US & Canada "selling" residency positions to Gulf countries

[ThreadMaker]

I wanted to ask about this practice in the US and Canada of "selling" residency positions to foreigners especially from rich gulf countries. I think Dalhousie medical school in Canada even sold 10 spots to saudis! Apparently this isn't limited to medical residency positions but even extends to medical school spots.

So how common is this practice? Are there any restrictions on this practice? For ex. do they have to go back home when they finish or are do they usually stay? Are the admission standards for such applicants weakened because of their financial situation (sort of like college athletes getting a easier time because of their athletic skills)? And how do they perform as residents?

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[shan564]

I think it's an oversimplification to say that these positions are being "sold." A foreign government is covering the cost of training an additional resident. In exchange, the host institution gets an extra resident without having to get funding from Medicare or pay for it themselves.

The "restrictions on this practice" would be that a program still has to meet ACGME requirements (or whatever the equivalent is in Canada). If they're taking a bunch of extra residents, they have to find the appropriate supervision, the appropriate rotations, etc. in order to maintain quality.

I think they have to go back home when they finish.

I don't know the answer about admission standards, but I'd imagine that they'd be lower, since the program is limited to a particular nationality. If the admission standards were higher, then people from that nationality would just go to any program elsewhere in the US/Canada.

I also don't know how they perform as residents, but given that they have their own source of funding, they probably perform well enough. If the hospital/Medicare doesn't have to pay for them, then they really only need to be good enough so that they don't make life more difficult for the rest of us.

Overall, I think that this is a win-win-win-win relationship. The host hospital and the North American health systems win because they get more doctors without having to pay for them. The "rich gulf country" wins because they get more Western-trained doctors and they only have to pay a meager amount by their standards. The residents win because they get more choices for their training. The citizens of the "rich gulf country" win because they theoretically get better-trained doctors.

Reading between the lines of the original post, I'm guessing that your concern is that by "selling" these residency spots to a particular country, there are fewer spots left over for the rest of us. I don't think that's a concern, since this financial relationship creates new spots that weren't previously there. It doesn't give away spots that already existed.

I googled the Dalhousie thing... it seems like they had some extra medical school (not residency) spots that they couldn't fill with Canadian students because the government hadn't funded enough student places to fill up the medical school after they created more seats by creating a satellite campus. So the choice was either to have a class that's smaller than their capacity, or create this relationship with Saudi Arabia. Or they could allow Canadian students to enter with full-fee-paying places rather than government-supported spots (like they do in Australia), but the Canadians don't seem to have any intention to do that.

 

[Substance]

I think it's an oversimplification to say that these positions are being "sold." A foreign government is covering the cost of training an additional resident. In exchange, the host institution gets an extra resident without having to get funding from Medicare or pay for it themselves.

The "restrictions on this practice" would be that a program still has to meet ACGME requirements (or whatever the equivalent is in Canada). If they're taking a bunch of extra residents, they have to find the appropriate supervision, the appropriate rotations, etc. in order to maintain quality.

I think they have to go back home when they finish.

I don't know the answer about admission standards, but I'd imagine that they'd be lower, since the program is limited to a particular nationality. If the admission standards were higher, then people from that nationality would just go to any program elsewhere in the US/Canada.

I also don't know how they perform as residents, but given that they have their own source of funding, they probably perform well enough. If the hospital/Medicare doesn't have to pay for them, then they really only need to be good enough so that they don't make life more difficult for the rest of us.

Overall, I think that this is a win-win-win-win relationship. The host hospital and the North American health systems win because they get more doctors without having to pay for them. The "rich gulf country" wins because they get more Western-trained doctors and they only have to pay a meager amount by their standards. The residents win because they get more choices for their training. The citizens of the "rich gulf country" win because they theoretically get better-trained doctors.

Reading between the lines of the original post, I'm guessing that your concern is that by "selling" these residency spots to a particular country, there are fewer spots left over for the rest of us. I don't think that's a concern, since this financial relationship creates new spots that weren't previously there. It doesn't give away spots that already existed.

I googled the Dalhousie thing... it seems like they had some extra medical school (not residency) spots that they couldn't fill with Canadian students because the government hadn't funded enough student places to fill up the medical school after they created more seats by creating a satellite campus. So the choice was either to have a class that's smaller than their capacity, or create this relationship with Saudi Arabia. Or they could allow Canadian students to enter with full-fee-paying places rather than government-supported spots (like they do in Australia), but the Canadians don't seem to have any intention to do that.

I'm a Canadian and I think that Saudi recruitment is a short-sighted strategy that benefits hospitals, governments, and Saudi Arabia, but not domestic residents or Canadians. Penny wise but pound foolish.

The Saudi residents are by and large competent and English-fluent in my experience, but the issue is that they are added to programs in addition to domestic residents, often without the infrastructure to support their training. This means that Saudi and domestic residents compete with each other for procedures, OR time etc. which worsens the training for both. And since its the Canadians that are the only ones sticking around to care for my little ol' grandparents, they're the only ones I care about right now.

Furthermore, I also see this as a double-standard. Plenty of Canadian medical students would love to pay full price to do a competitive residency like derm or plastics, but that opportunity is prohibited to them. Yet the Saudis are allowed to do exactly that. Same goes for those Dalhousie medical school spots and dumb albeit rich Carib IMGs.

 

[ams81]

I know a bunch of people that are sponsored from thier "Oil Rich Countries" including Saudi Arabia and Libya.

Yes the countries to sponsor them for higher education in the US. This includes many other fields besides medicine. I know more about the ones in the medical field. There are two ways for them be sponsored.

1. They get in on thier own, just like the rest of us, and thier country will then cut them a monthly stipend check to live here. Yes I know two guys that get a check from residency and also from thier country.
2. They get in threw a program that has an arrangment with thier country, and the fund alotted for thier education then goes directly to the program, and they get paid from the program threw that fund.

All of the ones that I have met are brilliant and competent. Some maybe rough on the edges because of language and customs, but most of them adapt very quickly.

I know a university surgery program here that takes a few of these IMGs every year. And from my discussion with the Chief of that program, they dont just take anybody, these guys are very competitive, and go above the criteria that is required to get in to the program. The problem is that these big name programs, rarely take IMGs, because that is thier policy, because they have obligations to thier own and nearby univesity graduates. And alot of these IMGs are insanely inteligent and dedicated, but because they are an IMG, their application will never even get looked at. A friend of mine who will be doing Neuro at Univ of Chicago, who happens to be very well published, told me that he interviewed at Wash U, because someone referred him. At that interview the PD was bascially trying to convince him that Wash U was the place for him, and told him that if it wasnt for the referal, she would have never even known about his application, and is so thankful she got to meet him. (PS this guy's country doesnt do this sponsor stuff)

So my point here is....alot of these guys are brilliant and dedicated, you can't just write them off.

Okay so how does this work. These IMGs are expected to return back to thier countries and to practice and improve thier health care systems. They do not go back to a meager salary, infact they get the same if not more, and in dollars because they are US trained, and to top if off thier lifestyle is quite chill compared to ours. If they do not go back, they are expected to pay back that money to thier country. So is it enforced not really, but bc of the moral obligation 95% of them go back. BUT...they will usually stay here, practice, or even continue work at a major academic unversity and also some will contribute back to thier respective specialty with research, and then after about 10 years (arbitrary number), they will go back to thier country, give back to them, and enjoy a very cushy life. Most of those freinds of mine are now doing fellowships, sponsored by their countries.

I think its pretty nice that countries want to send thier citizens to train with us. Programs are strapped for cash, and if they can find a way to make to increase thier budget by taking on an equally competitive resident, then why not

Yes I do wish I was able to pay up for the program, or fellowship of my choice. Yes it does suck that I am strapped for cash on my resident salary and some of my counter parts are living it up. Is it fair...prolly not, but thats just life. Some of them are actually pretty cool, and I have made a friendship that will last a lifetime, and I am priveledged to have met some of them.

 

[Substance]

I know a bunch of people that are sponsored from thier "Oil Rich Countries" including Saudi Arabia and Libya.

Yes the countries to sponsor them for higher education in the US. This includes many other fields besides medicine. I know more about the ones in the medical field. There are two ways for them be sponsored.

1. They get in on thier own, just like the rest of us, and thier country will then cut them a monthly stipend check to live here. Yes I know two guys that get a check from residency and also from thier country.
2. They get in threw a program that has an arrangment with thier country, and the fund alotted for thier education then goes directly to the program, and they get paid from the program threw that fund.

All of the ones that I have met are brilliant and competent. Some maybe rough on the edges because of language and customs, but most of them adapt very quickly.

I know a university surgery program here that takes a few of these IMGs every year. And from my discussion with the Chief of that program, they dont just take anybody, these guys are very competitive, and go above the criteria that is required to get in to the program. The problem is that these big name programs, rarely take IMGs, because that is thier policy, because they have obligations to thier own and nearby univesity graduates. And alot of these IMGs are insanely inteligent and dedicated, but because they are an IMG, their application will never even get looked at. A friend of mine who will be doing Neuro at Univ of Chicago, who happens to be very well published, told me that he interviewed at Wash U, because someone referred him. At that interview the PD was bascially trying to convince him that Wash U was the place for him, and told him that if it wasnt for the referal, she would have never even known about his application, and is so thankful she got to meet him. (PS this guy's country doesnt do this sponsor stuff)

So my point here is....alot of these guys are brilliant and dedicated, you can't just write them off.

Okay so how does this work. These IMGs are expected to return back to thier countries and to practice and improve thier health care systems. They do not go back to a meager salary, infact they get the same if not more, and in dollars because they are US trained, and to top if off thier lifestyle is quite chill compared to ours. If they do not go back, they are expected to pay back that money to thier country. So is it enforced not really, but bc of the moral obligation 95% of them go back. BUT...they will usually stay here, practice, or even continue work at a major academic unversity and also some will contribute back to thier respective specialty with research, and then after about 10 years (arbitrary number), they will go back to thier country, give back to them, and enjoy a very cushy life. Most of those freinds of mine are now doing fellowships, sponsored by their countries.

I think its pretty nice that countries want to send thier citizens to train with us. Programs are strapped for cash, and if they can find a way to make to increase thier budget by taking on an equally competitive resident, then why not

Yes I do wish I was able to pay up for the program, or fellowship of my choice. Yes it does suck that I am strapped for cash on my resident salary and some of my counter parts are living it up. Is it fair...prolly not, but thats just life. Some of them are actually pretty cool, and I have made a friendship that will last a lifetime, and I am priveledged to have met some of them.

I agree with what you are saying regarding the oil-rich residents being competent. However, diluting the current training pool's educational experience by whoring out spots to Saudi Arabia is not, in my opinion, an ethical move.

 

[gasthrowaway]

I wont mention the program but I know of one that just expanded 3 spots. Apparently the Saudis agreed to sponsor all three spots if they signed a contract to take at least 1 saudi each class. The person they take is apparently also obligated to return to saudi arabia after he completes his residency in america

 

[deleted109597]

I agree with what you are saying regarding the oil-rich residents being competent. However, diluting the current training pool's educational experience by whoring out spots to Saudi Arabia is not, in my opinion, an ethical move.

Consider that many places are already approved by the RRC for more slots than they currently have. Funding has been an issue for decades. This just gives an alternate method for funding.
The RRC still has to approve the number of slots, it's not like they're just adding positions to places already barely cutting the mustard for minimum procedures.

It is a slippery slope though.

 

[NotAProgDirector]

It is a slippery slope though.

One person's slippery slope is another person's ski hill. Where you sell lift tickets.

 

[deleted109597]

One person's slippery slope is another person's ski hill. Where you sell lift tickets.

I agree.

Wonder when the first court case from a rich family occurs since the precedent for $$$=residency slot has been established.

 

[dragonfly99]

Places to this for fellowship as well.
I trained somewhere for residency in IM and they had 1 guy from a Gulf country being sponsored by his country. He was a nice guy and I guess competent enough, from what I could see, but the fact remains that if this guy is in the cath lab, doing TEE procedures, etc. that is likely 1 less procedure for a US trained fellow, who will be staying her to care for patients, to be able to participate in. And it's possible that if the program wanted another fellow and had enough procedures and clinical volume to support on, they would have "found" the ability to take one on, even without the extra money from this guy's country, but it would have then been a US person. This was not some hospital that was struggling to get by in terms of finances - they/it has money - I'm not saying they for sure could have or would have taken another 1 US fellow, but I don't think it is for sure they would not have done so.

I don't think it is the fault of the foreign residents, but yes, I do think it is a slippery slope. And I also think that, although they may be fine/good, I doubt these foreign residents (or fellows) are necessarily better than some people who fell through the US match. Specialties like surgical specialties, cardiology, GI, etc. - you can be sure there are/were other qualified US applicants who could have used a spot - some hospitals may not/might not have had the $ to take them without foreign funded spots, but some of them might...but with getting "free" money from another country what is the incentive to take another US person when from the program's point of view the trainee is partly just a body to fill in a void and do work.