IMG Tennessee Bill - Implications for med students and current residents in the US

[Imtocardio]

Ever since Tennessee opened up a pathway for IMGs [with previous 'home residency' experience] to obtain an independent state license and be able to practice without restrictions, many more states have followed suit and are opening up pathways for IMGs to come into the US, work as an Attending [in a University Hospital setting] with peer to peer supervision for 2 years and then obtain unrestricted license to practice, many more states like Idaho, Wisconsin, Arizona, Florida, and Virginia, to name a few, have followed suit. The goal of this pathway was to eliminate 'physician shortage' in rural areas and to ?prevent mid-level creep in the profession. However, on looking at this a bit closer, there are important caveats:

1. The program is not going to attract a physician practicing in Switzerland or New Zealand to come over here. Most of the incoming IMGs are going to be from third-world countries. While a lot of them are really bright and have excellent clinical skills, what about acclimatizing them to the culture of the US and vetting of residency before they start off directly as an Attending [albeit with peer-to-peer supervision]?
2. There is no mandate for these physicians to settle down and practice in rural America once they obtain their independent state license. There is NO guarantee these docs are going to want to stay in a rural town in Tennessee once they get their full state license. What is the process to ensure they actually practice in areas of need [such as what Australia has at present where it forces doctors to work in Areas of Need before moving to the bigger coastal cities]?

3. If anyone can come here and avoid the competitive residency match process, what about med students in the US with 6-figure student loans planning to go into surgical specialties? Take for example, getting into ENT or Ophthal is pretty easy in India as there is a surplus number of spots available and not many well-paying jobs available. Now, contrast this with the US where it is the exact opposite where these specialties are the hardest to get into. If this pathway is opened up, hundreds of graduates will be applying to come in as they can make bank here and they don't need to go through the bottleneck of the residency match. Sure they have to give all steps of the USMLE, but it has become a joke anyway with Step 1 being made pass/fail and CS being converted to an English exam. Matching into these specialties in the US involves spending many months doing research and building up a strong CV, whereas in most countries you just sit for an entrance exam and can get into any specialty if your scores are decent enough. What happens to all those students here who have put in efforts to get into these competitive specialties?

4. Remember this is not restricted to primary specialties alone. If you look at the wording of the law, it says anyone with a residency OR fellowship training abroad can come in, work under 'supervision' for 2 years and get licensed. So being fellowship-trained isn't going to make you immune from the competition you may be facing a few years from now.
5. Mid-levels: Yes, this will reduce the number of mid-levels for sure as hospital systems can bring in IMG physicians who will be willing to work for $80,000 per year as an Attending as this salary itself will go a long way in many of their home countries. The winners here are going to be corporate hospital systems which will be able to hire cheaper physicians from abroad for cheaper salaries and kick local ones [demanding higher pay] out easily.

6. Sure, IMGs with prior experience do not need to do extensive residency training here to be able to practice, but they sure can be given a year of credit AFTER they match into a US residency spot [just like everyone else does]. This, along with officially increasing the number of residency spots in primary care specialties along with incentivizing rural medicine would solve the problem, not opening the floodgates wide to everyone who wants to come here. As people have pointed out multiple times, there is no standardized residency/fellowship training in many third-world countries and log books, etc can easily be fudged up to meet procedural requirements. Some countries also have residency programs where you just pay your way in [and out, sometimes]. Does it mean that someone who fails to match goes to a country, does Dermatology in some sham institution, gets a certificate of completion, and comes back to the US to be able to practice after 2 years of 'supervision'? What about the IMG who has 20+ first author publications and has been traveling across the US struggling to get observerships in Dermatology to get LoRs and is hoping to someday match into Derm residency here? Will this punish hard working young IMGs?

7. Finally for everyone who says, hospitals will not credential physicians who come in through this pathway or insurance companies won't approve, keep dreaming. They said the same thing about mid-levels too, and look how the situation is now. NPs can practice independently in a large number of US states. Plus once these physicians get a valid state license, there is no reason why they should not be board-eligible [and there will be a push for this from corporations too]. End result: that lucrative hospitalist job pays $100,000 only now and there are 10 candidates for 1 spot. Guess how those student loans are going to pay themselves now. A similar thing happened in the tech industry with outsourcing of jobs, guess medicine is the next one to take a hit

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[timpview]

Yea it’s not a good thing.

There’s a reason why the center place of corporate medicine (Tennessee) is leading the charge on this.

 

[NewYorkDoctors]

not to get too political, but the real reason for the border issues (I am in NYC and see it everyday) is not to get votes for anyone one side. Long term it is get census counting to get more House of rep seats for one team. But the other side (in cahoots with big industry and lobbyists) wants to drive the price of labor by importing non citizens so they can reap more profits. This is the end game of crony capitalism.

(note I am not some tree hugger socialist wannabe. i know the hammer and sickle means we all toil in the fields together)

The road to hell is paved with good intentions and this is no different

 

[DrMetal]

I don't understand why in this country we don't simpler things first (to bring more physicians into the work force, or to keep them there): like, getting rid of BC/MOC. You went to a US medical school and completed a US residency: done, go practice, no BC needed (we'll judge you based on the work your provide).

 

[bronx43]

Def bad news for all, but I can see this being absolutely disruptive for non patient facing specialties like rads or path. It allows these “academic” centers to load up on cheap labor who don’t see patients, and they can theoretically outsource these services to outlying hospitals for a fee.
Sweatshop model - medicine style.

 

[NewYorkDoctors]

I don't understand why in this country we don't simpler things first (to bring more physicians into the work force, or to keep them there): like, getting rid of BC/MOC. You went to a US medical school and completed a US residency: done, go practice, no BC needed (we'll judge you based on the work your provide).

to control the physician

do something out of line, get BC revoked, have a hard time finding a job.

 

[DrMetal]

to control the physician

do something out of line, get BC revoked, have a hard time finding a job.

Yeah, while an IMG trained in Uganda is taking your job, b/c you refused to MOC.

We have to just be honest and admit, the profession of 'Physician' is dying, on life-support, on it's last legs, pick your favorite euphemism. I give it 50 years, tops. By 2075, we'll have AI bots and IMGs doing most of this, procedures included.

 

[bronx43]

Yeah, while an IMG trained in Uganda is taking your job, b/c you refused to MOC.

We have to just be honest and admit, the profession of 'Physician' is dying, on life-support, on it's last legs, pick your favorite euphemism. I give it 50 years, tops. By 2075, we'll have AI bots and IMGs doing most of this, procedures included.

50? Wow that’s optimistic.

 

[NewYorkDoctors]

Yeah, while an IMG trained in Uganda is taking your job, b/c you refused to MOC.

We have to just be honest and admit, the profession of 'Physician' is dying, on life-support, on it's last legs, pick your favorite euphemism. I give it 50 years, tops. By 2075, we'll have AI bots and IMGs doing most of this, procedures included.

when a pateint goes to the hospital, who is the patient greeted by?

An administrator, a bureaucrat, and a nurse manager.
Pick any order you desire.

No physicians lol . If lucky a midlevel

 

[dozitgetchahi]

It’s incredibly stupid and shortsighted. I am continually amazed at how this country is willing to kneecap its highly trained professionals in the name of “keeping the prices down”.

That said, one thing (at least for now) will help keep the physician labor market from being flooded with cheap foreign labor: these people need a visa. And changing the visa situation at a federal level to allow a ****load of additional foreign trained doctors into the country isn’t going to be as easy to do. Also, these doctors aren’t going to be able to be board certified. Although I’m sure the board certification rackets will figure out a way to grandfather them in.

(If anyone should be afraid here, it should be the ****ty “sweatshop” residency programs that don’t teach and just rely on FMGs as slave labor. If you’re an FMG, why bother going to these types of places if you can just skip it altogether?)

 

[dgdg]

Why do we have by far the most expensive health care system in the world, yet unable to afford to pay primary care physicians fairly, keep hospitals from closing, and fail to prevail in the basic population health metrics?

 

[NewYorkDoctors]

It’s incredibly stupid and shortsighted. I am continually amazed at how this country is willing to kneecap its highly trained professionals in the name of “keeping the prices down”.

That said, one thing (at least for now) will help keep the physician labor market from being flooded with cheap foreign labor: these people need a visa. And changing the visa situation at a federal level to allow a ****load of additional foreign trained doctors into the country isn’t going to be as easy to do. Also, these doctors aren’t going to be able to be board certified. Although I’m sure the board certification rackets will figure out a way to grandfather them in.

(If anyone should be afraid here, it should be the ****ty “sweatshop” residency programs that don’t teach and just rely on FMGs as slave labor. If you’re an FMG, why bother going to these types of places if you can just skip it altogether?)

you mean transfer of wealth from the doctors to the administrators, lobbyists, and politicians?

yep transfer of wealth happens a lot. look at the "eastern european situation now" lol. it's all done under the guise of benevolence. virtue signaling at its finest

 

[dozitgetchahi]

Why do we have by far the most expensive health care system in the world, yet unable to afford to pay primary care physicians fairly, keep hospitals from closing, and fail to prevail in the basic population health metrics?

You know why, bro. Because all hospital administrators need to make at least $700k. And we have a bazillion rent seeking middleman businesses (Change Healthcare, looking at you) that exist just to make money off another layer of healthcare.

 

[Imtocardio]

It’s incredibly stupid and shortsighted. I am continually amazed at how this country is willing to kneecap its highly trained professionals in the name of “keeping the prices down”.

That said, one thing (at least for now) will help keep the physician labor market from being flooded with cheap foreign labor: these people need a visa. And changing the visa situation at a federal level to allow a ****load of additional foreign trained doctors into the country isn’t going to be as easy to do. Also, these doctors aren’t going to be able to be board certified. Although I’m sure the board certification rackets will figure out a way to grandfather them in.

(If anyone should be afraid here, it should be the ****ty “sweatshop” residency programs that don’t teach and just rely on FMGs as slave labor. If you’re an FMG, why bother going to these types of places if you can just skip it altogether?)

Visa and board certification are going to be relatively easy. Healthcare professionals would need an H1B visa. For non-profit organizations such as hospital systems, there is no cap for sponsoring H1B visas [unlike in the IT industry which operates for profit mostly]. Thus anyone can sponsor any number of visas as long as they are non-profit [such as hospitals]. And they can sponsor these visas throughout the year too!

Secondly, any hospital that sponsors an H1B visa can also sponsor a green card. Assuming an IMG comes in from any country [and is not Indian or Chinese by country of birth], they can easily get a green card within a year or two and then, will be on the same pedestal as any local US MD, in terms of rights and employment opportunities.

Finally, board certification rules will definitely be changed to accommodate these new physicians who already would have a valid state license by then. I mean not allowing them to sit for board exams will be seen as a ridiculous idea to everyone. And after they pass the boards [with some Uworld and a couple of months of prep], now you have a huge number of available physicians ready to work for half your salary or even lower. If you have the courage to negotiate for higher pay with your employer at your contract renewal, they can easily replace you with two physicians [not NPs, mind you] and this would only give them more reasons to replace you so that they can work the new physicians to generate additional revenue.

All this is moving towards a classic scenario of supply outstripping demand. Take, for example, the situation in India. To encourage physicians to go to rural places, India had increased the number of medical school spots [and there physicians can practice after med school as they do a year of rotating internship as part of their med school curriculum]. They however did not increase the number of residency spots as much as they increased med school spots, forcing a bottle-neck situation and leaving thousands of med school graduates scrambling to get into residency spots available or seeking to go abroad to further their careers. The med school graduates who could not afford to get a residency in India or leave the country now work for salaries as low as $200 a month, sometimes lower than what manual labor jobs pay in the country!!! A lot of them have switched to alternative careers too because of this. And no, most of them do not want to work in rural areas as the government thought they would do too. Unless there is a heavy financial incentive or a huge career boost that is guaranteed with rural service, very few physicians would go there.

 

[bronx43]

Visa and board certification are going to be relatively easy. Healthcare professionals would need an H1B visa. For non-profit organizations such as hospital systems, there is no cap for sponsoring H1B visas [unlike in the IT industry which operates for profit mostly]. Thus anyone can sponsor any number of visas as long as they are non-profit [such as hospitals]. And they can sponsor these visas throughout the year too!

Secondly, any hospital that sponsors an H1B visa can also sponsor a green card. Assuming an IMG comes in from any country [and is not Indian or Chinese by country of birth], they can easily get a green card within a year or two and then, will be on the same pedestal as any local US MD, in terms of rights and employment opportunities.

Finally, board certification rules will definitely be changed to accommodate these new physicians who already would have a valid state license by then. I mean not allowing them to sit for board exams will be seen as a ridiculous idea to everyone. And after they pass the boards [with some Uworld and a couple of months of prep], now you have a huge number of available physicians ready to work for half your salary or even lower. If you have the courage to negotiate for higher pay with your employer at your contract renewal, they can easily replace you with two physicians [not NPs, mind you] and this would only give them more reasons to replace you so that they can work the new physicians to generate additional revenue.

All this is moving towards a classic scenario of supply outstripping demand. Take, for example, the situation in India. To encourage physicians to go to rural places, India had increased the number of medical school spots [and there physicians can practice after med school as they do a year of rotating internship as part of their med school curriculum]. They however did not increase the number of residency spots as much as they increased med school spots, forcing a bottle-neck situation and leaving thousands of med school graduates scrambling to get into residency spots available or seeking to go abroad to further their careers. The med school graduates who could not afford to get a residency in India or leave the country now work for salaries as low as $200 a month, sometimes lower than what manual labor jobs pay in the country!!! A lot of them have switched to alternative careers too because of this. And no, most of them do not want to work in rural areas as the government thought they would do too. Unless there is a heavy financial incentive or a huge career boost that is guaranteed with rural service, very few physicians would go there.

Like we said before here, everyone should have a 5 year plan.

 

[NewYorkDoctors]

I'd like to think my primary care second practice is doing right for the patients.

I have a very low hospitalization rate for the patients (only the most elderly and unavoidable chronic this and that), I get over 90% of the "quality metrics" done, get all the immunizations (including the new RSV) done for everyone except for those who just dont want any vaccines, I get over 90% of screening done. I very infrequently refer out unless its something for a procedure or a rare disease that MKSAP clearly says is specialty disease.

It HELPS that I see a lot of Medicaid patients (for whom in NYS managed medicaid pays really darn well and no deductible or copays and limits means basically its pseudo-concierge care). I have extra help including another Internist (who is the lead doctor for the primary care side) and two midlevels. I have "walk in hours" for acute visits or for silly-nonsense.

It also helps that the two local hospitals (one of which is a tertiary care center and the other a smaller community hospital) are packed to the brim already and the ER is full of drunks, migrants, and gang members that most of the "normal population of patients" want to avoid going there unless they are dying.

In addition to solo-ing the specialty practice (the midlevel just helps me call about results and convey messages but I still see each patient myself), I go through all of the primary care labs, results etc... and guide management. In the event a case gets too "hard," I just see the patient for consultation. The previous critical care training comes in handy outpatient in the sense that I get a more broader view of more aspects of disease that belong under the scope medicine (and neurology) and I'd like to think I have big ****s and like to solo things myself (within reason).

In my practice, I AM the administrator lol. So I am incentivized to "do right by the patient" to make my extra money. Perhaps this is what that "value based care thing" meant. But in that case the doctor must be the administrator and not some MBA hack.

 

[CatFactorial]

Curious to see how the FTC Noncompete ban plays into this. I mean, the Supreme Court will kill it, but in the unlikely assumption that it survives, it would protect physicians.

Hospitals that claim nonprofit status to avoid the noncompete ban may be subject to having their nonprofit status evaluated (as the FTC claims in their rule), which would limit their ability to offer H1B visas.


Also paradoxically would ABIM and other rackets help physicians by doubling down on the need for board certification and MOC, (barriers to all but especially IMGs)? Given how annoying board exams are for USMGs, I wonder if the poorly trained foreign grad with a 2 year training period in the US would be able to pass?

 

[Mehena]

In my opinion, these directives originated within ABIM and were then channeled to specific states, such as Tennessee. Every state wants to be a trendsetter, whether they fully understand the ramifications or not. For example, this is what ABIM Oncology sent a while back:

Medical Oncology Board Meeting Summary | Spring 2023

The Medical Oncology Board held its spring meeting on Monday, May 22, 2023. The agenda provided an opportunity to update the Specialty Board on activity at ABIM and allowed for discussion of pressing issues in the field. The Specialty Board was joined by Jamie H. Von Roenn, MD, FASCO, Vice...

blog.abim.org

The USMLE is an easily gameable standardized exam, and foreign graduates have historically done very well because they focus exclusively on studying and practicing for the exam day in and day out, sometimes for years. In contrast, US medical graduates take the exam during the busiest times of their medical training, such as their 3rd and 4th years.

 

[DrMetal]

need for board certification and MOC, (barriers to all but especially IMGs)

IMGs aside, we should get rid of BC/MOC. Board Certification is a made up, fictitious credential. The Board doesn't belong to a hospital, to a university, to a State nor Federal gov't entity.

It's just something we made up decades ago, b/c we weren't happy enough with our achievements (medical school, residency, fellowships).

If there needs to be a test, a 'final exam', after the completion of residency, said test could/should be run by the ACGME and should be done at the end of residency. Fail it? Not allowed to graduate, must remediate. Pass it? You're done, graduate, no more tests for the rest of your life, go practice and you will be judged on said practice

ABOLISH BOARD CERTIFICATION AND MOC !

 

[dozitgetchahi]

IMGs aside, we should get rid of BC/MOC. Board Certification is a made up, fictitious credential. The Board doesn't belong to a hospital, to a university, to a State nor Federal gov't entity.

It's just something we made up decades ago, b/c we weren't happy enough with our achievements (medical school, residency, fellowships).

If there needs to be a test, a 'final exam', after the completion of residency, said test could/should be run by the ACGME and should be done at the end of residency. Fail it? Not allowed to graduate, must remediate. Pass it? You're done, graduate, no more tests for the rest of your life, go practice and you will be judged on said practice

ABOLISH BOARD CERTIFICATION AND MOC !

I think part of the reason the ACGME “test at the end of residency” doesn’t exist is that it would become a major inconvenience for training programs when (oops) one or more of their trainees fails the test. Now what? Damn, we have to remediate a bunch of people.

The training programs don’t want to deal with this, hence the fact that certification got bounced out to some unrelated organizations to be taken sometimes years after training ends.

 

[dozitgetchahi]

Curious to see how the FTC Noncompete ban plays into this. I mean, the Supreme Court will kill it, but in the unlikely assumption that it survives, it would protect physicians.

Hospitals that claim nonprofit status to avoid the noncompete ban may be subject to having their nonprofit status evaluated (as the FTC claims in their rule), which would limit their ability to offer H1B visas.


Also paradoxically would ABIM and other rackets help physicians by doubling down on the need for board certification and MOC, (barriers to all but especially IMGs)? Given how annoying board exams are for USMGs, I wonder if the poorly trained foreign grad with a 2 year training period in the US would be able to pass?

“Nonprofit” status at huge hospital systems making literally billions of dollars each year needs to be looked at much more closely than it is. IMHO there needs to be a long overdue conversation about how this 501c3 thing has become totally ridiculous.

Another thing that would potentially fix this whole “give licenses to random foreign graduates” situation? Federal medical licensure. I already think the state licensing process has become Byzantine and really stupid. If individual states are going to start handing out licenses to random foreign doctors, state licensing for docs needs to go out the window. And we need to properly lobby federally to ensure licenses are given only to graduates of American GME programs.

 

[Imtocardio]

In my opinion, these directives originated within ABIM and were then channeled to specific states, such as Tennessee. Every state wants to be a trendsetter, whether they fully understand the ramifications or not. For example, this is what ABIM Oncology sent a while back:

Medical Oncology Board Meeting Summary | Spring 2023

The Medical Oncology Board held its spring meeting on Monday, May 22, 2023. The agenda provided an opportunity to update the Specialty Board on activity at ABIM and allowed for discussion of pressing issues in the field. The Specialty Board was joined by Jamie H. Von Roenn, MD, FASCO, Vice...

blog.abim.org

The USMLE is an easily gameable standardized exam, and foreign graduates have historically done very well because they focus exclusively on studying and practicing for the exam day in and day out, sometimes for years. In contrast, US medical graduates take the exam during the busiest times of their medical training, such as their 3rd and 4th years.

Agree with this. IMGs are usually required to write multiple entrance/exit exams in their country and are really good with theory-based exams as they read UpToDate/Western books during their training too. With good practice, any IMG can easily clear, if not score high on our board exams. The key difference will be in adapting to the culture and practice, not in passing exams

 

[CatFactorial]

Agree with this. IMGs are usually required to write multiple entrance/exit exams in their country and are really good with theory-based exams as they read UpToDate/Western books during their training too. With good practice, any IMG can easily clear, if not score high on our board exams. The key difference will be in adapting to the culture and practice, not in passing exams

Just to consider the other position, such IMGs (if they have the clinical experience) sound qualified

 

[dozitgetchahi]

Just to consider the other position, such IMGs (if they have the clinical experience) sound qualified

Which isn’t the point.

Those who trained to become a physician in this country have often taken out a ****load of student loans to get there. We deserve to at least be able to get jobs that offer compensation adequate to pay off those loans - not to mention make the long and hard road to become a physician “worth it”.

If the market is flooded from physicians from elsewhere, all bets are off. (And my bet is that the quality will indeed be worse. Yes, there are absolutely places in the world where medical training is very good - but there are also places where it is much more questionable. In the past, we at least had all of these folks go through the US GME process to level this out.)

Also, oddly enough, my bet is that this will not help much with getting enough physicians to practice in rural areas. Foreign doctors particularly do not tend to stay in rural areas in America to practice - they like to congregate in urban areas (as do most other doctors) where they can live in/near communities of their respective ethnicities. So in the long run, all this will likely do is lead to the further oversaturation of urban physician markets.

 

[CatFactorial]

Which isn’t the point.

Those who trained to become a physician in this country have often taken out a ****load of student loans to get there. We deserve to at least be able to get jobs that offer compensation adequate to pay off those loans - not to mention make the long and hard road to become a physician “worth it”.

From the perspective of a policy maker aiming for affordable healthcare of reasonable quality, if IMGs can provide that for lower cost, I doubt US grads “deserve” anything?

If the market is flooded from physicians from elsewhere, all bets are off. (And my bet is that the quality will indeed be worse. Yes, there are absolutely places in the world where medical training is very good - but there are also places where it is much more questionable. In the past, we at least had all of these folks go through the US GME process to level this out.)

This is true, the lack of residency requirement opens up a whole can of worms, but like you said some places produce outstanding physicians who are able to hack it here.

 

[Dragonite7]

From the perspective of a policy maker aiming for affordable healthcare of reasonable quality, if IMGs can provide that for lower cost, I doubt US grads “deserve” anything?

Physician salaries make up only about 8% of healthcare costs. Physicians also already bear the brunt of reimbursement cuts while admin and corporate groups gobble up bigger pieces of the pie ever year. Even if physician salaries were slashed by an insane 40%, it would only decrease healthcare spending by about 3%. So it's both very ineffective and hurtful to keep trying to gut physicians (and worsening patient care in the process) while ignoring the real parasites in the healthcare system. Efforts that target doctors are primarily designed to increase profits for the latter, not to help patients.

Letters to the Editor: Don't blame doctor pay for the high cost of U.S. healthcare

Physicians' salaries account for a small fraction of U.S. healthcare costs; furthermore, doctors in this country often graduate deeply in debt.

www.latimes.com

 

[Mehena]

America's current turbocharged economy is, in part, the result of protectionism against unfair competition by foreign competitors. Auto workers protest against this, farmers scream out loud, and Silicon Valley has a great alley in Congress, and they get heard. America's protectionism should extend to each sector of the economy and workforce. I admire the European farmers for their resolve; basically, they bring the country to a grounding halt. When doctors push back against such egregious moves, they are immediately called selfish and greedy. Double standard.

 

[CatFactorial]

Physician salaries make up only about 8% of healthcare costs. Physicians also already bear the brunt of reimbursement cuts while admin and corporate groups gobble up bigger pieces of the pie ever year. Even if physician salaries were slashed by an insane 40%, it would only decrease healthcare spending by about 3%. So it's both very ineffective and hurtful to keep trying to gut physicians (and worsening patient care in the process) while ignoring the real parasites in the healthcare system. Efforts that target doctors are primarily designed to increase profits for the latter, not to help patients.

Letters to the Editor: Don't blame doctor pay for the high cost of U.S. healthcare

Physicians' salaries account for a small fraction of U.S. healthcare costs; furthermore, doctors in this country often graduate deeply in debt.

www.latimes.com

I don’t disagree, I just mean from the perspective of some addled policymaker, physicians are an easy if mistaken target

 

[NewYorkDoctors]

America's current turbocharged economy is, in part, the result of protectionism against unfair competition by foreign competitors. Auto workers protest against this, farmers scream out loud, and Silicon Valley has a great alley in Congress, and they get heard. America's protectionism should extend to each sector of the economy and workforce. I admire the European farmers for their resolve; basically, they bring the country to a grounding halt. When doctors push back against such egregious moves, they are immediately called selfish and greedy. Double standard.

yep

it's all virtue signaling by "administrators" who do not produce anything of value but simply want more money flowing to them. crony capitalism (not true capitalism) at its finest

see the "eastern european situation" for prime examples of such virtue signaling by our "leaders."

 

[collegestud2013]

Agreed this will only be detrimental to the job market for US-trained MD or DO physicians. Would also doubt it will be effective at improving patient care, given healthcare standards of practice can be very different in other countries, especially more third world countries; these physicians would be practicing without much training in the US (doubt this supervision period will suffice for the rigors of residency). Similar to increased use of PAs and NPs, it's another way for hospital systems to hire labor for cheaper and increase profits in the short run, but likely at the expense of long-run profits For example, poorer care would be expected to result increased malpractice lawsuits against hospital systems and increased payouts, though could take almost a decade for it to really make an noticeable impact in the bottom line given how long malpractice cases take to settle.

The only case this setup may not impact US trained physicians would to limit practice to the rural areas that no US-trained physicians wants to work (and for a much longer period of time than just a 2-year supervision period). Also, it should be limited to specialties that have hard time recruiting (often due to low pay), notably primary care and pediatrics.

As has been suggested ad nauseum, the easiest way to increase interest in med students and residents in going into primary care in the U.S. is to raise PCP pay. CMS can actually do this pretty easily by re-weighing payments and RVUs to better pay for services that are typically done by a PCP. They have already started to this slowly; for example this year there is the new G2211 add-on code to allow PCPs to bill a bit more for complex primary care visits. If one day, a PCP taking insurance can make nearly as much as a higher paid surgical specialist on a per-hour basis (combined with the benefit that most primary care specialties usually only require 3 year of training rather than 5-7 years that's typical in procedural specialties), I would more med students can truly pick a specialty based on interest alone. Note that since the CMS budged has to be neutral, increasing one specialty's pay means cutting pay for another specialty, so while redistributing reimbursements from high to low paying specialties can get controversial; but it it would more even out pay across specialties.

 

[bronx43]

Also, oddly enough, my bet is that this will not help much with getting enough physicians to practice in rural areas. Foreign doctors particularly do not tend to stay in rural areas in America to practice - they like to congregate in urban areas (as do most other doctors) where they can live in/near communities of their respective ethnicities. So in the long run, all this will likely do is lead to the further oversaturation of urban physician markets.

the influx of foreign physicians into urban markets will make the already hellish landscape 100x worse. Just that alone will probably drive a ton of US grads (like us) into rural areas.

 

[Doc mu]

the influx of foreign physicians into urban markets will make the already hellish landscape 100x worse. Just that alone will probably drive a ton of US grads (like us) into rural areas.

Florida bill been active for a while now, doesnt seem to be doing much damage

 

[Imtocardio]

Florida bill been active for a while now, doesnt seem to be doing much damage

Google "IMG Tennessee bill" and see all the YouTube videos from IMG 'guidance gurus' with comments from people asking how they can apply ASAP. A guy was asking if he could come here as a neurosurgeon, and another one was asking if he could come and do interventional cardiology after coming here as a non-invasive cardiologist from his home country. There was barely anyone actually wanting to come to practice 'rural primary care' which is what the so called intention of the bill was. The Tennessee bill has made quite the wave in the IMG community, unlike the Florida one.

 

[dozitgetchahi]

From the perspective of a policy maker aiming for affordable healthcare of reasonable quality, if IMGs can provide that for lower cost, I doubt US grads “deserve” anything?



This is true, the lack of residency requirement opens up a whole can of worms, but like you said some places produce outstanding physicians who are able to hack it here.

In case you haven’t noticed, American healthcare policy makers don’t really give a rats ass about quality (or else the midlevel “thing” wouldn’t be a thing). They care about cheap, at any cost. God forbid we stand up for our own country’s taxpayers who trained here and busted their asses here to do well, and provide a needed service to their country and community. Most other countries seem to get this right for their physician markets (there are only a handful of other countries where it’s possible to come in easily as a doctor from elsewhere).

They can also talk about cutting my salary after they’ve cut the salaries of the grossly overpaid administrators and middlemen first. There’s plenty of fat to be cut there - more than if you made every US doctor work for free. But you know that will never happen.

 

[voxveritatisetlucis]

Florida bill been active for a while now, doesnt seem to be doing much damage

It has not been active in practice yet. The board of medicine still needs to create language regarding the pathway. Once it’s in place, it will be disastrous. Nobody has been approved yet because the path is not in place yet. The board should refuse to create the path but they’re probably all sell outs or practice owners who will benefit from cheap labor

FL Board of Medicine to craft new licensure path for foreign-trained physicians • Florida Phoenix

Florida lawmakers passed a measure this year allowing physicians trained in other countries to be licensed in Florida without completing a residency, and the Florida Board of Medicine is starting to grapple with the change. Under the “Live Healthy” initiative Senate President Kathleen Passidomo...

floridaphoenix.com

 

[voxveritatisetlucis]

Google "IMG Tennessee bill" and see all the YouTube videos from IMG 'guidance gurus' with comments from people asking how they can apply ASAP. A guy was asking if he could come here as a neurosurgeon, and another one was asking if he could come and do interventional cardiology after coming here as a non-invasive cardiologist from his home country. There was barely anyone actually wanting to come to practice 'rural primary care' which is what the so called intention of the bill was. The Tennessee bill has made quite the wave in the IMG community, unlike the Florida one.

Same in Florida. Thousands of doctors from Cuba attended this one seminar on how to apply. If they make it really broad, there will be 200k new doctors in Florida within 3 years

Cuban Doctors Seek Path to Validate Their Credentials in Florida

The recent enactment of Florida Senate Bill 7016 by Governor Ron DeSantis has opened new avenues for Cuban doctors and other foreign-trained healthcar...

www.cubaheadlines.com

 

[lolthroaway]

Same in Florida. Thousands of doctors from Cuba attended this one seminar on how to apply. If they make it really broad, there will be 200k new doctors in Florida within 3 years

Cuban Doctors Seek Path to Validate Their Credentials in Florida

The recent enactment of Florida Senate Bill 7016 by Governor Ron DeSantis has opened new avenues for Cuban doctors and other foreign-trained healthcar...

www.cubaheadlines.com

Bro no offense but every little thing causes you to panic and think the sky is falling.

1. Even if it is really broad, it's quite optimistic to think there'll be 200k foreign physicians within three years. The USCIS is the poster boy of government bureaucracy and inefficiency. They don't just rubber stamp GCs and visas just because there's a need and no cap, it's a massive headache for the applicant and the sponsor. Coming from an immigrant family and knowing plenty of immigrants, it's an arduous, costly, often years-long process to file the paperwork and get it approved. And that's assuming all the paperwork is filled out and filed perfectly the first time. Not to mention the USCIS has been overwhelmed for years now, leading to backlogs, delays, and increased filing fees. Doesn't look like they'll get more manpower anytime soon to handle hundreds of thousands of new applicants. Furthermore, the only ones who would wade through that sort of nightmare are for profit institutions, who have a cap on visas. And even without a visa cap don't non-profits have to file extra paperwork ensuring that no American wants the job and that wages aren't being depressed? That won't exactly be a quick process.

2. Even if we don't advocate for ourselves, mid-levels probably will. If the market gets oversaturated and physician wages are severely depressed, you don't need PAs, NPS, CRNAs, etc. Or if you do hire them, it'll be at steep discount. So funny enough, they'd rush to block or reverse this.

All that said, we can't sleep on things like this. Having meltdowns on the internet isn't the answer, calling your reps and being involved physician advocacy groups is. If they're spineless, then it's time for a new generation to take over.

 

[CatFactorial]

In case you haven’t noticed, American healthcare policy makers don’t really give a rats ass about quality (or else the midlevel “thing” wouldn’t be a thing). They care about cheap, at any cost. God forbid we stand up for our own country’s taxpayers who trained here and busted their asses here to do well, and provide a needed service to their country and community. Most other countries seem to get this right for their physician markets (there are only a handful of other countries where it’s possible to come in easily as a doctor from elsewhere).

They can also talk about cutting my salary after they’ve cut the salaries of the grossly overpaid administrators and middlemen first. There’s plenty of fat to be cut there - more than if you made every US doctor work for free. But you know that will never happen.

Right, that was my point. Policymakers don't care about "our taxpayers who trained here and busted their asses to do well, and provide a needed service to their country and community." IMGs are likely to do it cheaper. Pouting doesn't change that, but you keep fighting the good fight.