate compared with non-USMGs (88.6% vs 79.7%). This is due in large part to their higher pass rates on the COM component (99.2% vs 88.8%), which in part reflects proficiency in spoken English. Pass rates for the ICE component were more similar between the groups, with the USIMGs marginally outperforming the non-USIMGs. "

**************************************************
Med Care. 2002 Jan;40(1):68-72.
Exclusion of international medical graduates from federal health-care programs

"The adjusted exclusion rates of international medical graduates from OECD countries were similar to that of US medical graduates. Among board-certified physicians, the relative risk of exclusion of non-OECD international medical graduates was 2.19 (P <0.001) compared with US medical graduates. "

**************************************************
JAMA. 2000 Apr 5;283(13):1751
Overcoming cultural barriers: international medical graduates in the United States

"Residency programs trying to improve IMGs' data-gathering skills have focused primarily on teaching essential English-language skills to IMGs educated in non?English-speaking countries.4 Considerably less attention has been given to teaching IMGs to recognize regional patient dialects, colloquial speech, body language, and speech inflection, yet studies show that even IMGs who are proficient in standard English may find it difficult to understand patients' more subtle or informal means of communication.5 Formal English classes may not prepare an IMG to recognize a patient's use of the phrase "high blood" to refer to hypertension, for example, or to understand a substance user who says "one day at a time" to allude to the philosophy of Alcoholics Anonymous."

"...many IMGs come from developing countries where epidemic disease, physician shortages, and disparities in education leave little room for exploration of the patient's story as a focus for clinical training. As a result, some educators have suggested that communication skills are not a primary concern of these countries' undergraduate medical curriculum"

"A 1990 study of foreign-born IMGs found significant disparities between patients' and IMGs' attitudes toward health-related issues such as family involvement in health care, the meaning of facial expressions, and the use of life-sustaining technology"

***************************************************
Am J Psychiatry. 1999 Mar;156(3):496-7.
Another Explanation for the Apparent Discrimination Against International Medical Graduates by Residency Programs

"...By the end of 1997, we had received 710 applications for six residency positions; 685 were submitted by international medical graduates. We are keenly interested in identifying qualified applicants, regardless of their demographics, as are the other training directors we know. We have been successful in recruiting a diverse residency group that includes both U.S. and foreign graduates. The problem for us, and perhaps for other programs, is the amount of time and money expended in the search for those residents. In 1997, our faculty spent more than 70 hours thoroughly reviewing every application; for every application that results in an interview, 24 are declined because of inadequate qualifications.

The expense of recruitment is too great to be sustained in the manner suggested in the Balon et al. article. That some programs did not even send applications to some U.S. graduates could be an indicator of an overburdened selection system. Limiting the number of applications sent out may be one way in which some programs attempt to deal with the cost and frustration of this early phase of recruitment. It is highly likely that programs would welcome a cost-effective approach to the screening of all applicants. We join in calling for the Educational Commission for Foreign Medical Graduates to take a more active role in the evaluation of clinical competence and language skills when determining who is likely to succeed in the U.S. medical system [3]. Currently, too much of this is left to the individual programs. This leads to fewer resources available to focus on the task to which we are best suited, that of identifying future psychiatric colleagues who are likely to thrive in our specialty at our particular institution."

 

[ZfoUro]

I usually refrain from posting in forums like these, especially when it evolves into a pissing match like this, but this thread really should just be thrown out. It grates on any mature person's judgement, and it is pride wallowing in its own filth. It has no positive value.

To be told that USIMG's are inferior because 1) the USMLE has no bearing on a physician's aptitude and 2) our faculty are smarter than yours? Really? I believe the price of tea in China is going up. And I believe that a Harvard professor does pronounce the words in Robbins a little bit better than in Dominica, though I could be mistaken.

But this is really a moot point, right, because as we all know american grads never kow-tow and apply to carribean and/or DO schools as backups. They would never dream of associating with such inferior trash.

The reason some program directors look unfavorably upon USIMG's, as do some american grads, is quite obviously that they did not get into a US school. Accordingly, this must mean that they either did not work hard enough or did not have the intellectual potential to become a suitable doctor for their institution, right (and by institution, I mean residency program, collegial circle, social circle, bathroom privilege circle, etc.)? Or they must be completely socially inept, somebody whose leisure activity consists of trolling around chat rooms all day in between study breaks (and eats at the same time -- got to respect that work ethic).

If you do not see the ridiculous nature of this, there is no saving your arrogant and pompous a$$.

USIMG's are not inferior, either in intelligence or work ethic. And they are certainly not lacking in any sort of personality quotient. What they are, however, is unproven. This is why I direct the next part of my post specifically to Skip's comments, and the man himself.

Skip, let me briefly give you my academic life history. I went to a very prestigious secondary school, graduated near the top of my class, went to UCLA because they were giving me money off an already low tuition for being a National Merit Scholar at their institution, and graduated there with a double major in English and Biology in less than 4 years. I scored a 34, S on my MCAT, and my GPA was a lackluster 3.29. I applied to pretty much only California schools, got rejected by all. Rather than wait a year for an unsure thing, I went to Ross.

Skip, I am pretty sure that my scores and my academic history beat a lot of people that got into US medical schools, and were I not a California resident I probably would have easily got in somewhere else. I have held that chip on my shoulder for a long time -- I even tried to transfer to a US school after I got to Miami. I got a few interviews, but alas I was rejected again.

Skip, I am telling you all this because I have as much a right to complain about the unfair nature of the system as anybody out there. But I will tell you the pearls of wisdom I have gleaned from all this, and I hope you take it to heart for your own sake.

1) Motivated, intelligent, humble people almost always end sunny side up.
Skip, my fault during my application process to med school was my own hubris. Pride can lead to many things -- in my case it was carelessness and laziness: careless in how I designed my classload and my application process, and lazy in relying on intelligence as a substitute for hard work. It took the stigma of a Carrib school to motivate me and teach me humility. I worked very hard on the island (well, hard for my lazy-a$$ standards) and did well on the Step I. I worked my butt off during my clinicals and put myself in a position through research and "above and beyond"-type projects to land a very competitive residency. Skip, I mean very competitive by US grad standards, not ours.
The cream of the crop have a way of ending up there, Skip.

2) Excuses only show inferiority issues.
The people that whine and complain, especially in medicine, are those that are insecure about their own abilities. Skip, don't be that guy. The residency process is biased against USIMG's, and even more so against non-US IMG's. Whether rightfully so or not, it is irrelevant, the fact still remains. But if you play your cards right, you can end up where you want to be. Trust me -- for my residency spot I was initially told that they don't even interview foreign grads, and that was from the eventual chair of the dept. who ended up being my biggest supporter and best LOR writer. It is frustrating, I know, when you outperform and have more knowledge than the US grad doing the exact same rotation as you knowing full well that he/she will probably land a better residency spot than you will. You may be a better applicant, but in the PD's eyes you are not. Excuses, Skip. You need to pull those eyes towards you, and the way to do that is networking.

3) Thick skin.
Obviously Skip what people write in this forum is getting under your skin. As a USIMG, you can't let that happen. And why does it matter, anyway? I am sure they get all the ladies by trolling the international grad forums and crushing the hopes of aspiring physicians. What girl wouldn't want his man to be compensating a lack of self-esteem by forcing his will on the internet? Skip, you will hear a lot worse from many a pompous PD and US grad colleague. However, it has been my experience that, at least with the US grads I've worked with, they do not feel threatened by me and treated me as an equal -- not out of courtesy but on the assumption that all medical students are created equal. Your motivation should not waiver on the actions of ill-wishing peers, and nor should your emotions.

4) Do not forget where you or your colleagues come form.
The fact is Skip that USIMG's, and DO's for that matter, have to work at least twice as hard to get the same positions. But my experience has been that the US grads I have run across are generally knowledgeable students, hard workers, and great people. You need the chip on your shoulder to motivate you -- not to turn you into a backstabbing gunner. People in medicine are generally very decent people, albeit a little strange more often than not. US grads often do deserve the spots they get, and have worked hard for them. Yes, that is riddled with exceptions, but do not count on your success by taking away that of another.

Skip, I know my advice is unsolicited, and I am partly putting all this out there so that another Carrib grad might glean something positive out of this atrocious thread. But trust me, complaining about the system on this forum will do nothing but cause you grief and waste your time. You spend an awful lot of your time posting threads on these forums, from my brief exposure. Please, for your own sake, spend that time doing the things that will land you that ultra-competitive residency. I was in your position last year as an MS-III, and I didn't have nearly the time you spend on doing this. Get away from this crap and spend your time doing on-the-side research and/or studying medicine.

Not Here.

 

[smf]

Originally posted by tofurious
I like how every IMG is calling the United States the most discriminatory country in the world when there is no control/comparison data from any other country. Why you ask? Because there aren't enough US doctors practicing in these other countries as there are FMGs practicing in the US.

Do you see the holes in your arguments now? Based on your data, US is the MOST and LEAST discriminatory country in the world.

As for why USIMGs are seen as inferior, consider two points: 1) USMLE and other tests are minimum competency tests, not a true reflection of how well you are trained as a physician. Having to pass it within 3 tries in 2 years is not that hard considering many/most US medical schools have 95+% first-time pass rates. 2) You are often a reflection of your instructors, and the faculty at the Carribean schools are nowhere near the caliber of US medical school faculty. You WILL argue that wait, many Carribean medical students do their rotations in great NYC hospitals where they show first year Cornell students who the boss is. I will point out that on any NBA team, there are starters and there are bench warmers. Yes, a bench warmer on the Lakers is probably better than a starter in some European minor league, but just because you're on the Lakers does not put you in the same league as Shaq and Kobe.

Boisterous ignorance will indeed make you shine throughout your career.

Kobe Bryant played in the Italian league prior to the NBA. Wilt Chamberlain also played in Italy.

Personally I dont think comparing superstar athletes with medical students is accurate. Such athletes may indeed be born with super talent and ability while it doesn't take much special intellect to study medicine, although the controlled market forces that create fierce competition to gain admission to US schools probably leads some to believe they are Gods gift to the earth.

Similar reasoning could pit a formally trained musician against one with zero formal training, such as Jimi Hendrix, who in the eyes of the formally trained one, with all his/her high calibre teachers, could say Hendrix is clearly inferior.


If what you say is true about usmle and the stunningly superior calibre of your instructors then you clearly should be exempt from such trivial examinations.


I am glad that usa students have a high pass rate on the exams their system created and prepares them for. Would you not expect this to be the case?

Kobe is surely a great basketball player. Some of the people I look up to and that have influenced my life include MLK, Ghandi, Mandela, JFK, John Lennon, Einstein, Alfred Nobel, Aung San Suu Kyi (sorry some of them are foreign graduates)

As I have said somewhere else before, you went to Carribean medical schools KNOWING that they are inferior schools and they are accurately seen as such. No one forced you to shell out the dough, and no one made you study in an area where the poor local residents do not like rich doctors' kids buying their way to a degree and a life of prosperity back in the US..

You may want to do some research on The University of Chicago School of Medicine. From what I understand, there is some real expertise to be had in the area of "purchasing admissions".

Neither of my parents went beyond high school and I was lower middle class. I borrowed money and had to interrupt my studies to work and save to be able to continue to study. I am not the exception in this. I had many classmates struggling to make ends meet.


.

You signed up for such a life, and you should stay quiet and cherish in your opportunity to return to this country to practice. Had Clinton had his way, you would have been forced to stay in the Carribeans.

Finally you resort to telling fellow students to "shut up and be happy" in so many words.
I would certainly cherish the opportunity to meet you, face to face.

Your eloquent words remind me of those of P.W. Botha and the likes.
Yes, ethnic and racial discrimination also have intellectual foundations and their so called intellectuals that preach them.

The initiation of medical colleges close to the US with instruction in English has infuriated some in organized US medicine. How dare they offer the acquisition of knowledge to those not chosen by the powers that be.

Perhaps several years ago when a St George student got the highest score ever recorded on the applicable exam at that time, it burst the bubble of magic and the perceptin of the hallowed halls of higher learning of n america. The genie was let out of the bottle.

As but one example, does Hopkins not allow students to repeat 1 year of the first 2 to make up for failing performance?

If you follow some of the threads on the US allopathic forums you will hear of clinical rotations failures, cutting out of or not showing up for clinical exposure, etc. There is a thread titled "cheating".

Anyway I know humans are far from perfect and am the first to admit my own imperfections or let my wife point them out.

Again I have trained with and later supervised some good people both from abroad and the usa. The ones that are confident and feel secure with themselves do not hav the need to try to prove/demonstrate their superiority.

When I was in medical college my only task was to study and keep up with a lot of material to learn. I wasn't interested in who was better than who, or my daddy can beat up your daddy.

I am not familiar with Bill Clintons role in this as you mentioned. Do you have a url for it?
Did he attempt to pass legislation? Perhaps he was too busy not having sex in the white house to follow through. I honestly don't know. I happen to like Bill Clinton.



]

And allow me to make an observation: FMGs are extremely discriminatory towards women in their countries, as the sampling of Wisconsin IMGs were overwhelmingly male (over 75%). I think this conclusion has as much statistical validity as your conclusions, and perhaps more truth associated with it. [/B]

In order for you to make that statement, would you not need to know the specific countries involved, since granted some countries do seem to trample womens rights.

Don't forget all the problems within the usa, that has led to the creation of sexual harassment statutes/laws. I need not add insult to injury since YOU mentioned Kobe as your superstar USMG like figure. I presume you are aware of the issues/accusations facing your role model?

I presume you are aiming at a program such as or similar to

U Pennsylvania
Thomas Jefferson
Georgetown
Mt Sinai
U Washington

Perhaps since you are clearly superior (as you inferred) and so very smart, perhaps you may gain entry at The UW prestigious Neurosurgery program.

http://seattlepi.nwsource.com/local/78832_uwfraud17.shtml

I understand that besides training with an Ivy league program director, residents educational exposure includes didactics in "obstruction of justice" and "fraudulent billing techniques"

Oops, perhaps it is too late to train with this superstar as it seems this convicted felon has found a new job at another prestigious institution
http://www.mssm.edu/neurosurgery/faculty/winnri01.shtml

Is it not interesting how his cv seems to have omitted something so unimportant as having been the PD of Neurosurgery at UW?

Ouch!



Please excuse any spelling errors I may have made, after all I'm an fmg.


Disclaimer; This is not indended as an attack towards all usms/grads, only a focused reply to a single author.

 

[tofurious]

Like Andrew said, we are just going in circles... I'll just point out a few holes in your understanding.

Originally posted by smf
Boisterous ignorance will indeed make you shine throughout your career.

Kobe Bryant played in the Italian league prior to the NBA. Wilt Chamberlain also played in Italy.

Yes, and they played it up to the NBA. There are superstars in Europe and they are rightfully here. Your claim is basically that the majority of the European basketball stars are the Kobe Bryants and the Wilt Chamberlains by claiming FMGs and USIMGs are as qualified as USMGs.

I am glad that usa students have a high pass rate on the exams their system created and prepares them for. Would you not expect this to be the case?

Who else but the American medical system should create a basic level examination to practice in the US other than the American medical system? What is your point? Plus, does the Carribean system NOT exclusively prepare their students to pass the USMLE and try to get them back into the US system? PLEASE.

And allow me to make an observation: FMGs are extremely discriminatory towards women in their countries, as the sampling of Wisconsin IMGs were overwhelmingly male (over 75%). I think this conclusion has as much statistical validity as your conclusions, and perhaps more truth associated with it.

In order for you to make that statement, would you not need to know the specific countries involved, since granted some countries do seem to trample womens rights.

You must have forgotten what sarcasm means having been away from the US for too long. I am making giant leaps in logic here by adopting your approach of making a mountain out of an incomplete view of a mole hill.

I presume you are aiming at a program such as or similar to

U Pennsylvania
Thomas Jefferson
Georgetown
Mt Sinai
U Washington

Perhaps since you are clearly superior (as you inferred) and so very smart, perhaps you may gain entry at The UW prestigious Neurosurgery program.

I am sure that the foreign medical systems are error free and fool proof. And just to answer your seemingly demeaning question, with the exception of U Penn and UW (I turned down UW's interview offer), no I did not apply to those places.

And here's the reference on Clinton:
http://www.imgi.net/internationalmedicalgraduate/corovofspecb1.html
To control the supply of physicians, the Council on Graduate Medical Education and the Physician Payment Review Commission recommended that the federal government limit the number of entry-level residency positions to 110 percent of the number of U.S. medical school graduates.7,8 This recommendation was embraced by the Clinton administration and included in the work-force provisions of its original plan for health care reform. Although the proposal for regulating residency positions was widely endorsed by medical educators and health policy analysts, it is unrealistic to expect serious consideration of this approach now.

 

[tofurious]

Originally posted by smf
I understand that besides training with an Ivy league program director, residents educational exposure includes didactics in "obstruction of justice" and "fraudulent billing techniques"

Oops, perhaps it is too late to train with this superstar as it seems this convicted felon has found a new job at another prestigious institution
http://www.mssm.edu/neurosurgery/faculty/winnri01.shtml

Well, I had to look at these links, and frankly I don't see your point. He took the blame for the university to avoid a publicity fiasco. He is still a great surgeon.

If you are so against the US residency programs, why are you spending all this effort and time to blast their alleged discrimination against you? Why not just bypass the US residency system and go on your merry way outside of the US?

 

[tofurious]

Uh, Skip, you realize that ZfoUro is arguing FOR you, right? He is not arguing AGAINST you. He is encouraging you to fight on, while the rest of us are saying that USIMGs have too low of a first time USMLE pass rates.

 

[tofurious]

We could ask him to clarify, but it seems to me (after re-reading) that you should fight on IN REAL LIFE and not give up... (I think interpreting his suggestion of better use of your time as him telling you to shut up is oversensitivity)

 

[smf]

QUOTE]Originally posted by tofurious
Like Andrew said, we are just going in circles... I'll just point out a few holes in your understanding.



Yes, and they played it up to the NBA. There are superstars in Europe and they are rightfully here. Your claim is basically that the majority of the European basketball stars are the Kobe Bryants and the Wilt Chamberlains by claiming FMGs and USIMGs are as qualified as USMGs.



Who else but the American medical system should create a basic level examination to practice in the US other than the American medical system? What is your point? Plus, does the Carribean system NOT exclusively prepare their students to pass the USMLE and try to get them back into the US system? PLEASE.



You must have forgotten what sarcasm means having been away from the US for too long. I am making giant leaps in logic here by adopting your approach of making a mountain out of an incomplete view of a mole hill.



I am sure that the foreign medical systems are error free and fool proof. And just to answer your seemingly demeaning question, with the exception of U Penn and UW (I turned down UW's interview offer), no I did not apply to those places.

And here's the reference on Clinton:
http://www.imgi.net/internationalmedicalgraduate/corovofspecb1.html
To control the supply of physicians, the Council on Graduate Medical Education and the Physician Payment Review Commission recommended that the federal government limit the number of entry-level residency positions to 110 percent of the number of U.S. medical school graduates.7,8 This recommendation was embraced by the Clinton administration and included in the work-force provisions of its original plan for health care reform. Although the proposal for regulating residency positions was widely endorsed by medical educators and health policy analysts, it is unrealistic to expect serious consideration of this approach now. [/QUOTE]





"This recommendation was embraced by the Clinton administration and included in the work-force provisions of its original plan for health care reform. Although the proposal for regulating residency positions was widely endorsed by medical educators and health policy analysts, it is unrealistic to expect serious consideration of this approach now."

I don't get it. The "good ol boys" wrote it and even got (lobbied) Clintons administration to accept it, yet they contradict themselves in saying it is unrealistic to expect serious consideration of this approach now.


Why in the world havn't they simply increased the number of seats in US schools to approximate the # of residency positions? They have had decades to to this.

What threat do graduates of schools abroad pose to you personally, aside from potential competition.


Yes indeed, the Carribean system in many cases does NOT exclusively prepare their students to pass the USMLE. There are public and private universities that train students within their own system and their own exams. The Dominican Republic is one such country.

I wish schools like SGU, Ross, etc were around when I was a student. Its ok and perhaps a blessing in disguise since I feel very much at home in the Spanish speaking world. New horizons so to speak.

To those who are studying abroad or considering to do so PLEASE do not be crippled by some peoples attempts to berate non US education. Just know that you WILL encounter and have to deal with such personalities who believe THEIR SHxT doesn't stink.

Although clearly technically adept and able to do well on standardized exams, certain individuals are lacking just enough self esteem and/or character to lead them into this behaviour.
Confident secure people have no need to vocalize superiority to anyone.

Study hard and believe in yourself as much as you doubt.

Un fuerte abrazo a todos.

 

[tofurious]

I am sure you will do well or have done well in your hospital, as you have mastered the skill of answering whatever you think the question is instead of what is asked of you.

As you may know, very few simple bills are introduced in the Congress. The Clinton health care bill contained many more provisions than just the work force provision, and was defeated because the Republicans controlled the Congress and the health care reform is too complex to be fixed by one bill. The same problem exists for the Bush health care bill, but this time his party controls all three branches of the government and the bill passed with all its baggage and future problems. Of course, I was not surprised when you used this as an opportunity to attack the American medical system instead of seeing the point.

FMGs and USIMGs do not pose a threat to me personally. They do pose a threat to the American medical system. You can look at this year's match and see that very few people are going into family med. People joke that all family docs will be foreign some day soon, and that is a scary reality: people with the worst communicaiton abilities when interacting with AMERICAN PATIENTS will be the first line physicians. Tremendous medical errors and alienation will inevitably occur in this system. There are a limited number of medical school positions because there is only a NEED of that many physicians in society. The need for residents is artificial and does not reflect the need of physicians in this country (you can argue all you want about physician shortage, but the issue is not absolute physician number but physician allocation - and FMGs do not solve that problem as they tend to aggregate in 2-3 states). In their profit-driven mind, residency programs care as much about the problems of bringing in FMGs as Texas factories care about bringing in illegal workers across the border. It is up to policy makers to limit how many FMGs should be allowed into the system, and that will not happen until another enlightened leader steps into office.

And you can attack USMGs all you want on our questionable self-esteem. Ross and SGU graduates always claim they have extremely high pass rates on USMLE as their qualification. All I have done is point out the data that they actually do NOT have that high first time pass rate. Of course, then you turn around to say what does USMLE mean? That's why we are going in circles. I am just glad that you are not in this country any more.

 

[smf]

Originally posted by tofurious
I am sure you will do well or have done well in your hospital, as you have mastered the skill of answering whatever you think the question is instead of what is asked of you.

Flattery will get you nowhere.



QUOTE]As you may know, very few simple bills are introduced in the Congress. The Clinton health care bill contained many more provisions than just the work force provision, and was defeated because the Republicans controlled the Congress and the health care reform is too complex to be fixed by one bill. The same problem exists for the Bush health care bill, but this time his party controls all three branches of the government and the bill passed with all its baggage and future problems. Of course, I was not surprised when you used this as an opportunity to attack the American medical system instead of seeing the point.QUOTE]

Can they not pass some aspects of a bill and not others? I don't now.



QUOTE]FMGs and USIMGs do not pose a threat to me personally. They do pose a threat to the American medical system. You can look at this year's match and see that very few people are going into family med. People joke that all family docs will be foreign some day soon, and that is a scary reality: people with the worst communicaiton abilities when interacting with AMERICAN PATIENTS will be the first line physicians. Tremendous medical errors and alienation will inevitably occur in this system. There are a limited number of medical school positions because there is only a NEED of that many physicians in society. The need for residents is artificial and does not reflect the need of physicians in this country (you can argue all you want about physician shortage, but the issue is not absolute physician number but physician allocation - and FMGs do not solve that problem as they tend to aggregate in 2-3 states). In their profit-driven mind, residency programs care as much about the problems of bringing in FMGs as Texas factories care about bringing in illegal workers across the border. It is up to policy makers to limit how many FMGs should be allowed into the system, and that will not happen until another enlightened leader steps into office.QUOTE]

AMG's I have spoken with seem not to want the drudgery associated with primary care. They prefer a field (not everyone) that provides consultation and or procedures. One learns fast how pediatricians, FP's, Internists spend lots of time, write tons of notes and earn less than surgical subs or derm or EM, or GI, etc etc.

Am I wrong in assuming you are NOT going into FP? If not then what field have you been accepted into?

As far as second languages go everyone cannot be perfect in it. Interestingly enough you can find fmg's speaking in their native languages working with patients that also speak that primary language. I've often bailed out non Spanish speaking doctors seeing non English speaking patients.

I have friends for example from the philipines who have huge practices in the usa. Almost all of their patients speak very little english if any. How would the reverse scenario function. The non Philipino(non whatever language) speaking doctor in the midst of a patient population he couldn't understand(well) The same is true with spanish speaking practices.
I am no genius but at the front line be it opd or ed, spanish is not a barrier, nor italian nor portugese, limited french, though my english is very limited.
One solution to the dilemma you proposed would be to expell all those non English speaking people in the United States. If this were accomplished then eliminate the fmg's and you'd be left with USMG's and purely English speaking N americans.

How exactly do you define AMERICANs?


As you state "Tremendous medical errors and alienation will inevitably occur in this system. " One would imagine this physician population must already have a disproportionately high % of malpractice suits. Can you post a url that confirms this? It just seems logical, all kidding aside.

And you can attack USMGs all you want on our questionable self-esteem. Ross and SGU graduates always claim they have extremely high pass rates on USMLE as their qualification. All I have done is point out the data that they actually do NOT have that high first time pass rate. Of course, then you turn around to say what does USMLE mean? That's why we are going in circles. I am just glad that you are not in this country any more.

In case you havn't noticed from my prior posts, this debate is between us. Your views and those of others on this thread. I have known and have cherished friendships with doctors educated on each and every continent including N america.

It was not I that said usmle means nothing.

Out of curiousity, do they teach humanity and humility at your medical college?

 

[neilc]

Originally posted by tofurious
Ross and SGU graduates always claim they have extremely high pass rates on USMLE as their qualification. All I have done is point out the data that they actually do NOT have that high first time pass rate.

actually, the data you posted is overall first time pass rates...it is NOT school specific. these schools (ross and sgu) do have high first time pass rates...

i will be the first to agree that there are lots and lots of americans that went abroad for med school that likely should not have done it. i sit next to some in my classes every day, and i think that many other offshore students do too...and, likely these are the ones that fail USMLE on the first try. it just seems to me that a lot of folks are doing two things. 1) putting a lot of faith in the selection comittees and undergrad grades and 2) throwing the babies out with the bathwater.

in the first case, i will have to say that even someone with a C average can be a great doc, and that the selection comittees certainly do make mistakes. i likely would not have been accepted, and i make no qualms about it. my grades sucked, my motivation was not there, i partied, etc...such is life. but, i don't think that this automatically will make me a worse doctor. it means that i had to go abroad, and i am glad i did. i am happy, i am working hard. i can also accept that i will have to do better than the average US grad for the same residency spot. all of this is fine, i can easily accept this and live with it.

for the second point, it seems a bit silly, but it is true. there are great internationalgrads. there are crappy international grads. same can be said (to a much lesser degree) about the american grads. but, as with anything, we should really be looking at the individual vs passing judgement on the group. just seeing how worked up people get blows my mind. first of all, you don't have to worry about the crappy IMG's getting your jobs. ain't gonna happen. in fact, i think that lots of those IMG's that didn't pass the USMLE in the first go round are going to have trouble matching. so, tofurious, you should be happy. if that is your main argument (that we can't pass the USMLE) then you should embrace those that do.

now, you state that international grads pose a threat to the US medical system. well, show me the data. if you can show me that the FMG's that practice are hurting patients, that the thousands of patients that rely on international grads for thier health care are worse off because there doctor did not get into a US med school, i would have to reconsider my veiws. but, the fact is that these docs do a great job.

really, you guys put so much weight on such a small part of your education. in pre-med, really nothing was learned that was essential to success in med school. sure, it can help, and you need to do well to get in to a US school, whatever. but, i really don't see how you can say that someone with a 2.0 in undergrad can't be a good doc. the statistics may say that he can't handle the work, but that is certainly not always the case. in med school...really, how much did it matter where you went to school? we all read robbins, right? we all learn the same cell bio, physio, pharm, right? ask almost any doctor where they learned 90% of what it takes to be a good doc and they will say residency. so, if an international grad can go abroad, can pass the USMLE, can get one of those covetted residency spots...then, why do you think they will be such a danger to the system.

sorry guys, that you have so much hate for those of us that had to take the "other" path. but, the fact is that many of us will do quite well when we get home. and, you may even be sending your patients to us! so, my humble suggestion is that we learn to be colleagues, we embrace the things that make us different and we open our eyes to the fact that there is more than one way to do everything....yes, there is more than one way to be a good doctor!

so, in short, if my patient asks why i didn't go to a US med school. i will smile and say, i didn't apply because i would not have been accepted. and, i will bet you that 9 out of 10 times it will be the start of an interesting conversation, and when it is over i will have a patient that is even more confident in her choice of physician.

 

[tofurious]

As seen on page 3 of this thread (for neilc who asked for data):

**************************************************

Med Care. 2002 Jan;40(1):68-72.
Exclusion of international medical graduates from federal health-care programs

"The adjusted exclusion rates of international medical graduates from OECD countries were similar to that of US medical graduates. Among board-certified physicians, the relative risk of exclusion of non-OECD international medical graduates was 2.19 (P <0.001) compared with US medical graduates. "

**************************************************

JAMA. 2000 Apr 5;283(13):1751
Overcoming cultural barriers: international medical graduates in the United States

"Residency programs trying to improve IMGs' data-gathering skills have focused primarily on teaching essential English-language skills to IMGs educated in non?English-speaking countries.4 Considerably less attention has been given to teaching IMGs to recognize regional patient dialects, colloquial speech, body language, and speech inflection, yet studies show that even IMGs who are proficient in standard English may find it difficult to understand patients' more subtle or informal means of communication.5 Formal English classes may not prepare an IMG to recognize a patient's use of the phrase "high blood" to refer to hypertension, for example, or to understand a substance user who says "one day at a time" to allude to the philosophy of Alcoholics Anonymous."

"...many IMGs come from developing countries where epidemic disease, physician shortages, and disparities in education leave little room for exploration of the patient's story as a focus for clinical training. As a result, some educators have suggested that communication skills are not a primary concern of these countries' undergraduate medical curriculum"

"A 1990 study of foreign-born IMGs found significant disparities between patients' and IMGs' attitudes toward health-related issues such as family involvement in health care, the meaning of facial expressions, and the use of life-sustaining technology"

 

[neilc]

tofurious: i can easily understand where lack of english skills can get in the way of patient care....but, i was more specifically refering to the US IMG's. if that is your major point, i think that us US citizen IMG's should be safe from your critisisms, but that does not seem to be the case.

my main point is that the education of a doctor is a dynamic thing. as an international grad, i am comfortable with having to prove myself, perhaps at a higher level than an american grad for the same spot. however, it seems that many on this board are of the opinion that no matter what, i will be considered inferior because of where i went to school. i am no super star, i didn't get a 250+ on the boards. i do well in school, i know the material, but i am fully aware that i am not going to knock anybody's socks off academically....and that is not my goal, even if i had that ability. but, i am very comfortable with my knowledge level and skills, and would compare myself to the average US student. i think that most offshore grads fall in a similar skill level, and i think it is simply unfair and judgemental to group us up, say we are inferior and accuse us of being dangerous to the US health care system. that is really it....

bad docs are bad docs, they are bad for the system. no matter where they went to school, right? so, the fail rate is just over 50% for US IMG's. a good portion of those that fail will never make it to residency anyway, so don't punish the rest of us. we passed the stupid exam, often times in spite of never taking a multiple choice question in med school.

and, unless you can prove that as a group we are more prone to be bad doctors, and bad for patient care and the american system of medicine, than i think your thoughts about US IMG's are simply inaccurate and judgemental.

 

[tofurious]

I can never prove that you are competent or incompetent since any case of 1 studies cannot be generalized and generalized data should not be used to reflect n of 1. However, I have given you generalized data on the groups. Everyone keeps on saying but I am not the average USIMG/FMG. It just seems to me that no USIMG/FMG is the average USIMG/FMG. There is some intrinsic fallacy in that argument that I hope everyone can appreciate.

I quoted data on USIMGs (from the Carribean schools mostly) on page 3 as well. Please don't make me cut-and-paste again. It will show you that USIMGs do worse on boards than FMGs do. Also, here's what the AAIMG says about East European medical schools and you can make your own conclusion (since little data exists for these medical schools and their graduates):

"Eastern European medical programs provide a viable alternative for young Americans unable to gain acceptance into U.S. medical schools. A majority of the programs are cost effective and train competent physicians."

 

[neilc]

well, i consider myself an average US-IMG/FMG. i would say that means less than stellar undergrad, i did very well in my med school classes and passed the boards first try with a crappy score.

i guess i am just assuming that the average IMG is decent, while acknowledging the fact that as a group we have higher fail rates on the USMLE. but, i still think that those of us that get through deserve some respect. or at least we do not deserve such contempt.

but, believe me, i see your point every day about crap students that go offshore and should not be in medicine. i sat in class with many of those students, until they failed out, or never took the boards, or wandered off into the sunset. i would never want any member of my family treated by them. however, they never even get to see patients here, much less in the states. they fail. but, those of us that do get through are going to be fine. at least the vast majority of us. we may not have looked good enough on paper to compete for the US med school seat. too bad for us. but, we did manage to get a medical education, learn the material, pass the exams....though the path was quite different, the end result will be the same. all i am asking is that you don't prejudge us based on the path. look at the results, and not some table telling you how many failed. look at those that work beside you, the ones that passed and made it through. that is what you should be concerned with.

the system does seem to work, the sky is not falling, the IMG's that are in the system fill a vital role in medicine.

 

[smf]

There are pending questions directly related to your prior post.




AMG's I have spoken with seem not to want the drudgery associated with primary care. They prefer a field (not everyone) that provides consultation and or procedures. One learns fast how pediatricians, FP's, Internists spend lots of time, write tons of notes and earn less than surgical subs or derm or EM, or GI, etc etc.

Am I wrong in assuming you are NOT going into FP? If not then what field have you been accepted into?

As far as second languages go everyone cannot be perfect in it. Interestingly enough you can find fmg's speaking in their native languages working with patients that also speak that primary language. I've often bailed out non Spanish speaking doctors seeing non English speaking patients.

I have friends for example from the philipines who have huge practices in the usa. Almost all of their patients speak very little english if any. How would the reverse scenario function. The non Philipino(non whatever language) speaking doctor in the midst of a patient population he couldn't understand(well) The same is true with spanish speaking practices.
I am no genius but at the front line be it opd or ed, spanish is not a barrier, nor italian nor portugese, limited french, though my english is very limited.
One solution to the dilemma you proposed would be to expell all those non English speaking people in the United States. If this were accomplished then eliminate the fmg's and you'd be left with USMG's and purely English speaking N americans.

How exactly do you define AMERICANs?


As you state "Tremendous medical errors and alienation will inevitably occur in this system. " One would imagine this physician population must already have a disproportionately high % of malpractice suits. Can you post a url that confirms this? It just seems logical, all kidding aside.

In case you havn't noticed from my prior posts, this debate is between us. Your views and those of others on this thread. I have known and have cherished friendships with doctors educated on each and every continent including N america.

It was not I that said usmle means nothing.

Out of curiousity, do they teach humanity and humility at your medical college?

 

[tofurious]

Originally posted by smf
There are pending questions directly related to your prior post.

I do not see how most of your questions have anything to do with the topic of discussion other than a strategy of distraction.

AMG's I have spoken with seem not to want the drudgery associated with primary care. They prefer a field (not everyone) that provides consultation and or procedures. One learns fast how pediatricians, FP's, Internists spend lots of time, write tons of notes and earn less than surgical subs or derm or EM, or GI, etc etc.

As far as I know, internal medicine and pediatrics are still quite popular career choices. You should check your sources. What I want to go into is completely irrelevant.

As far as second languages go everyone cannot be perfect in it. Interestingly enough you can find fmg's speaking in their native

Yes, it would be great to transport a small section of each country in the world to America (note sarcasm here). Alternatively, as the American educaiton does encourage second languages and cultural exploration, sons/daughters of early immigrants often speak their parents' native tongue and can serve as bridges between new immigrants and mainstream America/American medicine. You don't need to transport the moon to NYC for people to appreciate the beauty of the moon.

As you state "Tremendous medical errors and alienation will inevitably occur in this system. " One would imagine this physician population must already have a disproportionately high % of malpractice suits. Can you post a url

The use of future tense "will inevitably" suggest that this has not happened yet. One also cannot prove alienation except through word of mouth, which we have all heard growing up in America.

Out of curiousity, do they teach humanity and humility at your medical college?

Yes, just not for self-proclaimed gurus whom we are taught to question and discredit.

After 5 of your questions, I fail to see any valid point. At least neilc and Skip Intro have a somewhat reasonable flow in their arguments. You are just keeping this up to let out all the long-winded anger for the US system you have built up throughout the years. You make baseless generalizations you expect people to believe, and question everyone else's generalization. When provided with evidence, you simply choose to ignore such evidence and present your own skewed evidence unrelated to the subject matter at hand. On the other hand, when you are cornered, you employ low blows to discredit single individuals in the US system when the systemic problems outside the US are magnitudes greater. Of course, you will always come back to the sour grape mentality of claiming US to be not so great, even though you spent all your life trying to convince people that your departure was voluntary.

There are two threads on this issue elsewhere that are much more meaningful than any further discussion with you (smf). I will cease my participation here (knowing perfectly well that you will call this an un-American cowardly exit) and put my time to better use somewhere else.

 

[smf]

Originally posted by tofurious
I do not see how most of your questions have anything to do with the topic of discussion other than a strategy of distraction.



As far as I know, internal medicine and pediatrics are still quite popular career choices. You should check your sources. What I want to go into is completely irrelevant.



Yes, it would be great to transport a small section of each country in the world to America (note sarcasm here). Alternatively, as the American educaiton does encourage second languages and cultural exploration, sons/daughters of early immigrants often speak their parents' native tongue and can serve as bridges between new immigrants and mainstream America/American medicine. You don't need to transport the moon to NYC for people to appreciate the beauty of the moon.


The use of future tense "will inevitably" suggest that this has not happened yet. One also cannot prove alienation except through word of mouth, which we have all heard growing up in America.


Yes, just not for self-proclaimed gurus whom we are taught to question and discredit.

After 5 of your questions, I fail to see any valid point. At least neilc and Skip Intro have a somewhat reasonable flow in their arguments. You are just keeping this up to let out all the long-winded anger for the US system you have built up throughout the years. You make baseless generalizations you expect people to believe, and question everyone else's generalization. When provided with evidence, you simply choose to ignore such evidence and present your own skewed evidence unrelated to the subject matter at hand. On the other hand, when you are cornered, you employ low blows to discredit single individuals in the US system when the systemic problems outside the US are magnitudes greater. Of course, you will always come back to the sour grape mentality of claiming US to be not so great, even though you spent all your life trying to convince people that your departure was voluntary.

There are two threads on this issue elsewhere that are much more meaningful than any further discussion with you (smf). I will cease my participation here (knowing perfectly well that you will call this an un-American cowardly exit) and put my time to better use somewhere else.

Poor child