Number of FMGs in the US: Is it a problem?

[Adapt]

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So do you think the number of foreign medical graduates coming to the US for residency is a problem? I am curious as to what people think. The following is an article I found awhile ago that I posted before. I will post it here again as there is another thread that involves this subject.

http://www.imgi.net/internationalmedicalgraduate/corovofspecb1.html

Some quotes of interest.

"...The number of such graduates who enter residencies (approximately 17,500 in 1994) has remained relatively constant for more than a decade. In contrast, there has been a marked increase in recent years in the number of graduates of foreign medical schools who enter residencies in the United States. In 1994, approximately 6750 graduates of foreign medical schools entered residency programs, or almost 40 percent of the number of graduates of U.S. medical schools who entered residencies.3 Seventeen percent of these graduates of foreign medical schools were U.S. citizens..."

"...Approximately 75 percent of the graduates of foreign medical schools who train in the United States ultimately establish practices here.5 If their number continues to increase, the specialty choices made by graduates of U.S. medical schools will have a diminishing influence on the specialty mix of the physician work force..."

"...I suggest that the federal government control the supply of physicians not by regulating the number of residency positions but by limiting the number of graduates of foreign medical schools who enter residency programs each year. In my view, it is not reasonable at this point to consider limiting access to residency training for graduates of U.S. medical schools..."

"...The effects of a continued stalemate are clear: the United States will invest substantial sums of money to educate physicians who are not needed, and some of the young men and women who pursue careers in medicine may find few professional opportunities when they finish their education..."

 

[MacGyver]

I agree that FMGs should be controlled tightly.

I also agree that there is no way in hell that individual hospitals and departments are going to voluntarily cut back on FMGs.

That being said, the threat posed by PAs and NPs is far greater than FMGs.

 

[ryanbeckworth]

you run the risk of irritating the more kooky types on the board. I can't wait to read the responses if someone dares to question to fairness of allowing them in without penalty.

 

[VentdependenT]

I'm sure the FMG/IMG's who landed competitve spots worked extremely hard for them. Kudos to them.

As for primary care, there are more than enough spots to go around. Of those spots I'm sure there are more than enough undesirable locals/programs which need to be filled by someone. If the gov lets those spots go unfilled then what?

 

[Renovar]

There is a great paradox in the US medical system.

The number of total residents needed in all US hospitals does NOT equal to the demand of BC physicians, because residents provide cheap labors that the hospitals love.

From the hospital's administrative standpoint, they dont give a rat's a$$ about the oversupply of physicians and future of the MD race - all they care about is getting enough cheap labor to run the floor. And to all but the most prestigeous of residencies, they dont give a rat's a$$ whether the MD comes from a US school or wherever else they are from - as long as they pass step 3, and do a sufficiently good job that they dont have problem with accreditation (which will disallow them to have residents.)

According to ACGME report back in about 1999, they have recommended a motion to cut down the number of US PGY1 positions down to 105-110% of US grads, from 120+% (ie. effectively decreasing slots for IMG's by 1/2). But so far, they are meeting a lot of resistence from the hospital's administrative side.

Why?

By cutting down the number of residents, hospitals across the country would lose so much money in hiring additional MD's/PA's/RN's to do whatever the work the residents would do in order to provide patient care. The amount of additional money spent in this manner would be quite substantial. AAMC reported that by instituting a 80 hour resident work week costed a hospital on average $2-3M/yr. PER HOSPITAL WITH RESIDENCY PROGRAMS. That's just switching from no hour limit to 80 hour limit. Imagine cutting down the resident number by 10%, and how much money that would be.

No wonder hospitals are not exactly willing to cut down their own number of residency spots, even if those spots are taken by FMG's.

FInally, keep in mind that there may be undesirable spots that need to be filled, but that does not represent there isn't already a gross oversupply of physicians out there, especially in subspecialties and especially in major desirable metropolitan areas such as california.

The whole system is pretty f'ed up.

 

[dr.smurf]

of course they (we) are deserving. weve sacraficed alot...paid our fees, taken the same tests (one more in fact..csa) and worked our ass for spots. just b/c people didnt match and are crying about scrambling isnt our problem.

im an american citizen that chose to go down to the caribbean. and guess what i have no regrets...and got my 1st yep 1 st choice in residency. face it if it wasnt for IMG's going into specialties like FP and IM there would be an extreme shortage. almost 45% of all IM spots go to IMG's.

now i can put myself in the shoes of U.S. grads and i can relate, but guess what..thats life. you are always going to be struggling and competing with peers and others for certain things, jobs, etc.

for what it sworth...good luck to all...U.S. or IMG tomorrow. dont forget we are all future colleagues and physicians!

peace..

 

[VentdependenT]

Agreed

 

[tofurious]

I do like the idea of having residency slots limited to 110% of the number of US graduates per year. I was surprised to find out that more USIMGs than nonUS-IMGs enter the Match, but nonUS-IMGs generally outperform USIMGs on standardized tests. Limiting the number of residency slots would really force the programs to take the best of nonUS-IMGs and a few USIMGs rather than just "warm bodies for the call schedule".

 

[juddson]

Look,

There are two seperate arguments here that need to be evaluated seperately. The first is the alleged (prospective?) over-supply of physicians in the US. The point above is well taken - that the number of residency spots does not necessarily reflect the "need" for physicians in the workforce. In fact, because residents are paid so little (and represent needed low cost labor for hospitals), it is possible for there to be an under-supply of residents (in some specialties like, say, IM) and an oversupply of practicing physicians. Hence, the number of residency spots (or open residency spots - which ostensibly represent an over-demand of spots and an under-supply of residents to fill them) is a poor indicator of the number of physicians actually needed to fill the medical needs of the US. Accordingly, it does not necessarily follow (and may in fact NOT follow) that a 45% decrease (representing the number of FMG into IM residencies) will result in a shortage of IM physicians in the US. It may very well, however, translate into an acute shortage of IM residents in US hospitals. What effect an undersupply of low-cost residents to hospitals will have on the public health system in the US is unclear, particularly if at the same time there is an oversupply of practicing IM physicians.

Depending on which side of the over/under supply of physicians you come down on, the question of limiting the number of residency positions in the US will certainly have an effect on it. It is my position that IF there is an oversupply of physicians in the US (I happen to think there probably is an over-supply of primary care physicians) than the number of residency positions in those specialties should be cut back despite what effect this may have on the supply of cheap labor to hospitals. All, some, few, or none of you may agree with this assesment. It's a matter of economics, and little else.

That said, the question of WHO ought to be able to fill whatever residency positions we deem neccesary is an entirely seperate issue. And in this regard, I'm utterly and totally unconcerned with the notion that IMG's should be able to fill whatever positions they qualify for. Look, there are a number of what I would consider "legitimate" complaints about the migration of labor to this country AND/OR the migration of jobs to another country. In both of those instances, however, the question is one of unfair competitive advantage, NOT the nationality of the laboror. Accordingly, I would agree with McGyver (and others) if IMG's were taking residency positions for less pay, or were able to secure these positions will relatively fewer hours of undergraduate medical training, or fewer examinations. But unlike the software developer in Banglagor, IMG's are competing on EXACTLY the same field as USG's in terms of salary, benefits, training and qualifications. In every instance where an IMG beats out a USG for a residency position (or even later in career, for an attending position, say) it was NOT due to an artificial barrier to USG competition (such as a willingness to work for a radically diminished wage, as offshore workers are) but rather due to a genuine competitive advantage either in training, competance, etc.

If the playing field is level with respect to wages and barriers to practice (ie, examination requirements, etc.), on what basis, then, do USG's have to complain about IMG competition other than a bald sense of entitlement based on nothing more than serendipity of being born here?

I don't see it. As long as the competition remains fair, I've got nothing against IMG's. On the other hand, if the number of residency spots needs to be reduced due to an oversupply of physicians (a purely economic determination), then IMG's and USG's should participate equally in that reduction in spots based solely on thier repective genuine competitive advantage for those spots.

Judd
ps. The only reall argument i can see about restricting spots to IMG's is the fact that residency salaries seem to be financed with tax-payer dollars. I would presume that IMG's did not pay into this system, and therefor should not be able to benefit from it. Again, though, this strikes me as a sort of non-normative, economic concern. And besides, even where an IMG has not paid into the system, there is still an arms length negitiation between the hospital (ie, government money) and the resident for the supply of labor for fair value.

 

[MacGyver]

judd,

in theory i agree with you. However, if there EVER comes a time when AMGs have a hard time getting residency slots, and many FMGs are still coming in, the the AMGs should be protected first.

 

[secretwave101]

Why "protect" anything? There's standards that are set - to the victor goes the spoils. The best person, all things in the application considered, should get the spot. Who cares where they went to school?

What if the idea of spending the majority of your youth in schools in the same country is toxic to you? Why should your medical career be ruined just because you want to live and interact with other cultures...especially when you intend to practice in a nation of (largely) immigrants? Why can't someone go to a good school (as evidenced by all the hurdles you have to clear to even apply for residency) in a unique culture and still be considered "equal"? Why can't someone who CAME from a culture like this have an equal shot as well? Incidentally, as an FMG, I can say that of all the criticism I hear about Americans, the one that has the most strength is that we are horrendously ethnocentric. In general, I think they're right, and our stigmas associated with "outsiders" helps to continue the trend.

What are you all afraid of? If you're as dang good as you seem to think US students are by definition, there shouldn't be a problem. Or, is the arugment that "American students have paid their dues"? IMHO, making this claim makes you look like an idiot because it is so blatantly wrong. FMG's do more work to practice in this country than US students would possibly believe, even USFMG's. American students, from American med schools, with US citizenship, pay the LEAST in dues of any kind. The road is paved in gold by comparison.

I have to say, this "protect residency spots" talk smacks of racism, elitism and the feudalism that white America originally came from.

"Everybody knows the deal is rotten, old black Joe's still pickin' cotton..."
-Leonard Cohen (and Concrete Blonde)

 

[DireWolf]

To suggest that "protecting your own" is racist and elitist is false. This principle has persisted since the beginning of man. It is a very natural and innate survival mechanism.

1. Families protect their own (Ex. nepotism)
2. States and cities protect their own (Ex. tax breaks to companies in exchange for jobs)
3. Nationalities protect their own (Ex. Jews, Irish, Italians, Germans, etc. have all helped their own tremendously in this country)
4. Countries protect their own (Ex. tariffs that protect jobs)

5. Other countries protect their own medical students/physicians. Why do you think it can be so difficult for a U.S. MD to get a visa to practice overseas?

The concept of "protecting our own" medical students is neither new nor wrong. Does that mean we should prevent all FMGs from training/practicing in the U.S.? Of course not. There should always be room for well-qualified FMGs to participate in the U.S. health care system. However, we should always protect our own.

 

[VentdependenT]

Its match day. Who cares anymore.

 

[Winged Scapula]

Just my two cents (in brief)...

where does "protecting your own" stop? Hasn't this country always (with the exception of some Cubans and various other groups from time to time) accepted the huddled masses on its shores with open arms?

I guess I was lucky since my grandparents decided to come here decades ago. I doubt they were welcomed with open arms (what with a grossly obvious German surname at the time of WWII).

Just wondering why we're offered some sort of protection since my grandparents were either savvy, wealthy or just plain lucky enough to move here, when thousands of others - each year - make the same decision, just perhaps a little late.

Interesting topic and I'm glad to see it handled (so far) in a mature fashion.

 

[Fermi]

I don't think FMGs have been creating a problem for U.S. medical graduates. On the contrary, in the mid-60's to mid-70's, FMGs were the only immediate resource available to fill a need during the physician shortage. Their numbers were significantly cut down in 1976 by the Health Professions Educational Assistance Act, but that's another story. FMGs remain an integral part of graduate medical education, and for good reason--there are still more residency positions available than there are qualified U.S. medical graduates. Now, some may complain about FMGs taking the more competetive residency slots, but as someone posted above, to the victor go the spoils. They take the same exams as we do (actually more, as we don't yet take the Clinical Skills Exam). And it's not as if cost-cutting arguments against foreign labor apply, as everyone gets the same salary in residency.

Well, that's not completely true. FMGs may be cheaper because the U.S. and state governments don't have to subsidize their medical education as they do for U.S. medical schools, so there's no monetary risk there. So why wouldn't they rely even more on FMGs? There are ethical issues as well, as we are "taking away" the best and brightest from developing countries liek India and the Philippines. As you can see, there are many facets to this issue.

 

[Adapt]

Remember that the government pays for the funding of residency programs and this comes out of taxpayers' money. Americans pay for the programs and FMGs who don't pay receive all the benefits from it.

I really have no stance on the issue as FMGs do fill spots that go unfilled. The reality is though that as the article said, 75% of FMGs who do residencies here eventually practice here. They most likely will move to better places to practice after residency and I can see how this can saturate the supply of physicians.

As the article stated, I think there may be a concern in that aspect about the oversupply issue.

Also, if an FMG is picked over a US grad for certain spots, with all else being equal, I am not sure if that is right. The reason why I have second thoughts about it is FMGs don't pay taxes while the US grad did. Of course if the FMG came from the caribbean and was a US citizen that would be different.

I think the biggest argument anyone can make against letting a lot of foreign physicians in is that they don't pay taxes, and if they steal spots from American grads, and eventually cause the oversupply of physicians, I am not sure if that is good.

 

[Docxter]

Originally posted by Slickness

Remember that the government pays for the funding of residency programs and this comes out of taxpayers' money. Americans pay for the programs and FMGs who don't pay receive all the benefits from it.

And once the FMG resident is working as a residency, American taxpayers will benefit from his/her services and cheap labor and the FMG will be paying taxes like the rest of us.

Also, if an FMG is picked over a US grad for certain spots, with all else being equal, I am not sure if that is right.

It's not right and it almost never happens. If all things are equal or even mildly in favor of the FMG, the US grad will get the position hands down. That's how it should be and how it actually is.


I think the biggest argument anyone can make against letting a lot of foreign physicians in is that they don't pay taxes, and .. .

They pay taxes like everyone else when they're here!.

 

[Adapt]

Originally posted by Docxter

Originally posted by Slickness

Remember that the government pays for the funding of residency programs and this comes out of taxpayers' money. Americans pay for the programs and FMGs who don't pay receive all the benefits from it.

And once the FMG resident is working as a residency, American taxpayers will benefit from his/her services and cheap labor and the FMG will be paying taxes like the rest of us.

Also, if an FMG is picked over a US grad for certain spots, with all else being equal, I am not sure if that is right.

It's not right and it almost never happens. If all things are equal or even mildly in favor of the FMG, the US grad will get the position hands down. That's how it should be and how it actually is.


I think the biggest argument anyone can make against letting a lot of foreign physicians in is that they don't pay taxes, and .. .

They pay taxes like everyone else when they're here!.

Well if FMGs are not stealing spots from American grads than everything is fine. Somehow I don't believe that though since many American grads are trying to scramble while undoubtedly many FMGs have already matched. Yes it may be by specialty but to say that a FMG beating out an AMG ALMOST NEVER happens is just ludicrous. You have no support for that statement and you can't back it up.

I do agree that FMGs do pay taxes once they come and provide an invaluable service to their patients.

As the article stated though, 75% of FMGs after residency eventually stay here to practice. These FMGs who did their residency in undesirable places will probably move to more desirable places which may cause an oversupply in certain regions. I don't see how you could refute that.

After all, that's the point of this discussion isn't it? If FMGs are causing an oversupply of physicians in the US.

 

[secretwave101]

I also don't think it is true to say that, all things being equal, FMG's lose out to AMG's hands down. If it WERE true, I'd say that is wrong (or at least ignorant). However, all things are NEVER equal and no two applicants are ever the same.

I also think the "paying taxes" argument is weak. Americans pay taxes so that our health care system trains the best people for the job. It isn't so that Americans (99.9% of whom immigrated here at some point) can get the best jobs even if they aren't the best for them when compared against people who haven't yet immigrated. And as mentioned, once here, FMG's pay taxes just like everyone else.

If you're black, and you're better for the job, you should get it. If you're a woman, and you're better for the job, you should get it. If you're gay, and you're better for the job, you should get it. If you're from Chulaggi&*%%istan, and you're somehow better for the job, you should get it too.

If you're a white, male protestant American who lives on land that likely wasn't your's originally anyway...you shouldn't have the right to not compete against people who are different than you.

All this being said, it should be remembered that FMG's are rarely the best people for these jobs. There are so many intangibles, like communication skills and empathy gained by sharing common experiences (the American one, in this case) that make Americans intrinsically better qualified for American physician jobs the majority of the time. AMG's should rest in the comfortable thought that if they work hard on their grades and their character - they're probably going to be the best candidates for the majority of spots.

But this thread is about being entitled. And to cultivate this sense of entitlement because of one's nationality, or hard, hard work, or because of superior "intelligence" - is disgusting. It is, in fact, one thing that can quickly make an FMG more appealing than an AMG to a residency committee, I would think. Thus, some AMG's may be out of top jobs simply because they're jerks, not because there's too many FMG's in the match.

 

[MacGyver]

Originally posted by secretwave101
I also think the "paying taxes" argument is weak. Americans pay taxes so that our health care system trains the best people for the job. It isn't so that Americans (99.9% of whom immigrated here at some point) can get the best jobs even if they aren't the best for them when compared against people who haven't yet immigrated. And as mentioned, once here, FMG's pay taxes just like everyone else.

Uhh... thats faulty logic. Once they GET here, sure they pay taxes. Why does that erase the previous 20 years or so of not paying taxes?

then there's always the american IMG vs the truly foreign IMG. I think that the american IMG should be valued above the foreign IMG.

If you're black, and you're better for the job, you should get it. If you're a woman, and you're better for the job, you should get it. If you're gay, and you're better for the job, you should get it. If you're from Chulaggi&*%%istan, and you're somehow better for the job, you should get it too.

The primary duty of a national government is to protect its own citizens first and foremost. Thats the WHOLE PURPOSE AND BEING OF GOVERNMENT in the first place.

If you're a white, male protestant American who lives on land that likely wasn't your's originally anyway...you shouldn't have the right to not compete against people who are different than you.

What kind of BS logic is this? It has nothing to do with the fundamental DUTY of government to protect its own citizens first.

But this thread is about being entitled. And to cultivate this sense of entitlement because of one's nationality, or hard, hard work, or because of superior "intelligence" - is disgusting.

Show me ONE NATION THAT DOES NOT FAVOR ITS OWN CITIZENS.

JUST ONE.

Otherwise, please sit down and be quiet.

Federal govt has a DUTY to protect its own citizens first and foremost. Does that mean that all FMGs should be barred? No, but it does mean that there should be some protection for AMGs vs FMGs.

 

[tRmedic21]

Look, what's the avg age of a US medical student? MAYBE 25? I dunno, but it's not like we have a giant pool of med students who have all "paid their due" in taxes for 20 years, and now are reaping the benefits of their contribution to society. In fact, the vast majority of US medical students are in their low or mid twenties, have been in college since highschool, and have often held nothing more than a part-time job. These people have not been generous countributors to the American federal budget. So where does this argument come from?

I think it is a fallacious attempt to justify an entitlement mentality that US students need to be 'protected' from competition by 'outsiders' who are working their @$$3$ off to try to compete. As has been mentioned above, the playing field is level on paper, meaning the same tests, the same salaries, etc.

One thing that hasn't been addressed... what about the individual student's attitude, and/or personality? I'm not saying all US med students are arrogant, far from it, but if someone didn't match for a particular spot, then there's a reason behind it. If the numbers were equal, all things considered, and the FMG was chosen, then the PD had a damn good reason for it. Maybe they showed that they had a better work ethic, or personality traits. I have met many students, both US and foreign, and the fact is, there are some arrogant SOBs out there. There are people who may have blown away Steps I, II, and III that I wouldn't let put a suture in my dog.

As for USIMGs (that'll be me someday, I hope), I paid more in taxes than prolly 75% of the USGs who are in school right now, so where does that argument go? The American public pays taxes so that they can enjoy the benefit of services, one of those services being federally-funded residency programs. Now, I can see people wanting the federal gov't to use American products and labor when they are the best, but when American products fall behind the level of quality available from foreign products, then you are advocating the use of an inferior product simply because it puts money back into the American economy. While there is nothing wrong with supporting the American economy, we are talking about healthcare here. We're talking about people's lives, and when people's lives are at stake, accepting an inferior product to mantain brand loyalty (which is what we're really describing here, isn't it?) isn't acceptable. Students who haven't been draining the budgets of US education institutions for the last 20 years would actually be a better choice, from a strictly economic standpoint, wouldn't they? US students, by the time they get to residency, are many many thousands of dollars "in the red" as far as the monetary drain on society that their education has caused, while foreign students in general aren't, as they didn't attend US-funded institutions.

If a foreign grad is sub-par, then fine, they won't get the spot. But if I come in as a USIMG and blow away the USMLE, shine in my interviews, exhibit a good work ethic in my clinicals (w/subsequent stellar LORs), and generally impress, then why would you want to pick someone with mediocre numbers and/or a poor personal impression, just because they came from your alma mater? This is the kind of injustice people have railed about in the US med school admissions process for years! How many people had to apply multiple times and wait years for admission, while legacies with no personality were admitted through a revolving door?

Fair competition is what we're talking about. If US grads can't compete with foreign grads for residency spots (man, is this getting funny now ), then maybe they should learn to work harder, so as to outshine said foreign grads, who (according to so many) are inferior in some way or other?

 

[MacGyver]

Originally posted by Fermi
Now, some may complain about FMGs taking the more competetive residency slots, but as someone posted above, to the victor go the spoils.

The american taxpayers have invested a substantial amount of money training american medical students. AMGs deserve some favoritism over FMGs due to this, if nothing else.

Besides, 25% of FMGs go back to their home country, whereas for AMGs its damn near 100% that stay here. Thats yet another factor which suggests that AMGs are a better investment than FMGs.

They take the same exams as we do (actually more, as we don't yet take the Clinical Skills Exam). And it's not as if cost-cutting arguments against foreign labor apply, as everyone gets the same salary in residency.

Uhh.. thats not exactly accurate. Medicare reimburses FMG residency slots at a lower amount than AMGs. This is the way things should be.

Well, that's not completely true. FMGs may be cheaper because the U.S. and state governments don't have to subsidize their medical education as they do for U.S. medical schools, so there's no monetary risk there. So why wouldn't they rely even more on FMGs? [/qutoe]

Your logic here makes zero sense. Taxpayers have ALREADY invested those funds into AMGs, therefore they are a sunk cost and theres no way to get that money back. Given that, logic dictates that you should take measures to ensure that YOUR INVESTMENT ALREADY COMMITTED goes thru and that the AMGs practice medicine, preferably in their desired specialty.

There are ethical issues as well, as we are "taking away" the best and brightest from developing countries liek India and the Philippines. As you can see, there are many facets to this issue.

Nobody is "taking away" anything. IMGs WANT TO COME HERE, we dont force them here.

 

[Adapt]

After reading through the arguments, I have come to a few conclusions.

1. I think US FMGs and US grads should be considered equally when finding a residency, but non-US FMGs shouldn't be.

The argument of taxes is not a weak on. TRmedic, while it is true the average med student at 25 did not pay taxes, it is also true that their parents were paying taxes for the past 25 years and that should mean something. Non-US FMGs haven't paid taxes and neither have their parents.

2. The US should limit the amount of Non-US FMGs from coming in.

Why do you ask? Simple math. 75% of 6750 FMGs eventually stay to practice in the US or around 5,062. Of that number, only 17% are US citizens or 860. That leaves 4202 non-US FMGs practicing each year. I don't know about you, but I think that certainly will lower salaries and increase the competition to find physician jobs. This number must be limited and must not increase, but should decrease.

 

[MacGyver]

Originally posted by tRmedic21
Look, what's the avg age of a US medical student? MAYBE 25? I dunno, but it's not like we have a giant pool of med students who have all "paid their due" in taxes for 20 years and now are reaping the benefits of their contribution to society. In fact, the vast majority of US medical students are in their low or mid twenties, have been in college since highschool, and have often held nothing more than a part-time job. These people have not been generous countributors to the American federal budget. So where does this argument come from?

Its not just about the med student, its about their family which have been paying taxes for years.

I think it is a fallacious attempt to justify an entitlement mentality that US students need to be 'protected' from competition by 'outsiders' who are working their @$$3$ off to try to compete. As has been mentioned above, the playing field is level on paper, meaning the same tests, the same salaries, etc.

Do you apply that same critique to other nations, or just the US? Last time I looked, ALL NATIONS FAVOR THEIR OWN. I dont hear you complaining about how its hard for AMGs to practice medicine in England.

I'll say it again. The PRIMARY duty of government is to protect its own citizens first and foremost. Nobody is saying that all FMGs should be barred, but the US should look after its own first and worry about FMGs later.

One thing that hasn't been addressed... what about the individual student's attitude, and/or personality? I'm not saying all US med students are arrogant, far from it, but if someone didn't match for a particular spot, then there's a reason behind it.

Oh thats BS logic and you know it. Some residencies are very competitive and there are many "qualified" people that could have gotten the slot. It has very little to do with having a bad personality or attitude.

If the numbers were equal, all things considered, and the FMG was chosen, then the PD had a damn good reason for it. Maybe they showed that they had a better work ethic, or personality traits.

On an individual basis, I've got no problem with that. If there is an FMG who is clearly head and shoulders above the AMG applicants for the slot, then fine.

But thats a rather rare occurrence and you know it.

Unless there is a head and shoulders difference between the FMGs and AMGs, the AMGs should get the slot.

As for USIMGs (that'll be me someday, I hope), I paid more in taxes than prolly 75% of the USGs who are in school right now, so where does that argument go?

I already said that I think US IMGs should be given more preference than non-US IMGs.

But US IMGs should still be placed at lower priority than AMGs.

The American public pays taxes so that they can enjoy the benefit of services, one of those services being federally-funded residency programs. Now, I can see people wanting the federal gov't to use American products and labor when they are the best, but when American products fall behind the level of quality available from foreign products, then you are advocating the use of an inferior product simply because it puts money back into the American economy.

We favor AMGs in this system right now, and there is no evidnece that the doctor pool is "inferior" as a result. The few FMGs who are brilliant, can communicate in clear English with no heavy accent, and who shine on the boards have no problem getting a slot in teh US. I see no need to change the system such that the lower threshold FMGs can have a greater competing edge.

While there is nothing wrong with supporting the American economy, we are talking about healthcare here. We're talking about people's lives, and when people's lives are at stake, accepting an inferior product to mantain brand loyalty (which is what we're really describing here, isn't it?) isn't acceptable.[/qutoe]

Again, AMGs are currently favored over FMGs, and there is no evidence that healthcare quality is suffering as a result.

Do you know brilliant FMGs who are clearly heads and shoulders above AMGs who applied and couldnt get a residency slot? Thats a tremendously rare phenomenon.

Students who haven't been draining the budgets of US education institutions for the last 20 years would actually be a better choice, from a strictly economic standpoint, wouldn't they? US students, by the time they get to residency, are many many thousands of dollars "in the red" as far as the monetary drain on society that their education has caused, while foreign students in general aren't, as they didn't attend US-funded institutions.

Oh my god, this is teh 2nd time on this thread I've seen this idiotic logic.

Let me clear this up, once and for all.

The american taxpayers have ALREADY SUNK THE EDUCATION COSTS Of AMGs. There is NO WAY TO GET THOSE FUNDS BACK except to see to it that the AMGs enter residency (preferably in the specialty of their choice).

Your logic is that if we are -$20 in the hole, we should just give up, rather than try to recover that cost, especially when the risk of recovery is very, very low. What kind of BS is that?

This isnt a gambling scenario. Its EASY to recoup that cost if you give the AMG preference in residency matching.

If you choose the FMG, you are STILL -$20 in the hole. The BEST option is to give the AMG the residency slot, and recover that cost.

If a foreign grad is sub-par, then fine, they won't get the spot. But if I come in as a USIMG and blow away the USMLE, shine in my interviews, exhibit a good work ethic in my clinicals (w/subsequent stellar LORs), and generally impress, then why would you want to pick someone with mediocre numbers and/or a poor personal impression, just because they came from your alma mater?

Again, if you are CLEARLY heads and shoulders better than all the AMGs applying for the slot, then the slot should be yours.

Thats not a pervasive trend however. There is no evidence that massive numbers of FMGs who are heads and shoulders better than the AMG applicant pool are being denied slots.

This is the kind of injustice people have railed about in the US med school admissions process for years! How many people had to apply multiple times and wait years for admission, while legacies with no personality were admitted through a revolving door?

Injustice? You CHOSE to attend a foreign medical school. You agreed to take the benefits as well as the risks of such a decision. You should have thought about this before you made such a choice. When it comes down to AMGs vs FMGs, AMGs should be given the benefit of the doubt. That doesnt mean that AMGs should ALWAYS trump FMGs, or that FMGs should be barred.

Fair competition is what we're talking about. If US grads can't compete with foreign grads for residency spots (man, is this getting funny now ), then maybe they should learn to work harder, so as to outshine said foreign grads, who (according to so many) are inferior in some way or other?

Again, this is selective criticism of the US. IF all other nations on earth didnt favor their own citizens in terms of medical training, and it was truly ONLY the united states with these kinds of protections for their citizens, then you might have a point.

Otherwise, thats hardly what I would call "fair" competition. You want the US to play by a different set of rules that the other countries dont. You call that "fair"?

 

[tRmedic21]

see full post below

 

[Adapt]

Originally posted by tRmedic21
A quote from someone who truly does not give a damn that hundreds of thousands, possibly millions of US TAXPAYERS have to wait weeks to see a doctor, or go to the ER for a minor problem.

Look I wasn't directly insulting you, so I think it's only right you don't insult me. Of course "I give a damn" about the patients waiting to see doctors. That's one of the reasons why I want to be a doctor.

The question comes down to if there is an undersupply or oversupply of physicians. Your argument is based on the idea that there is an undersupply and if there is, then we should continue allowing the same amount of non-US FMGs in the US to meet the demand. If there is an oversupply, we should limit it. If you read the article, it alluded to the fact there is an oversupply of physicians.

 

[tRmedic21]

Originally posted by Slickness
TRmedic, while it is true the average med student at 25 did not pay taxes, it is also true that their parents were paying taxes for the past 25 years and that should mean something. Non-US FMGs haven't paid taxes and neither have their parents.

You didn't address the fact that these very same students have been IN the American educational system for 20+ years. If you wanna talk about strictly economics, then don't pick and choose those aspects that suit your argument and leave out all others. If you are an American medical student, your government has spent many, many thousands of dollars educating you, in spite of your college tuition (much of which was likely paid for by federally-funded shcolarships, grants, and/or loans). In fact, you've paid out-of-pocket for only a fraction of the cost of your own education. Ask any college administrator who spends all their time writing grant proposals, and begging for more federal and/or state funding. This more than makes up for the small percentage of their parents' (and probably grandparents') income tax that was earmarked for educational systems. If every blue-collar worker in this nation decided to go back to school, the admissions lines would be around the block, and the funding would run out the first month of the semester!

Originally posted by Slickness
75% of 6750 FMGs eventually stay to practice in the US or around 5,062. Of that number, only 17% are US citizens or 860. That leaves 4202 non-US FMGs practicing each year. I don't know about you, but I think that certainly will lower salaries and increase the competition to find physician jobs. This number must be limited and must not increase, but should decrease.

A quote from someone who truly does not seem to give a damn that hundreds of thousands, possibly millions of US TAXPAYERS have to wait weeks to see a doctor, or go to the ER for a minor problem. There is a shortage of physicians outside major metropolitan areas. I know this is true in my hometown, as well as hundreds or thousands of other towns across the US. The fact is, the US system isn't training enough docs to meet demand. Foreign grads, whether US-bred or otherwise are meeting that demand. If it weren't for the last 20 years of those thousands of FMGs filling those spots, what kind of healthcare crisis would we be dealing with right now?

If you want a better salary, then provide a better service, but consciously denying adequate access to healthcare for millions of Americans so people can line their pockets isn't just wrong, it's criminal.

When the number of physicians trained by the US system meets the demand of the US population, then maybe we can talk about limits. Anyone who claims there are too many physicians in America hasn't seen the things I've seen...

 

[tRmedic21]

When it times out, I never know if it posted or not.

<sigh>
I am not insulting you, I am merely addressing the fact that you don't think those many thousands of FMGs a year are serving a valuable purpose, they are just dragging your salary down. It's sad, really, there's too many people in medicine with the same exact philosophy... money seems more important than people these days.

 

[Adapt]

Originally posted by tRmedic21
You didn't address the fact that these very same students have been IN the American educational system for 20+ years....



A quote from someone who truly does not seem to give a damn that hundreds of thousands, possibly millions of US TAXPAYERS have to wait weeks to see a doctor, or go to the ER for a minor problem.

First, I don't know what you mean by how they were in the US educational system before. Many non-US foreign physicians came from other countries like Mexico, India, Vietnam, and so forth and were not US citizens.

I do understand non-US FMGs are filling a need and I think their contribution is very important.

I do care about patients and it is one of the reasons why I want to be a doctor. As I said in my previous post, the question comes down to whether there is an oversupply or undersupply of physicians in the US. The article I posted said there was an oversupply. Until the truth is found, then we could better discuss this issue.

 

[tRmedic21]

Originally posted by Slickness
First, I don't know what you mean by how they were in the US educational system before. Many non-US foreign physicians came from other countries like Mexico, India, Vietnam, and so forth and were not US citizens.

I do understand non-US FMGs are filling a need and I think their contribution is very important.

Haha! Then why would you want to limit their numbers? And the people I was referring to are USGs.... if you wanna say their parents paid taxes, even though they themselves didn't, then I say the cost of their education far outweighs the money contributed. Foreign docs who come into the US don't have that 'educational debt' to the country that needs to be paid back first, hence making them a more economically sound choice. Obviously, this is an extreme veiwpoint, made more to point out the ridiculousness of the whole monetary argument than something intended to be taken literally.

Again I would appreciate it if you don't resort to personal attacks. I do care about patients and it is one of the reasons why I want to be a doctor. As I said in my previous post, the question comes down to whether there is an oversupply or undersupply of physicians in the US. The article I posted said there was an oversupply. Until the truth is found, then we could better discuss this issue.

Gee, I'm sorry if I hurt your feelings by pointing out your apparent insensitivity to the urgent needs of millions of American citizens as opposed to the pocketbooks of an 'elite' few.

 

[Adapt]

Originally posted by tRmedic21
Gee, I'm sorry if I hurt your feelings by pointing out your apparent insensitivity to the urgent needs of millions of American citizens as opposed to the pocketbooks of an 'elite' few.

You are changing the issue. I am not insensitive to the patients. I am merely going by the article. Maybe, if you can present an article saying their is an undersupply of physicians and we need more non-US FMGs, then I would agree with your viewpoint.

Since I guess you probably didn't read the article, here's a quote...

"It is estimated that there will be an excess of approximately 165,000 specialist physicians in the United States in the year 2000.1,2 Consistent with these projections are anecdotal reports that physicians completing residency training in some specialties are having difficulty finding suitable professional opportunities and that the growth of managed care is adversely affecting established specialty practices in some regions.

There is no consensus on how to address the problem of an oversupply of physicians. At issue are conflicting views on the appropriate roles of government and the market in restricting the supply of specialist physicians. Analysts who see the current size and specialty mix of the physician work force as irrefutable evidence that the market has failed to correct the problem are convinced that the government must begin to regulate both the number of new physicians and their specialty choices. Other analysts, primarily members of the medical profession, are adamantly opposed to any form of government regulation of medical education. They believe that market forces will ultimately correct the oversupply of physicians."

This clearly describes a problem of oversupply of physicians which directly contradicts your inference that there is an undersupply. Could you show evidence that there indeed is an undersupply of physicians?

 

[tofurious]

1. THere is no question that USMGs deserve first look/favoritism/whatever. Besides, a large percentage of USMGs are better than USIMGs and nonUSIMGs. With or without protectionism, they will be on the top of everyone's list.

2. There are a small number of FMGs who are superior physicians or have received superb trainings. They would have been good anywhere, and they choose to come to the US for further training. These folks should get an open invitation to the US system as they will undoubtedly make the US medical system better.

3. The people left are now the people fighting for the same spots: subpar USMGs, average/subpar nonUSIMGs, and USIMGs. These are the spots that should be limited, not only to protect the job market of 1 and 2, but also to maintain a minimum quality of American medicine.

Too many people/arguments mix up 1 with subpar USMGs, and 2 with average/subpar nonUSIMGs. 1 and 2 are what WE WANT, and 3 is probably what many community hospitals need to keep their revenues going. People from category 2 are not here arguing about how unfairly they have been treated: they are packing up to move to Boston, SF, LA, NYC, Chicago to take up their rightful spots. As for USIMGs, the Carribean schools are in the same category as the US med schools ranked 100+. There are plenty of places for them, but they seem to want to go to places where the top USMGs are. I don't quite understand why it is that the subpar USMGs know where they have realistic chances at while USIMGs don't. Perhaps the salesmanship at these schools is just too good...

 

[tRmedic21]

I am not advocating just eating those lost dollars, I am saying if you wanna talk about it from a purely monetary standpoint, then those programs should never be instituted. All US med schools could close down and those tax dollars spend on better things, like research, etc, that other countries CAN'T do as well as we in the US can. If they can provide foreign docs at no cost to the US, wouldn't that make more sense? Of course! Will it happen? Of course not! And nor would I want it to! I am merely pointing out that money is a silly argument when you're talking about such important issues.

I am not saying that the current system is unfair. If an AMG and and FMG are equal in terms of skill, grades, etc... then sure, let the AMG have the spot. THAT COVERS YOUR "TAKE CARE OF OUR OWN" RHETORIC. But to require that one be 'head and shoulders' above the rest of the applicants implies a double standard, and that is what is wrong. If I am a better candidate than you, then I should get the job, period. And vice-versa. If I (as a foreign grad) am less qualified, then I wouldn't blame someone for not choosing me.

As far as injustice, you quoted me incompletely. I was speaking of someone less qualified getting a spot over someone more qualified because of nothing more than a pedigree. This is injustice, any way you smoke it.

One more thing....

It has very little to do with having a bad personality or attitude.

Haha! I think you need to take a look around you, there are plenty of people in the medical education system who have absolutely zero personality, both US and foreign. These people will still be doctors, by and large, but you are implying that the choice of AMG/USIMG/FMG is strictly based on a numbers game and that personality has nothing to do with it. This is obviously ridiculous.

 

[tRmedic21]

So then USIMGs and nonUSIMGs are fine, as long as they are content to take the leftovers, but don't try to shoot for anything better? lol Man, things get more elitist by the moment, don't they? lol

 

[tRmedic21]

If there is an oversupply of 165,000 specialists, then why are people still waiting months to get in to see them??? Why are physicians out there (both primary care and specialists) refusing to take new patients? Because their practices are full, that's why. Doesn't sound like an oversupply to me.... lol

As for not being able to find a job, I think far too many people are far too picky about where they live. A newly-accredited specialist who says, "I can't find a job!" may very well be ruling out anything in a city of less than 1 million or so. I have seen this again and again, people who say they won't work anywhere but Miami, NYC, or Cali. There are tons of places all over the country begging for physicians, both primary and specialty, but so many of them seem to love the big-city pace and won't look elsewhere.

Too bad, really, I think they're missing out on a lot.

 

[MacGyver]

Originally posted by tRmedic21
As far as injustice, you quoted me incompletely. I was speaking of someone less qualified getting a spot over someone more qualified because of nothing more than a pedigree. This is injustice, any way you smoke it.

First off, I dispute the notion that this is a common occurrence. I have yet to hear of vast numbers of superbly qualified FMGs being denied spots.

Governments do this all the time. Why the hell do you think that foreigners arent given teh same rights as citizens? According to your logic, this constitutes "injustice."

Its only injustice when people EQUALLY DESERVING of something are denied it based on faulty grounds. There is longstanding tradition that ALL GOVERNMENTS CONFER PROTECTIONS TO THEIR OWN CITIZENS THAT THEY DONT CONFER TO FOREIGNERS.

FMGs are NOT AS DESERVING AS american medical grads for residency slots in the united states. Thats like arguing that illegal aliens have just as much a right to vote as US citizens.

 

[tRmedic21]

I was speaking of the admissions process in American medical schools and the use of race as a reason to allow some students in, while more-qualified students of a different race are rejected. Or that fact that some whose daddy is an alumnus gets picked easily over someone who is a 1st-gen applicant that seems a better candidate.

Actually, I do NOT think non-US citizens should be privy to the same benefits as US citizens when they are illegal aliens. I also said that if all things are equal (scores, experience, personality, etc.) then an AMG>USIMG>FMG. Like I said before, that takes care of the "take care of our own" attitude. But to choose less-qualified US applicants over USIMGs/FMGs carries it too far, I think, and THIS is what I meant by diluting the pool of doctors, choosing someone less qualified for a position when lives are on the line. I think this happens all the time. You can look at dozens of posts on these fora where so many people seem to share your view that FMGs need to be "head and shoulders" above AMGs for the same spot, as evidenced by advice that FMGs need to score 10-20 points higher on Step exams for equivalent consideration of a position.

Of course, it's my opinion, but I think that's just wrong.

 

[MacGyver]

the system we have now works fine. We already take in almost 40% of medical residents as foreign-trained. Thats FAR MORE than any other nation.

Occassionally, a superior FMG will beat out AMGs for a coveted slot. But thats rare, and most times the FMGs have to go to undesirable locations and residencies.

FMGs have no right to complain, just as I have no right to complain that Europe puts protections against influxes of foreign doctors.

You can cry and whine all day long about how its supposedly not fair, but thats besides the point. The role of government is to protect its citizens first and foremost. Whether thats "fair" or not to foreigners is totally irrelevant.

 

[JPD]

where would the small number of foreign citizens from US MD/DO schools fall?

 

[coffeestat]

tRmedic 21,

Interestingly enough your argument for unhindered FMG entrance is the impact upon underserved areas. Being from such a designated locale and being in health care I seem to notice a different trend. The FMG grads come due to J1 visa requirements and serve the poor that others won't....untill the time limit is up and they make tracks to NY, LA, Chicago, etc.. However, it's usually the AMG who stays and add's to the community. Maybe the governmenal supplement and minimum pay scale requirements could be directed toward AMG's who may stay and stabilize said areas. As for USIMG, well I believe thats the risk you run. There is a tremendous investment in AMG schools, not to mention local economic impact. Other arguments of "brain drain" from other impoverished nations with no requirement for return have merit as well. In the end, we must guard against the balance of supply and demand. Untill we can get a precise measure, it makes it hard to take corrective actions.

 

[Lexmark]

One point to note - many IMG's don't have any loans to service. I think last year the US gave India $40M for health and education. So, when an Indian IMG comes over here they are depriving their own society of a much needed service that we might have already paid for with US taxes - perhaps unlikely, but possible.

Anyway, that IMG will effectively recieve a higher salary here, because they have no loan to service. Obviously, this doesn't apply to island grads.

 

[Apollyon]

Originally posted by Lexmark
So, when an Indian IMG comes over here they are depriving their own society of a much needed service

India graduates about 100K doctors per year; I asked a resident about the seemingly huge numbers of Indian docs coming to the US, and she said that it doesn't even put a dent in the numbers - at all.