Non-American FMGs should be discouraged to practice in the USA

Nov 17, 2009
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I'd like to clarify that I'm not a nativist or racist by any stretch of the imagination. However, I believe that the developing countries, such as India and China, have more of a need for the scarce MDs than we do.

Moreover, we have many more people who want to become physicians in the USA. If we can't even produce our own MDs, then we shouldn't be hustling foreigners to this country to practice.

Importing these MDs is economically equivalent to "importing" an MD education. We shouldn't have to import an MD education. We should increase capacity of this as well as increase the capacity of residency slots.

I've had very bad experiences with foreign MDs. I know one elder woman in my neighborhood who had a "shooting pain in her lower back." Her Iranian MD prescribed her antibiotics for her kidney! This was clearly a case of sciatica.

Another friend of mine -a young, healthy guy - had a vessel pulsate every once in a while in his eye, and it wasn't painful, just annoying. His Albanian MD prescribed him acetominephan (Tylenols, basically)!

In those types of countries, society is less merit-based and more feudalistic. Those who have money can easily - and often do - purchase their kids MD for them for a sum of money that serfs in that country can't afford.

1. Let's start increasing the number of MDs that we produce.
2. Let's increase the number of residency spots in the USA.
3. Let's update/change/improve upon the way that we reimburse our physicians.
 

VA Hopeful Dr

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I've had very bad experiences with foreign MDs. I know one elder woman in my neighborhood who had a "shooting pain in her lower back." Her Iranian MD prescribed her antibiotics for her kidney! This was clearly a case of sciatica.
Pyelo can easily present this way. Just saying "shooting pain in lower back" does not equal sciatica.

Another friend of mine -a young, healthy guy - had a vessel pulsate every once in a while in his eye, and it wasn't painful, just annoying. His Albanian MD prescribed him acetominephan (Tylenols, basically)!
Its not basically tylenol, it IS tylenol.

Seriously, what's your motivation for posting here?
 

Dr McSexy

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Importing these MDs is economically equivalent to "importing" an MD education. We shouldn't have to import an MD education. We should increase capacity of this as well as increase the capacity of residency slots.
We should. But let me know where you going to come up the money to do it or if you are willing to be taxed out of your ass to do so. Medical education in this country is heavily heavily subsidized.

I've had very bad experiences with foreign MDs.

.
I've had very good experiences with foreign MDs.

There we're even.
 

cpants

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I'd like to clarify that I'm not a nativist or racist by any stretch of the imagination. However, I believe that the developing countries, such as India and China, have more of a need for the scarce MDs than we do.

Moreover, we have many more people who want to become physicians in the USA. If we can't even produce our own MDs, then we shouldn't be hustling foreigners to this country to practice.

Importing these MDs is economically equivalent to "importing" an MD education. We shouldn't have to import an MD education. We should increase capacity of this as well as increase the capacity of residency slots.

I've had very bad experiences with foreign MDs. I know one elder woman in my neighborhood who had a "shooting pain in her lower back." Her Iranian MD prescribed her antibiotics for her kidney! This was clearly a case of sciatica.

Another friend of mine -a young, healthy guy - had a vessel pulsate every once in a while in his eye, and it wasn't painful, just annoying. His Albanian MD prescribed him acetominephan (Tylenols, basically)!

In those types of countries, society is less merit-based and more feudalistic. Those who have money can easily - and often do - purchase their kids MD for them for a sum of money that serfs in that country can't afford.

1. Let's start increasing the number of MDs that we produce.
2. Let's increase the number of residency spots in the USA.
3. Let's update/change/improve upon the way that we reimburse our physicians.
There is wide variety in the quality of medical education worldwide. That is why foreign educated physicians must pass all 3 steps of the USMLE and complete a residency in this country before being allowed to practice. No one with a purchased MD is going to be able to complete these steps. Your anecdotes are nonsense.

Yes, developing countries need physicians badly, but guess what? So do we. It's not our job to worry about the medical care in India. It's our job to fulfill our physician needs in the USA. Do we need expanded education and residency? Yes. However, I have no problem importing qualified physicians from anywhere in the world until such a time as we can train adequate numbers of homegrown physicians on our own soil.
 
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We should. But let me know where you going to come up the money to do it or if you are willing to be taxed out of your ass to do so. Medical education in this country is heavily heavily subsidized.



I've had very good experiences with foreign MDs.

There we're even.
So let's see:
1. Medical education is heavily subsidized. Yet there are private medical colleges.
2. The residency program is fully subsidized and paid out by the government. This is "costly" even though the highly-trained MD works for $50K for 80 hours week.


Look, all I'm suggesting is that, ultimately, we should allow more MDs to graduate and have more residency spots. I'm convinced that doing both can be budget neutral. Heck, if there are many aspiring MDs willing to purchase an MD education for $250K, and ~65% get turned down, I think that we could EASILY have a system where we allow more MDs pay an amount where the MD schools are profitable.

Once again, if we had more MD positions in our schools and more residency positions, we could save money, rely less on "MD exports". After all, the fixed costs are high to educate people, but the variable costs are much less. Therefore to educate 100 people would be X, but to educate 110 people would be X + 10, where X >> 10.
 

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From an ethical stand point this argument makes sense. But if you argue it from a racial bias or foreign doctors not being smarter then it appears stupid. The problem that we are creating is that we are taking away smart doctors from countries like China, India, Nigeria, South Africa, Ethiopia and bringing them here because we can't "afford" to pay for the training of more doctors. Doesn't this seem a little bit morally wrong? If you think about it in that way where you are draining small countries of their smartest and brightest doctors who wish to come to this country then what do you leave in those countries? I know countries like China and India have more than enough of a population of intellectuals to replenish them but places like Ethiopia and Nepal where the number of medical schools are scarce and the people who can afford to go to them is small, how do we justify taking those graduates. Our excuse is that we don't want to train more doctors because of higher taxes so we take the best and the brightest from there? I am not racist and am a foreigner who immigrated to this country legally as a child just incase anyone thinks there is a 60 year old white republican sitting at this end of the keyboard.

By the way all foreign docs have to still pass steps and do a residency again from what I understand. There was a nice article on this exact subject about draining other countries so we can feed our shortfall...
 

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Here is the article:
http://www.foreignpolicy.com/articles/2010/06/11/countries_without_doctors

Regardless of how many foreign docs are allowed the problem is that the number of residency spots will create a bottleneck for physicians trying to be trained. Foregin trained doctors can't be certified till they complete residency here. So the logic that residency training costs too much money which is why we import foreign doctors doesn't seem to hold much weight. I am just looking at the fact that we have 13 doctors per 1000 people while some countries have 1 per 1000...doesn't this make anyone go why? I am pretty sure people in those countries are sick too. I think this term is generally known as the brain drain.
 

gravitywave

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We should. But let me know where you going to come up the money to do it or if you are willing to be taxed out of your ass to do so. Medical education in this country is heavily heavily subsidized.
taxed out of your ass, what? There was a proposal not long ago to add 15,000 new residency slots at a ten-year cost to taxpayers of $10B. That's not bad considering the size of some of the other stupid things we borrow money from the Chinese for.

So let's see:
1. Medical education is heavily subsidized. Yet there are private medical colleges.
2. The residency program is fully subsidized and paid out by the government. This is "costly" even though the highly-trained MD works for $50K for 80 hours week.
you shouldn't be so condescending when you show your ignorance this way. Medical education in America is heavily subsidized - the reason you see private medical schools isn't because the students are paying much of the costs associated with their education. Tuition is single-digit percentages of medical school revenue. Public or private school, it doesn't matter.

Residency isn't paid for solely by the government, but Medicare funding is a major component. This is because residencies would be loss-leaders for hospitals if the government didn't help pay for them. Students cost money. Residents do too.

By the time I'm an attending, I will have been the beneficiary of over a million dollars worth of direct government subsidies for my education (thanks, America!)
 

Dr McSexy

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So let's see:
1. Medical education is heavily subsidized. Yet there are private medical colleges.
2. The residency program is fully subsidized and paid out by the government. This is "costly" even though the highly-trained MD works for $50K for 80 hours week.
Yes, I'm sure it is quite costly. Although, you are insinuating that the residency programs and associated hospitals are getting a bargain with "cheap" labor from a "highly-trained" MD.

Yes, they are better off by not having to replace those MDs doing scut work with fully-trained high-salaried docs. But by the same token, running a program, taking the time to train, having the resources and assets readily available (equipment, buildings,etc.) etc. are all costly and time intensive endeavors. I mean, you say they are highly trained MDs, but they definitely did not arrive to the program gift-packaged as such.

If training new docs wasn't such a "costly" thing to do, you would see more private practices trying to "cash in" and help out with new residency positions.

Look, all I'm suggesting is that, ultimately, we should allow more MDs to graduate and have more residency spots. I'm convinced that doing both can be budget neutral. Heck, if there are many aspiring MDs willing to purchase an MD education for $250K, and ~65% get turned down, I think that we could EASILY have a system where we allow more MDs pay an amount where the MD schools are profitable.
Your goal is to create residency spots (i.e. IM, FM, Peds, etc.etc.) to address the PCP shortage crisis. Becoming a PCP something already many to-be doctors do not want to seek, due to lack of compensation comparative to other specialties. So, now you want to increase the cost of medical education to these people and further drive them away from entering a lower-paying field? Sounds smart.


Once again, if we had more MD positions in our schools and more residency positions, we could save money, rely less on "MD exports". After all, the fixed costs are high to educate people, but the variable costs are much less. Therefore to educate 100 people would be X, but to educate 110 people would be X + 10, where X >> 10.
You lost me. ... How again is increasing the number of MD positions and Residency positions saving money when they both require more money input from the govt?

---

FWIW, something you haven't addressed...

Even if we increased the residency positions of PCPs, you can't just have them practice anywhere and say "shortage decreased."

Many of the physicians shortages are found in undesirable locations to practice, such as inner city or rural communities. How do you plan on convincing these trained doctors to practice in these undesirable locations?
 

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taxed out of your ass, what? There was a proposal not long ago to add 15,000 new residency slots at a ten-year cost to taxpayers of $10B. That's not bad considering the size of some of the other stupid things we borrow money from the Chinese for.
Being dramatic. :laugh:

It's not bad. But at the same time, it's unlikely to expect the govt. to cut funding from somewhere else to cover the cost of adding this expense. And that money comes has to come from somewhere, either increasing the debt or adding new taxes...
 

gravitywave

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Being dramatic. :laugh:

It's not bad. But at the same time, it's unlikely to expect the govt. to cut funding from somewhere else to cover the cost of adding this expense. And that money comes has to come from somewhere, either increasing the debt or adding new taxes...
i agree, esp. given the current anti-doctor theme in political life right now.

Right now I believe it's mostly just Medicaiders who can't find a FamDoc to take their crappy insurance - although it's worse in rural areas. But if the Massachusetts health plan is any guide, that problem will get worse, and worse still as docs retire and the Medicare rolls swell. By the time Congress wakes up and expands the residency count, it'll be too late....
 
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To the OP, time to take your head out of your butt, look around and see who actually practices in our nation's community hospitals. If it weren't for the FMG's my hospital couldn't surve. Take a walk by the surgical pathology lab some night around 11 PM and see whose still there grossing specimens from a 10 hour Whipple Procedure that my team just completed. Or who is still there at 11 PM sectioning the 200th mesenteric lymph node that I sent him from a GI carcinoma. 98% chance it will be an FMG path resident who doesn't punch a clock like some of the lazy American residents I've worked with. I'll take one industrious FMG over 3 lazy AMG's anytime.
 

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There were several studies showing that foreign doctors in america were statistically better in outcomes than foreign-trained american doctors. I think that makes sense considering how much more difficult it is to get residency here coming from another country.

So if we should discourage anyone it should be the IMGs.
 
OP
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From an ethical stand point this argument makes sense. But if you argue it from a racial bias or foreign doctors not being smarter then it appears stupid.
That is *NOT* what I was goind for, SOTT. I, in no way, shape, or form, imply that foreigners are less smart than Americans. I just believe that we Americans should *NOT* import MDs from developing countries on 2 merits:
1. The "MD-exporting" nation needs their physicians a *LOT* more than we do. As one poster here puts it: USA has 13 MDs/1000 and one developing country has 1 MD/1000. (As a side, I actually think that the USA has 2.5/1000). We are doing them a DIS-SERVICE by hustling their MDs. THE BEST DEVELOPMENT WORK THAT WE CAN DO, INSTEAD OF DOCTORS-WITHOUT-BORDERS OR HABITAT-FOR-HUMANITY IS TO ALLOW FOREIGN DOCS TO PRACTICE IN THEIR HOME-COUNTRIES.
2. We *NEED* more MDs, otherwise, we wouldn't be importing them from these developing nations. We have MORE THAN ENOUGH READY AND WILLING ASPIRING MDs here in the USA. Let's open the flood-gates and graduate 24,000 MDs (not the 16,000 currently graduating from American schools, and ~32,000 MD-school-rejects), and increase the number of residents. Therefore, let us ween ourselves off this dependency of foreign-docs.



The problem that we are creating is that we are taking away smart doctors from countries like China, India, Nigeria, South Africa, Ethiopia and bringing them here because we can't "afford" to pay for the training of more doctors. Doesn't this seem a little bit morally wrong? If you think about it in that way where you are draining small countries of their smartest and brightest doctors who wish to come to this country then what do you leave in those countries?
I don't think that it's morally wrong to bring in the best/smartest from these developing countries one bit. After all, attracting the best from other nations is what we've been doing for a long time: Many have come here since at least '65 to attend tertiary education in our great schools, and they decided to stay. Ummm...Einstein was from Germany, and he was sort of bright, I've heard.

What's morally wrong is that we have been made to think that everything that the AMA has been doing (i.e. limiting the supply of MDs to maximize doctor salaries) is always correct, and they are always in our best interests. We are not allowing ourselves to even challenge status quos, ask questions, or postulate "what if?" scenarios. I know this, because I proposed an idea for privatized residents, and some poster got hostile on me. However, in this thread, somebody else actually brings this up.


I know countries like China and India have more than enough of a population of intellectuals to replenish them but places like Ethiopia and Nepal where the number of medical schools are scarce and the people who can afford to go to them is small, how do we justify taking those graduates. Our excuse is that we don't want to train more doctors because of higher taxes so we take the best and the brightest from there? I am not racist and am a foreigner who immigrated to this country legally as a child just incase anyone thinks there is a 60 year old white republican sitting at this end of the keyboard.

Now *YOU* are being racist by implying that older, white Republicans are racist. :) Also, who care's if people think that you're an "old white republican [sic]"?

Anyways, I refuse to believe that educating more MDs = higher taxes. I do, however, believe that there is MORE cost in NOT having enough MDs.


By the way all foreign docs have to still pass steps and do a residency again from what I understand. There was a nice article on this exact subject about draining other countries so we can feed our shortfall...
Passing the USMLEs is not the rate-determining-step in the production of an MD. The RDS is getting accepted to MD-school (only 30% get accepted), and 98% of MDs pass the USMLE.
 
OP
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There is wide variety in the quality of medical education worldwide. That is why foreign educated physicians must pass all 3 steps of the USMLE and complete a residency in this country before being allowed to practice. No one with a purchased MD is going to be able to complete these steps. Your anecdotes are nonsense.
97% of our MDs pass their USMLEs, so this is not that big of a deal. The mental challenge is getting into medical school, and not graduating from medical school, or passing the USMLE.

How many people do you know flunked out of MD school? How many people do you know didn't pass their USMLE?

Yes, developing countries need physicians badly, but guess what? So do we. It's not our job to worry about the medical care in India. It's our job to fulfill our physician needs in the USA.
We can do both at the same time, which is what I propose.

Do we need expanded education and residency? Yes. However, I have no problem importing qualified physicians from anywhere in the world until such a time as we can train adequate numbers of homegrown physicians on our own soil.
We agree that we need expanded education and residency. However, I believe that we *CAN* train the numbers of homegrown MDs. We are unable to train adequate numbers of homegrown physicians due to the monopolistic forces of the AMA.
 
OP
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taxed out of your ass, what? There was a proposal not long ago to add 15,000 new residency slots at a ten-year cost to taxpayers of $10B. That's not bad considering the size of some of the other stupid things we borrow money from the Chinese for.
That is an amazing deal for US taxpayers. This comes to only $66,000/resident-year. This is a windfall considering that they perform 90 hours of high-margin, value-added work. This is not a *cost*. This is an *investment.* As a matter of fact, other more prominent health policy experts agree with me (or I agree with their assertions, independently). Please read: http://findarticles.com/p/articles/mi_m1272/is_n2630_v126/ai_20004039/

"Residents, who work long schedules--sometimes eclipsing 90 hours a week--staff hospitals at odd hours and provide valuable on-site supervision when more senior physicians are off. For this, they derive a salary of about $30-$40,000 a year. Residents, in many respects, are a financial windfall to some hospitals, not a liability."


you shouldn't be so condescending when you show your ignorance this way. Medical education in America is heavily subsidized - the reason you see private medical schools isn't because the students are paying much of the costs associated with their education.
It's definitely subsidized. But so is *elementary education*, police training, armed forces training, etc. What percentage of costs does the student actually pay, in that case? How does this compare to the costs that a parent reimburses the elementary education that their kids received?

Also, let's not confuse the subsidies that medical college students receive with the subsidies that residents receive. These are different things for the sake of this argument.

Tuition is single-digit percentages of medical school revenue. Public or private school, it doesn't matter.
Citations needed, please.


Residency isn't paid for solely by the government, but Medicare funding is a major component. This is because residencies would be loss-leaders for hospitals if the government didn't help pay for them. Students cost money. Residents do too.
http://findarticles.com/p/articles/mi_m1272/is_n2630_v126/ai_20004039/ states that "Residents, who work long schedules--sometimes eclipsing 90 hours a week--staff hospitals at odd hours and provide valuable on-site supervision when more senior physicians are off. For this, they derive a salary of about $30-40,000 a year.Residents, in many respects, are a financial windfall to some hospitals, not a liability."

Also, http://en.wikipedia.org/wiki/Residency_(medicine)
"some argue that Medicare subsidies for training residents simply provide surplus revenue for hospitals which recoup their training costs by paying residents salaries (roughly $35,000 per year) that are far below the residents' market value."

I personally think that it's commonsense that a highly-trained doctor working 80+ hours doing value-added work for $35K/year is a bargain. I'd love to finance a business-model like this.


By the time I'm an attending, I will have been the beneficiary of over a million dollars worth of direct government subsidies for my education (thanks, America!)
Citations needed, please.
 
OP
Z
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Yes, I'm sure it is quite costly. Although, you are insinuating that the residency programs and associated hospitals are getting a bargain with "cheap" labor from a "highly-trained" MD.

Yes, they are better off by not having to replace those MDs doing scut work with fully-trained high-salaried docs. But by the same token, running a program, taking the time to train, having the resources and assets readily available (equipment, buildings,etc.) etc. are all costly and time intensive endeavors. I mean, you say they are highly trained MDs, but they definitely did not arrive to the program gift-packaged as such.
Please review my previous posts where I cite 2 URLs that say that residents are a windfall of revenue for the hospital.


If training new docs wasn't such a "costly" thing to do, you would see more private practices trying to "cash in" and help out with new residency positions.
It is definitely *NOT* as costly as you think to train an MD, and 'yes', entities are cashing-in. DeVry, a publicly-traded company with $2B in revenues and 15% net profit margins, owns Ross University. There are far more applicants to Ross than there are entrants. Opening up privatized medical schools and residencies is not permitted in the USA, thanks to our friends at the AMA, who are anti-capitalist.

This would be an excellent business model in the USA, as I would think that far more people would want to stay in the USA for a MD degree than to move to the Caribbeans for 2 years. We can't "cash in" on the MD education or the short fall in residents.

I've actually suggested in a previous post that it'd be a great idea to have privatized residencies. I'd love to employ sweat-shop laborers with scalpels.


Your goal is to create residency spots (i.e. IM, FM, Peds, etc.etc.) to address the PCP shortage crisis. Becoming a PCP something already many to-be doctors do not want to seek, due to lack of compensation comparative to other specialties. So, now you want to increase the cost of medical education to these people and further drive them away from entering a lower-paying field? Sounds smart.
MDs don't want to become a PCP not because PCPs make too little, but because specialists MAKE TOO MUCH. PCPs make a lot of money as well. The median salary for primary care physicians stood at $186,044 in 2008, according to the Bureau of Labor Statistics (http://www.ehow.com/about_7462993_much-primary-care-doctors-make_.html).


You lost me. ... How again is increasing the number of MD positions and Residency positions saving money when they both require more money input from the govt?
You seem to think only in terms of costs, but you don't see the benefit/revenue-producing aspects of activity. Here's an analogy: If you were an employer, you'd view all your employees as liabilities because they incur cost. However, your employees, from their fruitful labor, produces MORE economic benefit than their economic costs to you, Mr. Employer.

If it costs $10,000,000 to educate 200 students, then it would only cost $11,000,000 to educate 300 students (for example), due to the high fixed costs, but low variable costs. So, "yes", this costs more - perhaps to the government as well as to the MD school, which would get passed off to MD students, tax payers, whatever. But, the extra 100 students would be paying a lot more than their $10,000/student that they incurred. Moreover, their service has a benefit, which ultimately reduces societal - and hence - tax payer's cost.

---

FWIW, something you haven't addressed...

Even if we increased the residency positions of PCPs, you can't just have them practice anywhere and say "shortage decreased."

Many of the physicians shortages are found in undesirable locations to practice, such as inner city or rural communities. How do you plan on convincing these trained doctors to practice in these undesirable locations?
I agree with the fact that one aspect of our problems is that not enough MDs want to practice in the outskirts of Tulsa, Oklahoma. What would I do to convince MDs to train at these undesirable locations? Hmmmm...I just saw a film about the Doctors Without Borders. It was a reality-TV-type of documentary about them, and it starred many photogenic and eclectic personalities who work in war-ravaged countries, such as Liberia. It seems that it's more easy to convince smoking-hot French MDs to work in Congo/Liberia than it is to work in the outskirts of Tulsa because of the "third-world chique" associated with the exotic location. So perhaps we should glamorize the outskirts of Tulsa, and making it appeal to our sense of adventure. Oh yes, and free baguettes for smoking hot French babes.
 
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Z
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To the OP, time to take your head out of your butt, look around and see who actually practices in our nation's community hospitals. If it weren't for the FMG's my hospital couldn't surve. Take a walk by the surgical pathology lab some night around 11 PM and see whose still there grossing specimens from a 10 hour Whipple Procedure that my team just completed. Or who is still there at 11 PM sectioning the 200th mesenteric lymph node that I sent him from a GI carcinoma. 98% chance it will be an FMG path resident who doesn't punch a clock like some of the lazy American residents I've worked with. I'll take one industrious FMG over 3 lazy AMG's anytime.

Anti-American troll.
 
OP
Z
Nov 17, 2009
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There were several studies showing that foreign doctors in america were statistically better in outcomes than foreign-trained american doctors. I think that makes sense considering how much more difficult it is to get residency here coming from another country.

So if we should discourage anyone it should be the IMGs.
Citations needed, please.

I am familiar with one study done very recently, but it had many shortcomings. The study simply compared the morbidity rates of heart patients from 3 different types of MDs: 1. American-born AMDs 2. American-born FMDs, and 3. Foreign born and FMDs. (1) did the best, followed by (3), and (2) wasn't far behind (3).

However, the study only looks at one surgical procedure. They should review many other procedures.
 
Oct 31, 2009
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wow, i dont know what to say. its like the pot calling the kettle black.

are you willing to pay for the 3 years of residency? are you willing to support tougher educational standards in elementary and secondary education? are you willing to make these changes? are you ready for the fact that you will not get a penny of your social security?

it seems like this discussion is going to turn into a purely political discussion. one with no scientific merit. since it most likely is, why participate in it myself

WE ARE ALL SCREWED!!!!!

conservative, liberal, tea party, douche party, everyone is in this for the same thing. "whats gonna make me better, while making the other looking like a horses ass."

should there be more residency spots, probably. but how about this. the govt stops providing for this, are you still gonna want to be a premed? knowing that not only are you gonna have to be in for the however many thousands for med school, but double that so you can pay for the opportunity to learn real medicine?

discouraging nonamerican fmgs from practicing? one question: (hypothetically) if your stats are so good, and your education is so great, why are you not beating them out for spots?

and yes, im a predent, but that might be soon changing. but still thought id throw my 2 cents in.
 

Depakote

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97% of our MDs pass their USMLEs, so this is not that big of a deal. The mental challenge is getting into medical school, and not graduating from medical school, or passing the USMLE.
Please refrain from making such comments to a forum full of medical students who know the contrary. It advertises your ignorance.
 

gettheleadout

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From an ethical stand point this argument makes sense. But if you argue it from a racial bias or foreign doctors not being smarter then it appears stupid. The problem that we are creating is that we are taking away smart doctors from countries like China, India, Nigeria, South Africa, Ethiopia and bringing them here because we can't "afford" to pay for the training of more doctors. Doesn't this seem a little bit morally wrong? If you think about it in that way where you are draining small countries of their smartest and brightest doctors who wish to come to this country then what do you leave in those countries?
Ah I remember this, back in policy debate we called this the Brain Drain argument.
 

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What's morally wrong is that we have been made to think that everything that the Illuminati has been doing (i.e. limiting the supply of MDs to maximize doctor salaries) is always correct, and they are always in our best interests.
We agree that we need expanded education and residency. However, I believe that we *CAN* train the numbers of homegrown MDs. We are unable to train adequate numbers of homegrown physicians due to the monopolistic forces of the Illuminati.
Opening up privatized medical schools and residencies is not permitted in the USA, thanks to our friends at the Illuminati, who are anti-capitalist.


MDs don't want to become a PCP not because PCPs make too little, but because specialists MAKE TOO MUCH. PCPs make a lot of money as well.
I think people don't become PCPs because they don't like the job and all the issues that come along with it.

You seem to be making some unsound assumptions and scapegoating the AMA...
 

cpants

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In reference to the brain drain, I feel it is irrelevant. We aren't stealing from anyone. This is a highly desirable place to live and work, and until that changes people are always going to want to come here. Those countries need to improve their quality of life and take steps to keep their smartest people there. Do people honestly think we should put policy in place to keep the best and the brightest from immigrating here, damaging our own country out of some kind of guilt?
 
OP
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In reference to the brain drain, I feel it is irrelevant. We aren't stealing from anyone. This is a highly desirable place to live and work, and until that changes people are always going to want to come here. Those countries need to improve their quality of life and take steps to keep their smartest people there. Do people honestly think we should put policy in place to keep the best and the brightest from immigrating here, damaging our own country out of some kind of guilt?
yes
 

RapplixGmed

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Zut, Cpants is right. Although it is charitable that the US cares, it has no inherent responsibility for health care infrastructure anywhere else in the world. Your argument that the US should create incentives for FMGs to stay in their home countries doesn't make any sense. Its just like arguing that China should work to reduce their trade deficit to help out the US. Its not their problem since they have a responsibility to their own people, it is the US who is messing up on trade. Just like in trade, it is the other nation's responsibility to make themselves an attractive place for doctors to live and practice. Who are we to reject those who are just trying to make their own lives better? If US produced doctors are so good and FMGs are so bad, shouldn't we accept all of those capable premeds, overproduce US graduates and send (the bottom) half of the graduating class of every US med school abroad to a 3rd world country to practice permanently? After all, they wanted to be doctors right? Who cares where you practice and raise your kids.

Of course we should take those who are smart and capable of becoming good physicians in the US. My father is a good example. He came here more than 20 years ago as a FMG and was dirt poor and slept on other people's couches the first year that he was in the US. He now has a practice with two offices and is a shareholder and member of the board of a major surgical center. Your comments are an insult to him and everything he has accomplished.
 
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OP
Z
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Who are we to reject those who are just trying to make their own lives better?
I agree. That's why we shouldn't be rejecting so many American students who want to go into medicine, and the only way this can be done is to:
1. Raise the number of seats available for MD students.
2. Raise the number of residencies available, because after all, that's an amazing use of tax-payer's dollar which has a very good rate-of-return, as I have pointed out.

Of course we should take those who are smart and capable of becoming good physicians in the US.
This won't happen unless we:
1. Raise the number of seats available for MD students.
2. Raise the number of residencies available.

And in doing so, we won't have to depend on imports as much as we do now.

Congratulations on your amazing father's American story. Only in America can something like this work out.

Also, only in America, can we change the status quo and think outside the box and challenge authority. We gave the world rock-n-roll and hip hop.
 

thechad

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There are 6 billion people in the world, you think the only smart ones are in America?
 

Raryn

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There were several studies showing that foreign doctors in america were statistically better in outcomes than foreign-trained american doctors. I think that makes sense considering how much more difficult it is to get residency here coming from another country.

So if we should discourage anyone it should be the IMGs.
I was going to say the same thing. If given the choice between a grad from India who went through the work to get into med school there, then worked his ass off after coming to America to pass the boards and match into a residency, compared to a caribbean grad, I'd take the Indian guy every time. There's a fairly good chance that the FMG could have made it into and through an American med school had he had the opportunity, while the IMG almost certainly couldn't have, given that he would have gone to an American school in the first place rather than the carib!

The real (and in fact only) bottleneck for US MD's is residency spots. You could increase the number of medical student seats by 50%, and the number of new physicians every year would stay the same. The only result would be FMG's/IMG's being pushed out. (Not *necessarily* a bad thing if you want to argue against the brain drain and the fact that accredited and US supervised schools are better, but it still doesn't solve any shortages) I don't know what the person blaming the AMA up above is smoking, but the entity that controls the number of residency spots is the government (mostly federal, but some are state funded). Governmental GME caps are exacerbating the shortage, not the AMA, the illuminati, or whatever other organizations you want to blame.
 

vasca

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Passing the USMLEs is not the rate-determining-step in the production of an MD. The RDS is getting accepted to MD-school (only 30% get accepted), and 98% of MDs pass the USMLE.
That seems kind of biased. Remember that American med school curricula is specifically designed to cover topics of the USMLE because universities want their students to become MD's (obvious).

In Mexico our curricula is designed for us to attempt to pass the ENARM exam and each university hands out their own standards to grant the MD degree. My university demanded me to pass a written standard exam called the CENEVAL, a practical exam (which seemed more like an oral exam than practical per se) and a 3 hour oral exam. The written one was a grueling 8 hours but a piece of cake because I knew my stuff, I didn't do very well on the practical because I had the flu and didn't study IM topics because I heard the hospital I was going to do that exam in usually loved to ask Gen Surg questions and the oral exam was grueling.

If I failed any one of the exams I could only retry them once more in my lifetime, fork another 1000 bucks (which for the slugging mexican economy is a huge deal) and if I fail any exam a second time I'll never EVER be granted the MD from my university. Luckily I passed every exam on the first shot but I have several friends that failed the oral exam because it's not easy at all to answer calmly in less than 5 minutes over 70 topics in medicine (where anything goes). You had to virtually cram 5 years of schooling to pass it.

Would an American student pass these exams.. in fully fluent spanish??? Maybe yes, probably not the oral. One of the doctors really crushed me on Neuroanatomy and my spanish is very fluent.

I think it's the same for the foreign doctors coming to the US. It's not easy to take a university level exam in your non native language. I know it because spanish isn't my native language and I get harassed by patients all of the time when I miss some slang or my strange accent becomes a major topic. That's the main reason why they started to enforce FMG and IMGs to do the CS exam as well.

Many mexicans have good enough english to get a 600 on the TOEFL because mexican curricula is designed for that purpose, but they can't even say the simplest of sentences even if their lives depended on it because their curricula doesn't promote learning how to speak the language. If it's hard for a native spanish speaker to speak in english when both languages have some similarities, a native Mandarin speaker probably has a really hard time doing well on the CS exam.

The 98% pass rate doesn't include FMG's and IMG's who have lower pass rates, more in the 70% range.

---

If the US trained more MD's you will get to the same problem Mexico has: too many MD's, not enough residency slots. If passing the ENARM is hard enough, most people who pass the exam will not get a residency slot in what they want. Mexico luckily allows GP's to work freely and sometimes get paid far more cash than even subspecialists so doing a residency here is more of a personal choice (sometimes fueled by the ego of being able to show off you're a specialist earning less cash, but a specialist nonetheless). In the US, if you don't get in a residency, you can't work outside of a lab because you have no license.

---

Yes, residents are exploited and so are med students (I've had to jump who knows how many hoops and still have a lot of annoying problems the government doesn't care much about). Medicine is a tough profession and it weeds out people only here for the $$$ pretty well. If you think residents earning 50,000 a year working 80 hours a week is bad (in the US they can't work more than 80 hours for the hospital will lose residency money funding and valuable employees), come to Mexico and you'll see guys up north are in the glory.. cept for the hideously huge money they owe and have to pay back.

---

Why always the hate against FMGs and IMGs taking away jobs that otherwise can't be filled I don't get. Maybe some people want to move to the US for the fun of working somewhere else or because they hope a US residency education will be far superior. The scut work up north goes to the med students and auxilliary staff whereas in Mexico interns and residents do 90% of the work. In my old hospital lab staff doesn't take peds blood samples so you had to do everything and notes here are done by typewriter. We use Pinard stethoscopes which is probably something guys up north have never even seen before outside of a museum. Some people might want a residency where education is more prioritized vs slave labor. Mexico has no legal work week cap. You could do 300 hours of nonstop work here and it's legal. I'm not surprised someone might want to live a cush lifestyle and get a great education.

It's like a lot of my patients that were lucky or smart enough to get inexpensive operations in the US because they qualified for the right insurance somehow. They weren't evil demons, they just knew how to play the game right and took advantage of something that's legal if not morally wrong to US citizens. I know a guy who had a knee ligament surgery done in the US virtually for free and he isn't a US citizen.

Good for the doctors that decided to move half a planet away from their family to achieve their dream. They worked hard for it!!! :luck:
 

silas2642

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Although I think that there are some ethical considerations regarding the "brain drain" that have been described, I welcome qualified FMG's to US medicine and all the contributions they bring. Why wouldn't we want other nation's best and brightest to come over here, adding experiences that US grads don't have? It seems elitist, foolish, and even anti-American to want to ban them from training and practicing here.

The concern is whether or not highly qualified FMG's will want to even want to train and practice here in the future given the state of our healtcare system. We certainly are not #1; despite spending the most amount of money per capita in the world, we do not have the best outcomes.
 

Melicopter

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Anti-American troll.
Actually, what he did was made a valid point based on years of experience as a practicing physician. What you did was start yet another trolling topic in a forum where you don't need to be starting debates.
 

thechad

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If given the choice between a grad from India who went through the work to get into med school there, then worked his ass off after coming to America to pass the boards and match into a residency, compared to a caribbean grad, I'd take the Indian guy every time.
You should realize that India, Pakistan, Nepal, etc are full of private school that anyone can attend so long as they have the money to pay.
 

Raryn

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You should realize that India, Pakistan, Nepal, etc are full of private school that anyone can attend so long as they have the money to pay.
100% of Carib grads went to such a school. The vast majority of Indian doctors I know didn't (at least the one's I've talked to, who described their process of getting into med school and such).
 

pingouin

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this has nothing specific to do with the allo forum. moving.
 

Raryn

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you're such an idiot. please leave these forums and stop giving US students a bad name.
What a well-reasoned rebuttal to my statements. I stand in awe at your impeccable logic.
 

benjee

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Although I think that there are some ethical considerations regarding the "brain drain" that have been described, I welcome qualified FMG's to US medicine and all the contributions they bring. Why wouldn't we want other nation's best and brightest to come over here, adding experiences that US grads don't have? It seems elitist, foolish, and even anti-American to want to ban them from training and practicing here.

The concern is whether or not highly qualified FMG's will want to even want to train and practice here in the future given the state of our healtcare system. We certainly are not #1; despite spending the most amount of money per capita in the world, we do not have the best outcomes.
I am all for those qualified FMGs to practice in us but I am pretty against those who already trained in their own countries and now come to US and get retrained AGAIN which is not necessary if they are that smart and experienced . why are they still want to compete with those freshly graduated from meds schools for training slots ?? As we know the residency slots are funded by medicare, why are we allowing some foreigners ( who never contribute abit only take ),to take up these resources which may or may not be increased in future? I don't see there is such open policy like US towards FMGs in other countries!!!
 

physasst

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Here is the article:
http://www.foreignpolicy.com/articles/2010/06/11/countries_without_doctors

Regardless of how many foreign docs are allowed the problem is that the number of residency spots will create a bottleneck for physicians trying to be trained. Foregin trained doctors can't be certified till they complete residency here. So the logic that residency training costs too much money which is why we import foreign doctors doesn't seem to hold much weight. I am just looking at the fact that we have 13 doctors per 1000 people while some countries have 1 per 1000...doesn't this make anyone go why? I am pretty sure people in those countries are sick too. I think this term is generally known as the brain drain.

Umm what?

The US has one of the lowest physician per 1000 rankings among any OECD country. Approximately 2.67 physicians per 1000 people. Not sure where you found 13 per 1000, but that is not supported by any of the data from WHO, Nationmaster, etc. BTW, that 2.67 was from 2004, it is likely lower now and physician output has been stagnant here, but the population has continued to grow. By way of comparison, Mexico has 2.89 per 1000, Germany 3.48, Italy 3.7, Switzerland 3.97, and Cuba has 6.4...

We do beat out the UK with 2.2, Canada with 1.91, and China with 1.51, and India with 0.58 per 1000

There is only one country with more than 10, and that is San Marino with an obscene 47.35 physicians per 1000.

Since I don't particularly feel like attaching the WHO excel sheet, here is a quick link:

http://www.nationsencyclopedia.com/WorldStats/WDI-health-services-physicians.html
 

VA Hopeful Dr

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I didn't know there were US MDs going without residencies....
Its fairly uncommon and, at least in everyone I've seen, usually the result of poor planning on the part of the student.
 
OP
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Please refrain from making such comments to a forum full of medical students who know the contrary. It advertises your ignorance.


No it does not. Passing the USMLE (98% pass rate) is, once again, NOT the rate-determining step.

Passing the USMLE is easier than getting accepted to a US medical school. I know many Americans who studied abroad who didn't get accepted to US schools who passed the USMLE.
 
OP
Z
Nov 17, 2009
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Umm what?

The US has one of the lowest physician per 1000 rankings among any OECD country. Approximately 2.67 physicians per 1000 people. Not sure where you found 13 per 1000, but that is not supported by any of the data from WHO, Nationmaster, etc. BTW, that 2.67 was from 2004, it is likely lower now and physician output has been stagnant here, but the population has continued to grow. By way of comparison, Mexico has 2.89 per 1000, Germany 3.48, Italy 3.7, Switzerland 3.97, and Cuba has 6.4...

We do beat out the UK with 2.2, Canada with 1.91, and China with 1.51, and India with 0.58 per 1000

There is only one country with more than 10, and that is San Marino with an obscene 47.35 physicians per 1000.

Since I don't particularly feel like attaching the WHO excel sheet, here is a quick link:

http://www.nationsencyclopedia.com/WorldStats/WDI-health-services-physicians.html


On top of this, the USA *IMPORTS* 25% of our MDs. About ~80% of the 25% are Americans studying abroad, and the other 75% are foreign-born/foreign-trained).

This is why we:
1. Need to increase the number of medical students in this country.
2. Need to increase the number of residents in this country.
 
OP
Z
Nov 17, 2009
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I am all for those qualified FMGs to practice in us but I am pretty against those who already trained in their own countries and now come to US and get retrained AGAIN which is not necessary if they are that smart and experienced . why are they still want to compete with those freshly graduated from meds schools for training slots ?? As we know the residency slots are funded by medicare, why are we allowing some foreigners ( who never contribute abit only take ),to take up these resources which may or may not be increased in future? I don't see there is such open policy like US towards FMGs in other countries!!!

http://findarticles.com/p/articles/m...6/ai_20004039/ states that "Residents, who work long schedules--sometimes eclipsing 90 hours a week--staff hospitals at odd hours and provide valuable on-site supervision when more senior physicians are off. For this, they derive a salary of about $30-40,000 a year.Residents, in many respects, are a financial windfall to some hospitals, not a liability."

Also, http://en.wikipedia.org/wiki/Residency_(medicine)
"some argue that Medicare subsidies for training residents simply provide surplus revenue for hospitals which recoup their training costs by paying residents salaries (roughly $35,000 per year) that are far below the residents' market value."

Therefore, residencies have a 'profit-side' to the equation as well. They cost $10B for 15,000, but their benefits to society is at least $20B.
 
OP
Z
Nov 17, 2009
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You should realize that India, Pakistan, Nepal, etc are full of private school that anyone can attend so long as they have the money to pay.


I've seen this with my own eyes. I've seen Americans study in expensive schools in scenic Indian beach resorts frequented by tourists. They are not doing badly at all when they came back to the USA. I know 2 people like this, and they both went to the same school in India. They are both internal medicine doctors. Of course they passed the USMLE, since this is the easy part.

Since an "American MD school reject" can pass the USMLE, then the rate-determining step is getting accepted to American based med schools.

However, I've seen cases of BAD foreign medical doctors (and I've also seen BAD American born/educated docs as well). I am advocating that we simply raise the number of docs and residency slots in this country.
 
OP
Z
Nov 17, 2009
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Actually, what he did was made a valid point based on years of experience as a practicing physician. What you did was start yet another trolling topic in a forum where you don't need to be starting debates.
Like the debate that you took sides on?