- Joined
- Nov 13, 2018
- Messages
- 26
- Reaction score
- 32
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
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