Is America Prospective For Trained Physicians?

[TAMallick]

.I am a Bangladeshi trained medical doctor. Recently I became successful at finding a residency position in America. I am curious to know, is America prospective for trained physicians?.

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[Perrotfish]

.I am a Bangladeshi trained medical doctor. Recently I became successful at finding a residency position in America. I am curious to know, is America prospective for trained physicians?.

I don't understand what you said. That's not how you would normally use the word prospective in a sentence. Could you rephrase?

 

[dragonfly99]

Not sure you meant "prospective"...at least that is not how we would use the word.
Do you mean, "What are the career prospects for a foreign-born physician in the United States?".

 

[jdh71]

Better here than east Pakistan

 

[John146]

Prospects aren't so hot if you can't speak the language.

 

[mlw03]

Prospects aren't so hot if you can't speak the language.

Agreed. Seriously, isn't the TOEFL supposed to take care of this issue? I have nothing against FMGs, but if you want to practice medicine in a country, speak the language fluently.

 

[Andreji]

Agreed. Seriously, isn't the TOEFL supposed to take care of this issue? I have nothing against FMGs, but if you want to practice medicine in a country, speak the language fluently.

Well you'd expect it to be so, but the TOEFL was left behind with the CS. however it shouldn't be so-- the CS in my opinion is way too subjective and permissive (given the pass/fail grading) of people who'd otherwise have a borderline TOEFL score, wich is pretty comprehensive and objective, I think (having taken it thrice in this lifetime).

 

[Socrates25]

When I was a med student, I did a rotation at a crappy FMG internal medicine place.

the ward attending for that day happened to be the IM program director, we were all in the room talking to the patient (elderly white woman), and I listened to this Eastern European resident (Albania maybe?) talk to the patient, understanding maybe 1/2 of what she said.

The patient asks politely a couple of times "can you speak more clearly I cant understand what you are saying."

The IM PD gets frustrated and eventually says "it doesnt matter if you understand her or not, I understand her which is all that matters."

Unfreakinbelievable

the truth of the matter is that some programs dont give a damn about their residents' english speaking skills -- they just want butts in the slots. If they speak good English thats all the better but its certainly not a requirement.

 

[Andreji]

Oh yes- as another FMG who had to interview *anywhere where an interview was offered*, I had a rather comical couple of interview days where communication was so ridiculous I couldn't have a coherent conversation with one or two of the interviewers. And even in spite of this, I'd step out and get the "are you interested in a prematch?" minutes after. What on earth would they be basing their offer on?

 

[mlw03]

how can a program not care about language skills? what happens when a misunderstanding leads to a negative patient outcome? i can't believe that hasn't happened many, many times across the US. again, not knocking FMGs, as I know and work with plenty that are great and speak fluent (albeit heavily accented) english.

to the original poster: no one can tell what the heck you're asking. i respect your desire to move to the US, but please work on your english skills for the sake of patient care.

 

[JgMantilla]

I am also an ESL- FMG and long time lurker. I agree that language skills should definitely be better evaluated when intereviewing residency candidates.
However, during my interview trail last year I noticed that most FMGs I met had pretty good communication skills and I generally had no trouble understanding them (with maybe a couple exceptions, who said they hadn't been very successful landing interviews)... maybe there is some heavy specialty-dependent variation when it comes to screening applicants.

To the OP: mlw03 is right. You should work on your English. Your accent should not be much of a problem, but your grammar/syntax/vocabulary seems to need some polishing.

 

[dragonfly99]

Do people not have to take the TOEFL to do residency? That seems weird...my college roommate, who was a foreign citizen and had been speaking English for years and went to an English speaking high school as well as graduating from college in the USA, still had to take the TOEFL AGAIN before she could get into a US MBA program.

 

[Andreji]

Do people not have to take the TOEFL to do residency? That seems weird...my college roommate, who was a foreign citizen and had been speaking English for years and went to an English speaking high school as well as graduating from college in the USA, still had to take the TOEFL AGAIN before she could get into a US MBA program.

Again, the CS apparently waived that former requirement. Yet, the TOEFL is so much more than the CS....

Of course, non-medical fields do not have a specific exam such as the cs so most (if not all) require TOEFL or an equivalent (IELTS, Michigan...). This, regardless of whether you went to a an english speaking school (my case for clerkships, for example, even in spite of coming from a british primary, mdille and high school and personally visiting and chatting with the visiting student coordinators; on the other hand, my brother had his requirement waived when studying at BU because of the IB diploma). In addition to that, the TOEFL's validity is two years, hence your friend's need to retake it afterwards.

 

[TAMallick]

Not sure you meant "prospective"...at least that is not how we would use the word.
Do you mean, "What are the career prospects for a foreign-born physician in the United States?".

You are really talented one, only you understand me. Yes I am interested to know, "What are the career prospects for a foreign-born physician in the United States?".

 

[Law2Doc]

You are really talented one, only you understand me. Yes I am interested to know, "What are the career prospects for a foreign-born physician in the United States?".

In the US it matters less where you are born and more where you trained. If you are coming out of a US residency, you will be able to interview for whatever jobs and fellowships your resident colleagues are able to get. I don't think you told us the field so we can't say much more than this. I agree with some of the posters that English language skills can be a hurdle in landing a job though, so you will want to keep working on this.

 

[dragonfly99]

Prospects for getting a job somewhere should be good if you finish your residency and do well in it. If you need a special visa in order to stay in the US legally, you probably would need to work in a small town or inner city "underserved area" for several years. Those places aren't necessarily bad places, but sometimes they are just small towns that not too many people want to move to (more people would rather live in New York or Chicago versus Marion, Illinois or Yakima, Washington, for example). Also, job prospects depend on your specialty. I found this out recently while looking for cardiology jobs. Even though cardiology is a well paying specialty, there aren't nearly as many hospitals or medical practices looking to recruit a cardiologist as there are places looking for a family physician or general internal medicine physician. Certain specialties are going to be more in demand. Also, the demand for physicians depends on where you are willing to live. For example, there are probably quite a few towns of 30-50,000 people that only have a few allergists, a couple dermatologists, and a couple of endocrinologists...if you are willing to move to those type places you can actually do quite well financially.

 

[TAMallick]

Prospects for getting a job somewhere should be good if you finish your residency and do well in it. If you need a special visa in order to stay in the US legally, you probably would need to work in a small town or inner city "underserved area" for several years. Those places aren't necessarily bad places, but sometimes they are just small towns that not too many people want to move to (more people would rather live in New York or Chicago versus Marion, Illinois or Yakima, Washington, for example). Also, job prospects depend on your specialty. I found this out recently while looking for cardiology jobs. Even though cardiology is a well paying specialty, there aren't nearly as many hospitals or medical practices looking to recruit a cardiologist as there are places looking for a family physician or general internal medicine physician. Certain specialties are going to be more in demand. Also, the demand for physicians depends on where you are willing to live. For example, there are probably quite a few towns of 30-50,000 people that only have a few allergists, a couple dermatologists, and a couple of endocrinologists...if you are willing to move to those type places you can actually do quite well financially.

I am very much happy for your helpful suggestion. So thanks a lot.

 

[mlw03]

I'll add a comment as a minority (religious), which obviously our OP would be as well (ethnic and/or religious most likely). Small town America, while a lovely place in many aspects, is not somewhere I or my wife would be willing to move to because there wouldn't be any other families of our background, no religious school for our kids, no place for us to worship, etc. This is an aspect not often talked about when I've heard about programs to try and recruit physicians to underserved areas. So while jobs are out there in these rural areas, there is a cultural aspect to consider. This may not be a politically correct thing to discuss, but is anyone other than a white Christian going to be willing to move to rural KS, OK, SC, ND, etc? And even if you get someone willing to go there for a few years early in there career, I find it hard to believe that an Iraqi, Vietnamese, Jewish, etc person is going to be willing to put roots down in these rural places.

 

[dragonfly99]

mlw, that is a good point,
On the other hand, I can tell you that I grew up in a town of 35k that had MANY Indian-born physicians and college professors. At that time a lot of the non WASP-y people in town were the docs and college professors and their families. A lot of these places do have branches of the state universities, etc. and may not be as culturally backward or "nondiverse" as you think. I do agree it could be an issue for some, but there are also "underserved" areas in some inner city places, I believe (especially if you do certain specialties like psychiatry). And there are rural locations that have a lot of hispanic people, or that have groups of Muslim doctors, etc. Also, a lot of the foreign born docs will just go to somewhere underserved for 3-4 years and then get a permanent green card, right? That's not a totally terrible deal to get into a well paying career that the vast majority of people never can get into. Also, a lot of foreign-born docs aren't saddled with 100-300k of student loans, which will be helpful in terms of their future prospects.

 

[Doctor Bagel]

mlw, that is a good point,
On the other hand, I can tell you that I grew up in a town of 35k that had MANY Indian-born physicians and college professors. At that time a lot of the non WASP-y people in town were the docs and college professors and their families. A lot of these places do have branches of the state universities, etc. and may not be as culturally backward or "nondiverse" as you think. I do agree it could be an issue for some, but there are also "underserved" areas in some inner city places, I believe (especially if you do certain specialties like psychiatry). And there are rural locations that have a lot of hispanic people, or that have groups of Muslim doctors, etc. Also, a lot of the foreign born docs will just go to somewhere underserved for 3-4 years and then get a permanent green card, right? That's not a totally terrible deal to get into a well paying career that the vast majority of people never can get into. Also, a lot of foreign-born docs aren't saddled with 100-300k of student loans, which will be helpful in terms of their future prospects.

I grew up in a very similar town, but if you weren't in a university town in my home state, you definitely wouldn't fit in if you weren't white, conservative, straight and christian. One of the many reasons why I was never interested in taking one of those fellowships for rural medicine.

 

[mlw03]

Sure, fair points. Again, my comments aren't about knocking rural living or anything like that, rather I just think it's something that's more important than one would think given the paucity of discussion on the topic in national discussions about serving the under-served population of rural America. while there probably are some small minority communities out there in random rural spots, rural America is mostly white, Christian (non-Catholic at that), and very culturally conservative; albeit there seems to be a growing Hispanic population in particular. But would this poster and his family feel comfortable in a small town in Iowa? Probably not. That's the only point I'm trying to make.

mlw, that is a good point,
On the other hand, I can tell you that I grew up in a town of 35k that had MANY Indian-born physicians and college professors. At that time a lot of the non WASP-y people in town were the docs and college professors and their families. A lot of these places do have branches of the state universities, etc. and may not be as culturally backward or "nondiverse" as you think. I do agree it could be an issue for some, but there are also "underserved" areas in some inner city places, I believe (especially if you do certain specialties like psychiatry). And there are rural locations that have a lot of hispanic people, or that have groups of Muslim doctors, etc. Also, a lot of the foreign born docs will just go to somewhere underserved for 3-4 years and then get a permanent green card, right? That's not a totally terrible deal to get into a well paying career that the vast majority of people never can get into. Also, a lot of foreign-born docs aren't saddled with 100-300k of student loans, which will be helpful in terms of their future prospects.

 

[TAMallick]

Yes, cultural and religious barriers are very important.

 

[dragonfly99]

Again, if I am not mistaken there are underserved areas that may be in inner cities, etc. Also, some of the places considered underserved for psych and perhaps some other specialties are fairly good sized towns or cities, even 100,000 people or so. Also, if someone needs to live somewhere for 3 years to get a permanent green card to stay in the country, I think a few years of banishment to a "white, rural Protestant" enclave that still has cable TV's, probably a synagogue and mosque, etc. isn't a fate worse than death. Also, not every rural place is full of protestants...lots of Catholics where I come from. There are culturally distinct areas throughout the country and now most all places have internet and cable TV and malls, and have become more culturally homogenous at least to some degree. But yes, cultural things are important, or can be...

 

[DOC PENGUIN]

Better here than east Pakistan

Are american physicians and medical schools still Top int the world, i heard from a singaporean doctor that american care is very bad and that healthcare is much better in Canada and such. Of course this is a very complex question.

 

[rule out normal]

Are american physicians and medical schools still Top int the world, i heard from a singaporean doctor that american care is very bad and that healthcare is much better in Canada and such. Of course this is a very complex question.

We are awful here in the US, like a 3rd world country. If I were you, I'd try Canada or UK instead. Maybe France...I hear they're cutting edge now; a few places even have cath labs!

Leave the US residency slots for us poor American graduates who can't compete anymore...

 

[splik]

We are awful here in the US, like a 3rd world country. If I were you, I'd try Canada or UK instead. Maybe France...I hear they're cutting edge now; a few places even have cath labs!

Leave the US residency slots for us poor American graduates who can't compete anymore...

Although you're being sarcastic, for many people in the US they might as well be living in a 3rd world country, indeed they would be better off in some middle income countries when it comes to healthcare. The US offers in many instances the very best of healthcare, but it also offers the very worst. On average, the quality of healthcare is much lower than in other developed countries, even though it paradoxically offers examples of the exceptional as well.

 

[Law2Doc]

Although you're being sarcastic, for many people in the US they might as well be living in a 3rd world country, indeed they would be better off in some middle income countries when it comes to healthcare. The US offers in many instances the very best of healthcare, but it also offers the very worst. On average, the quality of healthcare is much lower than in other developed countries, even though it paradoxically offers examples of the exceptional as well.

I think this is the answer. If you have complex medical issues and good insurance, there is nowhere better on the planet. If you have no or poor insurance, pretty much any other developed country is going to take better care of you than here.

 

[rule out normal]

Although you're being sarcastic, for many people in the US they might as well be living in a 3rd world country, indeed they would be better off in some middle income countries when it comes to healthcare. The US offers in many instances the very best of healthcare, but it also offers the very worst. On average, the quality of healthcare is much lower than in other developed countries, even though it paradoxically offers examples of the exceptional as well.

Totally agree. One point you may disagree with me on is the quality of ER care...it's probably better in the States than anywhere else. In that context, poor people get better emergent care (and in many situations, non-urgent ER care) than anywhere in the world.

 

[mlw03]

Are american physicians and medical schools still Top int the world, i heard from a singaporean doctor that american care is very bad and that healthcare is much better in Canada and such. Of course this is a very complex question.

Agree with the others. Too complex a question, and hundreds of books have been written on this topic. But yeah, if you're very wealthy the care one can receive in the US is the best in the world. If one is poor and maybe lives in a rural setting, not so much.

 

[Mattchiavelli]

Get a bunch of magazines from the grocery store like People, Us Weekly, etc and use them to help build your patient-language skills because that is like a different dialect than doctor-language skills. This can be tough for even people born and raised in the US.

 

[docu]

this is the exact situation i was talking about when PD's hire people on visas over a US citizen....and now you see why US citizen english speaking IMG's should be chosen for residency before a person on a visa who never lived here before. they may have the scores, but communication is lacking. also a lot of places overseas are corrupt and letting people cheat on the USMLE's (hence why there are so many 99ers from overseas) for bribes from what i've heard recently.

 

[142348]

this is the exact situation i was talking about when PD's hire people on visas over a US citizen....and now you see why US citizen english speaking IMG's should be chosen for residency before a person on a visa who never lived here before. they may have the scores, but communication is lacking. also a lot of places overseas are corrupt and letting people cheat on the USMLE's (hence why there are so many 99ers from overseas) for bribes from what i've heard recently.

Absolutely not. Language can be improved upon and cultural competency can be learned/taught; sure a FMG should have a good grasp on English (hence the ECFMG certification). This country needs to train the best doctors it can whoever they are, and not simply cater to entitled US-IMGs who couldnt get into a US med school to start with.

 

[mlw03]

this is the exact situation i was talking about when PD's hire people on visas over a US citizen....and now you see why US citizen english speaking IMG's should be chosen for residency before a person on a visa who never lived here before. they may have the scores, but communication is lacking. also a lot of places overseas are corrupt and letting people cheat on the USMLE's (hence why there are so many 99ers from overseas) for bribes from what i've heard recently.

Ha... you've gotta be kidding, docu. Your whole comment is rediculous. I'll take a hard-working, honest, dedicated FMG with mediocre English over a pissed-off, self-righteous US-IMG any day. Like groove said in your other thread, you f-ed up. Own it, try to do better in the future, and stop giving other US-IMGs a bad name with posts like this.

 

[lipomas]

I am trying to wrap my head around what "Is america prospective?" means. I keep thinking of that scene in Marathon Man. Is it safe? Tell me, is it safe? and Dustin Hoffman has no idea what he means but it doesn't matter. He just keeps asking.

I can picture that happening in an ICU room in a couple of years. "Is your condition prospective?"

 

[lipomas]

I'll take a hard-working, honest, dedicated FMG with mediocre English over a pissed-off, self-righteous US-IMG any day. .

Why do we have to choose? Can't I take neither?

 

[mlw03]

Why do we have to choose? Can't I take neither?

Yes you can. But until we have as many American/Canadian MD/DO grads per year as we do residency spots, programs will need to recruit US-IMGs and FMGs to fill their programs. So PDs may have to choose between the two groups at times.

 

[gutonc]

Yes you can. But until we have as many American/Canadian MD/DO grads per year as we do residency spots, programs will need to recruit US-IMGs and FMGs to fill their programs. So some PDs may have to choose between the two groups at times.

Fixed it for you.

Your point is well taken however the reality is that many PDs don't have to make those choices. They've got more than enough AMG grads to fill their classes.

 

[J-Rad]

A gentle reminder to not let this thread devolve into a personal back-and-forth argument. Thanks.

 

[docu]

Ha... you've gotta be kidding, docu. Your whole comment is rediculous. I'll take a hard-working, honest, dedicated FMG with mediocre English over a pissed-off, self-righteous US-IMG any day. Like groove said in your other thread, you f-ed up. Own it, try to do better in the future, and stop giving other US-IMGs a bad name with posts like this.

Why is this a personal argument against me. im speaking for many other US IMG"s who also feel the exact same way. We are forming a group to go against this unfairness. hater!

Check this article out where a company stole USMLE questions. http://www.nj.com/news/index.ssf/2011/07 /authorities_search_for_nj_coup.html

it is happening..and some one called qwery on usmleforum.com admitted to bribing a USMLE official http://www.usmleforum.com/files/forum/2010/4/543751-2.php

People recommending bribes to get through: http://www.usmleforum.com/files/forum/2012/4/652843.php
http://www.usmleforum.com/files/forum/2010/4/529213.php
http://www.usmleforum.com/files/forum/2012/4/675688.php

Here is another article about it: http://www.fbi.gov/newark/press-rel...ng-test-questions-from-medical-licensing-exam

matching into Johns hopkins after a bribe: http://www.usmleforum.com/files/forum/2011/4/575341.php

look at qwery at the bottom what he recommends: http://www.usmleforum.com/files/forum/2011/4/594287.php

I think a thorough world wide FBI investigation on the validity and integrity of the USMLE tests and test takers needs to be done.

 

[142348]

Its a personal arguement against you because you refuse to acknowlege your limitations and your situation and instead are trying to lump yourself with a group and scream about injustices that really don't exist. US-IMGs already get some benefit of the doubt over FMGs and if an FMG has a better CV and gets a spot so be it. Your links are merely anecdotal evidence with no real proof to a wide spread issue. good luck getting the FBI to start a "world wide investigation"

 

[docu]

Its a personal arguement against you because you refuse to acknowlege your limitations and your situation and instead are trying to lump yourself with a group and scream about injustices that really don't exist. US-IMGs already get some benefit of the doubt over FMGs and if an FMG has a better CV and gets a spot so be it. Your links are merely anecdotal evidence with no real proof to a wide spread issue. good luck getting the FBI to start a "world wide investigation"

did you not hear the moderater who said to stop the personal attacks? i personally don't like you either. all you ever do is attack me in your posts. don't you have anything better to do? you make yourself look bad by doing so. i dont like people with personal vendettas against me such as yourself. you didn't even read what i wrote. you just pick and chose what you want to hear. you're not that great of a person if i do say so myself.

 

[142348]

did you not hear the moderater who said to stop the personal attacks? i personally don't like you either. all you ever do is attack me in your posts. don't you have anything better to do? you make yourself look bad by doing so. i dont like people with personal vendettas against me such as yourself.

Didn't you just say "Why is this a personal argument against me. im speaking for many other US IMG"s who also feel the exact same way. We are forming a group to go against this unfairness. hater!"

Read my posts, I never insult you or are derogatory towards you. I call it how i see it and what Im saying seems to be in line with the majority of other posters. I never said I dont like you, I dont even know you. Why do you assume people have vendettas against you when they are evaluating the situation objectively? The reality is you are so blinded by your cause that you aren't looking at the facts objectively. I have no horse in this race, Ive finished residency now, and so I can look at things relatively objectively. Best of luck to you.

 

[docu]

Didn't you just say "Why is this a personal argument against me. im speaking for many other US IMG"s who also feel the exact same way. We are forming a group to go against this unfairness. hater!"

Read my posts, I never insult you or are derogatory towards you. I call it how i see it and what Im saying seems to be in line with the majority of other posters. I never said I dont like you, I dont even know you. Why do you assume people have vendettas against you when they are evaluating the situation objectively? The reality is you are so blinded by your cause that you aren't looking at the facts objectively. I have no horse in this race, Ive finished residency now, and so I can look at things relatively objectively. Best of luck to you.

what you said earlier sure sounded derogatory to me. im not blinded, i posted proof of people using bribery and cheating to get into residency. did you not take a look at those links? you would be surprised to see the corruption going on (or maybe not, maybe you just want to leave it the way it is?. i really think that needs to be investigated. why would you want these people as doctors? i got my low step scores the honest hard working way. cheating is wrong no matter how you look at it.. some of these people may not get their license because the company they learned through had a copy of the USMLE questions that are on the actual test.

 

[mlw03]

what you said earlier sure sounded derogatory to me. im not blinded, i posted proof of people using bribery and cheating to get into residency. did you not take a look at those links? you would be surprised to see the corruption going on (or maybe not, maybe you just want to leave it the way it is?. i really think that needs to be investigated. why would you want these people as doctors? i got my low step scores the honest hard working way. cheating is wrong no matter how you look at it.. some of these people may not get their license because the company they learned through had a copy of the USMLE questions that are on the actual test.

that's a very liberal use of the word "proof." you are doing nothing to bolster your case. keep ranting and raving if it makes you feel better. not gonna increase your residency prospects. the current way gave you a fair shot, and you failed to get a place even with the advantage you have of international FMGs.

how would you have the system work, if you were in charge?

 

[NotAProgDirector]

I agree that the examples you've listed above are not really proof of widespread bribes. Two of the links are bribes for something else entirely (nothing to do with the USMLE).

The Optima case is well known and described. Every person who enrolled in Optima had their scores invalidated and needed to take the exam again.

I do wonder about the wisdom of allowing the USMLE to be given outside the US/Canada. It clearly is more convenient for IMG's to do so, and I don't doubt that the NBME makes a pretty penny doing so (since more people probably take it that way). However, the security of the exam overseas is likely to be more lax. It wouldn't surprise me if there was bribery / cheating overseas.

The overall debate here is old and has been rehashed multiple times. US-IMG's who score above the mean likely get spots -- perhaps not in the most competitive fields, but likely in something. The question is whether whether those US IMG's who have done less well should get some priority over IMG's who score/do better. The answer depends upon your priorities.

 

[splik]

it also (depending on where the exam is done) costs ALOT more to do the USMLE outside of the US. They are I believe done in the same sorts of testing centers outside the US as in the US (having done exams both in and out of the country), and these testing centers also do the GRE, GMAT, SAT, and other standardized tests administered outside the US. There may of course be some countries where the standards can be circumvented because of widespread corruption but considering something like 35% of IMGs fail step 1, and the average passing score for IMGs is much lower than for US medical students, it seems unlike any supposed corruption is rampant or widespread. Another point is that many IMGs actually take their USMLEs in the US anyway.

 

[142348]

what you said earlier sure sounded derogatory to me. im not blinded, i posted proof of people using bribery and cheating to get into residency. did you not take a look at those links? you would be surprised to see the corruption going on (or maybe not, maybe you just want to leave it the way it is?. i really think that needs to be investigated. why would you want these people as doctors? i got my low step scores the honest hard working way. cheating is wrong no matter how you look at it.. some of these people may not get their license because the company they learned through had a copy of the USMLE questions that are on the actual test.

Your "evidence", as previous posters have noted is limited. The one real case documented had the violators scores removed which is how the system should work and it did. Cheating/corruption probably still happens but nothing you have posted shows that it is a widespread problem, it is likely a very small number of the total exams taken. Regardless, thats not the issue that kept you from not getting residency. The reality is that you didn't complete your first residency and are a US-IMG with poor step scores, thats why, not the big bad FMGs you seem to want to make the scapegoat.

 

[J-Rad]

I think this thread is cooked. Closing.