http://www.rockymountainnews.com/drmn/state/article/0,1299,DRMN_21_2625257,00.html
Proposal irks doctors
Measure would give foreign physicians at CU a break
By Bill Scanlon, Rocky Mountain News
February 3, 2004
Several Denver doctors and hospital officials are bristling over a bill that would give foreign doctors teaching at the University of Colorado up to five years before they have to pass a basic science test.
They say it's unfair to single out academic teaching hospitals for the waiver and that five years is too long to wait to make sure a doctor knows the science.
But CU officials say a five-year window is essential if they are to lure top teaching doctors from Europe and elsewhere and not lose the recruiting battle to other American medical schools.
They say the doctors they seek are experts in their specialties, but often are in mid-career and may have trouble on a test covering basic science that has changed so much since their medical school days.
The controversy highlights the reliance Colorado places on foreign doctors, not just at CU, but also at rural hospitals.
The CU Health Sciences Center employs five foreign doctors to teach medical students and residents, said spokeswoman Sarah Ellis. In the past five years, some 25 foreign doctors have taught at University Hospital or CU's affiliates: Denver Health Medical Center and Denver's Children's Hospital.
Colorado's strapped rural hospitals, which can't offer the salaries that urban and suburban hospitals can to U.S.-trained doctors, often recruit doctors right out of foreign medical schools.
Colorado's Board of Medical Examiners doesn't keep track of the number of licenses given to foreign doctors, said director Susan Miller.
The bill, which moved rapidly through the Senate and now is being considered by the House, would change from two years to five years the time foreign doctors at academic hospitals can apply to stay without passing the test.
The bill's Senate sponsor, Dan Grossman, a Democrat from Denver, said the change would enable Colorado to compete with other states to recruit top foreign physicians.
He said he limited the bill to academic hospitals because he doesn't want to encourage foreign doctors to come here to practice medicine. Instead, he wants to make sure the CU School of Medicine can recruit foreign doctors to teach specialties that aren't being taught by American doctors.
One of the reasons CU wants the bill involves Children's Hospital's highly recruited head of cardiology, Dr. Francois LaCour-Gayet of France, who will have been here two years in July.
"This is a factor in his case," said Dr. Moritz Ziegler, surgeon-in-chief at Children's Hospital.
Asked if LaCour-Gayet had taken and or passed the test, Children's spokesman Rachel Robinson would say only that "Dr. LaCour-Gayet is an active participant in the licensing test."
LaCour-Gayet deferred to Ziegler for comment on this story.
Ziegler called the hiring of LaCour-Gayet, who earns $750,000 a year, a huge coup for Colorado.
"The recruitment of (Dr. LaCour-Gayet) has changed the face and level and skill of cardiac surgery available to Colorado's children," Ziegler said.
Ziegler said Colorado faces substantial shortages in the areas of radiology, heart surgery, neurosurgery and anesthesiology, among other specialties.
"This bill tries to say that for a variety of good reasons - language barriers, time between basic science training and clinical training - there should be some flexibility to the exam process," Ziegler said. "Every hospital would still have a rigorous credentialing process."
Doctors describe the U.S. Medical Licensing Exam as difficult, especially the first of the three parts that deals with basic science.
Last year, 91 percent of U.S. medical school graduates and 64 percent of those from countries other than the U.S. or Canada passed the basic science test on their first try, according to the National Board of Medical Examiners.
Of those who had to take it a second time, 64 percent of those from U.S. schools passed, while just 36 percent of those from foreign schools passed.
But Dr. Roger Barkin, a pediatric emergency room specialist at Rose Medical Center, said the bill isn't fair. He said many foreign physicians who work in Colorado have had to complete the Board of Medical Examiners' test before they start working.
"Why should we have an inequity between physicians who work in the academic setting and those that work in other settings?" he asked.
CU School of Medicine Dean Richard Krugman said recruiting is a particular problem for academic hospitals because other hospitals are raiding their doctors by offering more money. CU and other academic hospitals can't match the compensation packages offered by private or nonprofit hospitals, he said.
"On the other hand, there are highly qualified people at medical schools in the United Kingdom, Europe and other parts of the world who would love to come to our institution," Krugman said.
Krugman said CU's competition for those doctors isn't hospitals, but medical schools in other states. Six states are considering extending the window up to five years, or already have done so, Krugman said.
Krugman said that after 14 years as dean, he's not sure he could jump right back into pediatrics practice, but is still in top form in his specialty area, child abuse work.
"The basic science I learned 40 years ago has changed. We don't ask physicians in their 40s to retake the basic science exam every five years. We ask that they keep up in their specialties. The hurdle is the basic science exam. Two years is too short a time."
Most of Colorado's hospitals also have shortages in certain disciplines and try to recruit foreign physicians on occasion, said Linda Kanamine, spokeswoman for Health One.
"We get no grace period. Before they can practice, they have to pass state licensure," she said.
