What do you AMGs REALLY think about IMGs?

[Nerve Gas]

I can stay, dont hate .

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[europeanIMG]

Ppl say over and over that it is important IMGs stay in the US after residency. Why? If I was an AMG only concerned about my own salary I would like all IMGs to return home after residency!

For America it is certainly good if we stay but AMGs lose money if we stay since we are ready to accept lower salaries in order to work in a nice location e.g. which of course drives down salaries.

And even if we don´t stay I still think it´s a good deal for American tax payers to get a doctor (though not a specialist) to work 80 hours a week for 50 K a year.

 

[tncekm]

Ppl say over and over that it is important IMGs stay in the US after residency. Why? If I was an AMG only concerned about my own salary I would like all IMGs to return home after residency!

For America it is certainly good if we stay but AMGs lose money if we stay since we are ready to accept lower salaries in order to work in a nice location e.g. which of course drives down salaries.

And even if we don´t stay I still think it´s a good deal for American tax payers to get a doctor (though not a specialist) to work 80 hours a week for 50 K a year.

I liked some of your previous stuff, but this is just stupid. It costs tons of money to train doctors, therefore it's bad when they leave after residency. Then you go on to say that the more indentured servitude we have here in the US -- not including specialists, of course-- the better.*sigh* And, again, although they're making $50k/yr, it costs MUCH more than that to train them.

 

[JeffLebowski]

True. Although if you think of residents in general as relatively cheap labor, the deal should still be fair. Anyhow, the large majority do stay.

Depends on who you think should benefit.

U.S. hospitals benefit from IMGs coming here to train, yes. Pretty much regardless of whether they stay or leave afterwards.

U.S. citizens benefit from IMGs coming here to train only if they stay to practice.

U.S. citizens get screwed if IMGs come here to train and leave afterwards.

 

[Nerve Gas]

Depends on who you think should benefit.

U.S. hospitals benefit from IMGs coming here to train, yes. Pretty much regardless of whether they stay or leave afterwards.

U.S. citizens benefit from IMGs coming here to train only if they stay to practice.

U.S. citizens get screwed if IMGs come here to train and leave afterwards.

I agree with you. And since the large majority of IMGs do stay here, you will agree that US citizens and hospitals benefit. That's why the qualified ones have their place in the system. If U.S. citizens & hospitals would not benefit from them, IMGs would have a much harder time to fit in.

 

[JelloBrain]

"Originally Posted by JeffLebowski
Depends on who you think should benefit.

U.S. hospitals benefit from IMGs coming here to train, yes. Pretty much regardless of whether they stay or leave afterwards.

U.S. citizens benefit from IMGs coming here to train only if they stay to practice.

U.S. citizens get screwed if IMGs come here to train and leave afterwards."

I agree with you. And since the large majority of IMGs do stay here, you will agree that US citizens and hospitals benefit. That's why the qualified ones have their place in the system. If U.S. citizens & hospitals would not benefit from them, IMGs would have a much harder time to fit in.

If US Hospitals and citizens all benefit from IMGs training and practicing in USA, then why not have a fair competition? Why can't programs pick the best person for the job?Why must IMGs endure such (unwritten and unsaid) discrimination?

 

[Obnoxious Dad]

We should discriminate because residency spots are paid for with US tax dollars. For every year of residency the cost is approximately $110,000. There is simply no reason to train foreign physicians here if we run out of residency spots and start denying residencies to US citizens.

As I stated in an earlier post we do not owe the world a thing when it comes to medical research. We have been carrying the world for the last 50 years.

Furthermore it is especially galling to hear people, who come from countries which have never been particularly friendly towards the U.S., whining that they can't get a US residency. It is also galling to hear this nonsense from foreigners who think that their health care systems are superior to ours. Stay home!

"If US Hospitals and citizens all benefit from IMGs training and practicing in USA, then why not have a fair competition? Why can't programs pick the best person for the job?Why must IMGs endure such (unwritten and unsaid) discrimination?[/QUOTE]

 

[Integrity]

We should discriminate because residency spots are paid for with US tax dollars.

Yeah, like that is the only option.

How about STOPPING financing residency spots with US tax dollars, and let hospitals COMPETE for doctors?

 

[Integrity]

Furthermore it is especially galling to hear people, who come from countries which have never been particularly friendly towards the U.S., whining that they can't get a US residency. It is also galling to hear this nonsense from foreigners who think that their health care systems are superior to ours. Stay home!

Exactly, every foreigner is personally responsible for anti-US sentiments in their population, and furthermore, every foreigner should at least be religiously praising all aspects of US foreign policy to be able to deliver impeccable health care.

It is also galling to hear this nonsense that you need to believe in the superiority of US health care in general for it to be legitimate wanting to work in the states.

 

[medicalgas]

I have been following this thread for the past few weeks. I must say it has opned up the situation and people have come out of their closets....all of which has been refreshingly candid.

For several years , the militant attitude of AMG towards IMG has been a product of their NINJA debt ridden debts which has left them extremely vile and protective.The whole situation has turned into a turf war ....''hell hath no fury like a vested interest masquerading as a moral principle''

The basis of American medical training is modelled on the indentured servitude of the 15th and 16th century. The 'I'll sell my mother for profit' attitude combined with 'sheeple' mentality has resulted in ....what you see as some of the vile and caustic comments which are seen on this forum.

Another explanation I can derive is from an example from the book 'freakonomic' ---on how the slaves and exiles in Siberian concentration camps , for fear of personal persecution would not only routinely carry on living under the cycle of bullying ; but they would also snitch on anyone who would not slog off like others.

Offcourse, the 'foreigners' who do not follow the party line or point out the obvious flaws in the system ---are not following the dictats of the Führer and need to chucked out.

 

[JeffLebowski]

I have been following this thread for the past few weeks. I must say it has opned up the situation and people have come out of their closets....all of which has been refreshingly candid.

For several years , the militant attitude of AMG towards IMG has been a product of their NINJA debt ridden debts which has left them extremely vile and protective.The whole situation has turned into a turf war ....''hell hath no fury like a vested interest masquerading as a moral principle''

The basis of American medical training is modelled on the indentured servitude of the 15th and 16th century. The 'I'll sell my mother for profit' attitude combined with 'sheeple' mentality has resulted in ....what you see as some of the vile and caustic comments which are seen on this forum.

Another explanation I can derive is from an example from the book 'freakonomic' ---on how the slaves and exiles in Siberian concentration camps , for fear of personal persecution would not only routinely carry on living under the cycle of bullying ; but they would also snitch on anyone who would not slog off like others.

Offcourse, the 'foreigners' who do not follow the party line or point out the obvious flaws in the system ---are not following the dictats of the Führer and need to chucked out.

Well answer this - why do you feel that the entire world should have open access to U.S. training spots? It bothers me that you feel absolutely ENTITLED to this extremely valuable U.S. resource. It bothers me further that you start calling us all greedy Nazis and slaves and sheep for wanting U.S. training spots to go to U.S. medical school grads.

 

[Nerve Gas]

Well answer this - why do you feel that the entire world should have open access to U.S. training spots? It bothers me that you feel absolutely ENTITLED to this extremely valuable U.S. resource. It bothers me further that you start calling us all greedy Nazis and slaves and sheep for wanting U.S. training spots to go to U.S. medical school grads.

I don't see how can anyone benefit from this discussion. I would say that nobody is entitled to any residency spot (I'm not discussing if AMGs/FMGs SHOULD be entitled or not, the fact is that nobody is). A residency program (hospital) is the employer and as such, they have the right to choose the best employee they can get. In most cases those are AMGs and some outstanding FMGs. Crappy programs take the best they can get - solid FMGs (as most AMGs and outstanding FMGs are not available to them). NO OFFENSE to anybody! Man, am I just saying obvious things...

 

[Nerve Gas]

We should discriminate because residency spots are paid for with US tax dollars. For every year of residency the cost is approximately $110,000. There is simply no reason to train foreign physicians here if we run out of residency spots and start denying residencies to US citizens.

As I stated in an earlier post we do not owe the world a thing when it comes to medical research. We have been carrying the world for the last 50 years.

Furthermore it is especially galling to hear people, who come from countries which have never been particularly friendly towards the U.S., whining that they can't get a US residency. It is also galling to hear this nonsense from foreigners who think that their health care systems are superior to ours. Stay home!

"If US Hospitals and citizens all benefit from IMGs training and practicing in USA, then why not have a fair competition? Why can't programs pick the best person for the job?Why must IMGs endure such (unwritten and unsaid) discrimination?

[/QUOTE]


You do make a point in the first paragraph, but you just don't give any RATIONALE for discrimination. See the post above. I think there is NO hospital that intentionally discriminates FMGs, because they would not benefit from discriminatig ANY applicant on ANY basis (school, nationality, gender, etc). If a hospital haven't had a single FMG for 100 years, does that tell you it discriminates? I don't think so. It tells you they thought AMG applicants (that applied to their program) were more qualifyied than FMGs (that applied to their program). Does anybody at least partially agree with me?

 

[Integrity]

Well answer this - why do you feel that the entire world should have open access to U.S. training spots? It bothers me that you feel absolutely ENTITLED to this extremely valuable U.S. resource.

He didn't say he was entitled to anything.

Why do people feel they should be allowed to work? Because work is a pivotal way of sustaining and giving meaning to one's life, and because they want to work.

Why do people believe they should have open access to markets? Because they increase the potential of finding a sweet spot to make a living, because the economy in general benefits from allocating jobs to those able to do it at a higher quality and for a lower price, and I dunno, because a European might meet someone American, and think of starting a family over there and such? Who knows?.

What people do not support mobility of workforce? Turf protectors. Why are you forced to become turf protectors? Because someone managed to make residency mandatory to practice as a doctor, resulting in the need to pay huge amounts to be educated in the US (when you could have done it cheaper elsewhere, without majoring in some unrelated bs subject first) and the need to work in the US, as there is no other place on earth allowing you to work off your huge debt like in the US.

It is a self-reciprocating system of slavery. And there is no other profession in the US allowed such a protected atmosphere.

 

[Crazy Diamond]

Excuse my assumptive notion ..Is integrity and Obnoxious Dad the same person... the style of writing is the same .. I don't know I might be wrong... does anyone notice this?

 

[Integrity]

Excuse my assumptive notion ..Is integrity and Obnoxious Dad the same person... the style of writing is the same .. I don't know I might be wrong... does anyone notice this?

If both me and obnoxious dad are banned, then you were right. If only I am banned, then you were wrong, but cunningly so. If you can't win the argument, throw in the allegations.

 

[medicalgas]

He didn't say he was entitled to anything.

Why do people feel they should be allowed to work? Because work is a pivotal way of sustaining and giving meaning to one's life, and because they want to work.

Why do people believe they should have open access to markets? Because they increase the potential of finding a sweet spot to make a living, because the economy in general benefits from allocating jobs to those able to do it at a higher quality and for a lower price, and I dunno, because a European might meet someone American, and think of starting a family over there and such? Who knows?.

What people do not support mobility of workforce? Turf protectors. Why are you forced to become turf protectors? Because someone managed to make residency mandatory to practice as a doctor, resulting in the need to pay huge amounts to be educated in the US (when you could have done it cheaper elsewhere, without majoring in some unrelated bs subject first) and the need to work in the US, as there is no other place on earth allowing you to work off your huge debt like in the US.

It is a self-reciprocating system of slavery. And there is no other profession in the US allowed such a protected atmosphere.

So. atleast one thing is clear. The opposition to FMGs is not based on their perceived lack of english, communication skills or their alleged mediocre medical knowledge. The opposition is not for the sake of patients or namesake of medical profession...................the one and only reason is the competition for jobs based in America.

Also , as painful as it may be to acknowledge, US has a lot to learn from Europe w.r.t worker rights. In absence of a potent and 'non toothless' resident unions in USA, working till you drop becomes a norm and standard operating protocol; despite the fact that you have bought the most over priced medical education. It is this degree bought on credit loans which act as the driving force for the pro-protectionist approach to jobs.

As far as the argumemt for American tax payer dollars going to foreigners----just to remind the readers , in the big scheme of things........can I remind that amount is trivial and akin to the proverbial piss in the ocean, in comprison to the monies spent on sponsoring American stooge regimes across the world, money spent for saving the banking cartels, not to mention the 'wars' to win the hearts and minds of people.

It has amazed me why exactly do the US hospitals even bother to pay residents, I mean , the cartels that they are, they can even make a case for asking for fees for doing the residency!!Within few years it will beome the norm and people questioning could be labelled as lacking commitment and passion for their work.!!! Residents could always get more loans for slogging off for the duration of residency and come back to work force/markets with an even more enthusiasm ( read vangeance) to make a killing while billing.

 

[142348]

Obviously this is an arguement that will never end...AMG's like myself are entrenched in set of beliefs and FMGs/IMG's entrenched in theirs. However, I think that a few points that have been made need to be clarified:

1. Unilateral movement- The US apparently should be an open door to any graduate but the recipricating relationship is lacking. US graduates would find it difficult to find residencies in the majority of countries where FMG's immigrate from. While EuropeanIMG points to the fact that there are FMG's in his country another consideration has to be loans. While FMG's like coming to this country because the compensation is fairly good for trainees, the contrary can't be said and therefore, AMG's would be at a deficit.

2. There is an obvious notion that the LCME accredits US/Canadian med schools, certifying that they are reputable institutions providing medical knowledge in an approved manner. The same can't be said for FMG/IMG schools. Shouldn't hospitals in this United States pay credence to an accreditation by a national organization and show preference to LCME schools ensuring that all students that matriculate through the approved curriculum be seated in a residency?

I figure this arguement will go on until the powers that be take action one way or the other. My guess is that over the next 5 years, competition will increase as the number of graduates increases and spots stay stagnant. Eventually enough AMG's will be left out of residency and something drastic will happen. What that magic number is, I have no idea.

 

[Integrity]

Obviously this is an arguement that will never end...AMG's like myself are entrenched in set of beliefs and FMGs/IMG's entrenched in theirs.

There are facts and there are preferences. Then there are attempts to skew facts to fit with one's own preferences. And then slap morality on top of it, to feign some extra entitlement.

1. Unilateral movement- The US apparently should be an open door to any graduate but the recipricating relationship is lacking. US graduates would find it difficult to find residencies in the majority of countries where FMG's immigrate from. While EuropeanIMG points to the fact that there are FMG's in his country another consideration has to be loans. While FMG's like coming to this country because the compensation is fairly good for trainees, the contrary can't be said and therefore, AMG's would be at a deficit.

This is true.

However, opening up would make it possible for Americans to become IMGs themselves, reduce the total amount of debt, and avoid doing undergrad studies to enter med school, thereby increasing length of training and expenses, while still being able to return to the American market.

The miserable situation with debt and slavery in residency should be pretty obvious. While I agree that CURRENT med school graduates have all reason to fight IMGs, future med school hopefuls don't and patients don't.

2. There is an obvious notion that the LCME accredits US/Canadian med schools, certifying that they are reputable institutions providing medical knowledge in an approved manner. The same can't be said for FMG/IMG schools. Shouldn't hospitals in this United States pay credence to an accreditation by a national organization and show preference to LCME schools ensuring that all students that matriculate through the approved curriculum be seated in a residency?

Why?

I figure this arguement will go on until the powers that be take action one way or the other. My guess is that over the next 5 years, competition will increase as the number of graduates increases and spots stay stagnant. Eventually enough AMG's will be left out of residency and something drastic will happen. What that magic number is, I have no idea.

I am pretty sure that the road ahead is more regulation, not deregulation. This is because those who lose out due to the current system aren't heard, and the AMGs have already graduated full of debt, so they have no interest in freeing up the market. The public in general are clueless, and believe obamacare is the only solution to have medicine affordable.

 

[JelloBrain]

Obviously this is an arguement that will never end...AMG's like myself are entrenched in set of beliefs and FMGs/IMG's entrenched in theirs. However, I think that a few points that have been made need to be clarified:

1. Unilateral movement- The US apparently should be an open door to any graduate but the recipricating relationship is lacking. US graduates would find it difficult to find residencies in the majority of countries where FMG's immigrate from. While EuropeanIMG points to the fact that there are FMG's in his country another consideration has to be loans. While FMG's like coming to this country because the compensation is fairly good for trainees, the contrary can't be said and therefore, AMG's would be at a deficit.

2. There is an obvious notion that the LCME accredits US/Canadian med schools, certifying that they are reputable institutions providing medical knowledge in an approved manner. The same can't be said for FMG/IMG schools. Shouldn't hospitals in this United States pay credence to an accreditation by a national organization and show preference to LCME schools ensuring that all students that matriculate through the approved curriculum be seated in a residency?

I figure this arguement will go on until the powers that be take action one way or the other. My guess is that over the next 5 years, competition will increase as the number of graduates increases and spots stay stagnant. Eventually enough AMG's will be left out of residency and something drastic will happen. What that magic number is, I have no idea.

Just want to reply to the bolded parts:

1. US grads would face the same amount of difficulty any foreign grads would face when applying for residency in a foreign land, as they would be the FMGs/IMGs in this case.

2. US compensation for trainees is comparable at least to UK NHS System (where I trained). I just checked their current rates-Starting base salary for Year 1 is $42,000.00 in today's exchange rate. When I left UK for a research fellowship in US in 2006, I was earning about £56,000.00 (= to $85k today) as a trainee. Take home pay was approximately £3,500.00 per month (= to $5,371.00 in today's rates). As a postdoc now, and as a future US resident I (will) make way less than that-My take home pay is barely $2,000.00 now.

US compensation is only good once you finish training and set up a practice-your earnings rise exponentially, but the same is not true in UK. In India (where I am from) again trainee pay is poor, but your earning rises greatly once you are set up in practice.

3.All institutes of medical education have to be approved by WHO which sets the international standards. Once a school has been approved by WHO, there is no reason for anyone to question its reputation. ECFMG also does an extremely thorough job of verifying candidates' credentials so once someone has been through these hoops, then they should be judged on their scores and achievements, not where they originated from!

When US schools consider all other countries' medical education inferior to their own but still find that some IMGs/FMGs have performed exceedingly well on their exams (the one common denominator), that should be proof that these candidates would prove to be some of the best out there for the job and give them a fair chance via interview invites. If during the interview they find that accent/language/cultural barriers cannot be overcome, then don't rank them, otherwise give IMGs as fair a chance as any AMG out there.

 

[142348]

Just want to reply to the bolded parts:

1. US grads would face the same amount of difficulty any foreign grads would face when applying for residency in a foreign land, as they would be the FMGs/IMGs in this case.

The ability is significantly hampered in other countries compared to the US as the number of available spots is limited.

2. US compensation for trainees is comparable at least to UK NHS System (where I trained). I just checked their current rates-Starting base salary for Year 1 is $42,000.00 in today's exchange rate. When I left UK for a research fellowship in US in 2006, I was earning about £56,000.00 (= to $85k today) as a trainee. Take home pay was approximately £3,500.00 per month (= to $5,371.00 in today's rates). As a postdoc now, and as a future US resident I (will) make way less than that-My take home pay is barely $2,000.00 now.

US compensation is only good once you finish training and set up a practice-your earnings rise exponentially, but the same is not true in UK. In India (where I am from) again trainee pay is poor, but your earning rises greatly once you are set up in practice.

The problem is this: in the UK the time to get through the system and the pay afterwards are a significant detriment in the repayment of loans. Talking to a few friends who trained in India and came to the US for residency, they said on their salaries in India it would have been nearly impossible to make the monthly loan payments we pay and live.

3.All institutes of medical education have to be approved by WHO which sets the international standards. Once a school has been approved by WHO, there is no reason for anyone to question its reputation. ECFMG also does an extremely thorough job of verifying candidates' credentials so once someone has been through these hoops, then they should be judged on their scores and achievements, not where they originated from!

When US schools consider all other countries' medical education inferior to their own but still find that some IMGs/FMGs have performed exceedingly well on their exams (the one common denominator), that should be proof that these candidates would prove to be some of the best out there for the job and give them a fair chance via interview invites. If during the interview they find that accent/language/cultural barriers cannot be overcome, then don't rank them, otherwise give IMGs as fair a chance as any AMG out there.

While WHO is a reputable institution, we all know that medical education is not all the same. Many medical schools around the world, including India, have spots that can be purchased and many have reputations that allow for bribes for passing grades among WHO approved schools. Further, while FMG/IMG use the USMLE as their litmus test you must realize that the 99 the FMG score needs to be taken with a grain of salt: How long did they study for the test, was their education guided to taking a test rather than treating patients. A lot of people could get a 99 on the USMLE if they focused solely on studying for the USMLE for a long time. this does not mean they should all be doctors. The LCME is the governing body of the US/Canada and holds more weight than WHO in this case.

 

[medicalgas]

Better pay in USA as a resident!!!

You Gotta be kidding. Are you delirious. On an per hour rate, the residents are the LEAST paid employee in the entire hospital. That includes, janitors, dinner ladies and what not.

You make more money after graduation!!!!
Once again a myth, a con. And off course any decent wage seems 'raking in' to anyone who has never seen better times. Adjusted for 5 years of resident slavery, you never recover a good 5-8% of your working at a bare minimal pittance. Also FMGs are tunnelled in( to get the work visa processed) small hill billy towns or areas where any decent sane person would never want to live otherwise.

 

[JelloBrain]

While WHO is a reputable institution, we all know that medical education is not all the same. Many medical schools around the world, including India, have spots that can be purchased and many have reputations that allow for bribes for passing grades among WHO approved schools. Further, while FMG/IMG use the USMLE as their litmus test you must realize that the 99 the FMG score needs to be taken with a grain of salt: How long did they study for the test, was their education guided to taking a test rather than treating patients. A lot of people could get a 99 on the USMLE if they focused solely on studying for the USMLE for a long time. this does not mean they should all be doctors. The LCME is the governing body of the US/Canada and holds more weight than WHO in this case.

I don't think medical schools that allow seats to be purchased are accredited anywhere (AFAIK). USMLE scores are used as the main criterion even by selection committees. Otherwise you wouldn't have an automatic cut-off of 220 (or whatever) at various programs. Rightly or wrongly, the Step 1 is the first yardstick measured and compared. The only students whose education is guided solely on taking the USMLE might be the US born kids who went to Caribbean medical schools. Neither in India nor in UK (the two countries I can talk about) is any teaching geared towards taking USMLEs. Due to the governance of LCME/ACGME, whatever, IMGs don't get credit for previous training, and have to start from the ground up.

However you look at it, they are discriminated against even after they jump through all hoops. That is the truth whether you accept it or not. Otherwise ECFMG would not allow so many IMGs to take the test. Only as many spots available after all AMGs are accounted for should be open for IMGs from the very outset-If 25000 residency spots are there and 22000 AMGs, then only 3000 IMGs should be allowed to apply via ERAS. It is not right to take their money cycle after cycle and give them an unfair chance.

 

[NotAProgDirector]

All institutes of medical education have to be approved by WHO which sets the international standards. Once a school has been approved by WHO, there is no reason for anyone to question its reputation.

This statement is not exactly true. The WHO does not "approve" schools. They simply list schools who are approved in their home countries. If a country has a very lax system that allows anyone to open a medical school, it will be listed by WHO. There is no quality control, other than what each individual country decides to implement.

So, in a nutshell, WHO listing doesn't really imply much.

 

[JelloBrain]

This statement is not exactly true. The WHO does not "approve" schools. They simply list schools who are approved in their home countries. If a country has a very lax system that allows anyone to open a medical school, it will be listed by WHO. There is no quality control, other than what each individual country decides to implement.

So, in a nutshell, WHO listing doesn't really imply much.

I didn't know that, thanks for clarifying. I assumed that if a school is on WHO list, it meets international standards. But am I correct in assuming every country's accredition body would be responsible for maintaining some standards set by and acceptable to WHO? I mean surely if I want to open a medical school in my backyard, no one would approve it, so it won't make the WHO list. Please let me know if I am right.

 

[gutonc]

I didn't know that, thanks for clarifying. I assumed that if a school is on WHO list, it meets international standards. But am I correct in assuming every country's accredition body would be responsible for maintaining some standards set by and acceptable to WHO? I mean surely if I want to open a medical school in my backyard, no one would approve it, so it won't make the WHO list. Please let me know if I am right.

There are no international standards for medical schools. The WHO's sole requirement for listing a school in its database is that it meets whatever standards the nation it is located in sets for it. That's it.

So, as far as the WHO is concerned, Columbia, UCSF, Johns Hopkins, "ECOLE NATIONALE DE MEDECINE DU MALI (the only medical school in Mali) and Pyongyang Medical University in North Korea are equivalent.

If you can get some sort of 4th world dictatorship to take over your backyard and approve the med school you set up in the shed where your Dad keeps the lawnmower and his weed stash, then yes, the WHO would approve it.

 

[JelloBrain]

If you can get some sort of 4th world dictatorship to take over your backyard and approve the med school you set up in the shed where your Dad keeps the lawnmower and his weed stash, then yes, the WHO would approve it.

Now all I have to do is find a 4th world dictatorship, find a backyard with a shed (a dad with a lawnmower and weed would be an added attraction, ), and viola! I will be the dean of my own school.

No more AMG/IMG residency issues to worry about,

PS: In case someone thinks otherwise, I have a wonderful dad but not the kind you mentioned.

 

[Speculatrix]

I didn't know that, thanks for clarifying. I assumed that if a school is on WHO list, it meets international standards. But am I correct in assuming every country's accredition body would be responsible for maintaining some standards set by and acceptable to WHO? I mean surely if I want to open a medical school in my backyard, no one would approve it, so it won't make the WHO list. Please let me know if I am right.

You are incorrect. There is a huge financial incentive for the governments of Caribbean countries to "approve" medical schools. You can pretty much open a medical school in your backyard (in Aruba of course) if you have some money - often these schools are nothing more than a few rooms in a Caribbean strip mall with some microscopes, "professors" who are washouts from the rest of the world.

Furthermore, what's even more telling is that medical graduates from many Caribbean schools often can't even practice in those same Caribbean nations. I believe that this is due to a difference between "accrediting" an educational institution and actually licensing its graduates. I don't think those Caribbean governments are that foolish.

 

[JelloBrain]

Thanks Speculatrix. Seems a sad state of affairs that financial incentives would be the major driving force when health and welfare is concerned. I am just going to go back into my own Utopian world and stay there.

 

[medicalgas]

You are incorrect. There is a huge financial incentive for the governments of Caribbean countries to "approve" medical schools. You can pretty much open a medical school in your backyard (in Aruba of course) if you have some money - often these schools are nothing more than a few rooms in a Caribbean strip mall with some microscopes, "professors" who are washouts from the rest of the world.

Furthermore, what's even more telling is that medical graduates from many Caribbean schools often can't even practice in those same Caribbean nations. I believe that this is due to a difference between "accrediting" an educational institution and actually licensing its graduates. I don't think those Caribbean governments are that foolish.

And what about ''ground breaking, phenomenal, best in the world, ranked No 1'' private US universities. They have brochures which could be mistaken for entertainment and theme parks and websites which seem a page taken from a life insurance company's brochure.

Like real estate, money thrown in unquestioned for just about any amount of annual tution fees for these universities is another tip of the credit crunch ponzi pyramid scheme.

A ten minutes google search will show you even the best of so called ivy league univesities thrive on a haze and mirage created by marketing and spin hype.There is no single--authority which can be described as THE accredition council of North American Universities.

Leave aside medicine, even the Harvard Business school had a chastizing review by BBC in a recent documentary in which the institution was mocked for being found with her pants down ---in the midst of the fact that the some of the biggest key players in business and finance responsible for credit crunch were all Harvard Business School Grads.

It all boils down to supply and demand in the end. If competition for patients gets even more nasty , I wont be surprised that physicians from one state will lobby to prevent their encashment turfs being utilized from out of state physicians. If you are scoffing at that hypothetcal scenario--please note that is exactly how it happens between different provinces in Canada!!!

 

[Speculatrix]

And what about ''ground breaking, phenomenal, best in the world, ranked No 1'' private US universities. They have brochures which could be mistaken for entertainment and theme parks and websites which seem a page taken from a life insurance company's brochure.

Like real estate, money thrown in unquestioned for just about any amount of annual tution fees for these universities is another tip of the credit crunch ponzi pyramid scheme.

A ten minutes google search will show you even the best of so called ivy league univesities thrive on a haze and mirage created by marketing and spin hype.There is no single--authority which can be described as THE accredition council of North American Universities.

Leave aside medicine, even the Harvard Business school had a chastizing review by BBC in a recent documentary in which the institution was mocked for being found with her pants down ---in the midst of the fact that the some of the biggest key players in business and finance responsible for credit crunch were all Harvard Business School Grads.

It all boils down to supply and demand in the end. If competition for patients gets even more nasty , I wont be surprised that physicians from one state will lobby to prevent their encashment turfs being utilized from out of state physicians. If you are scoffing at that hypothetcal scenario--please note that is exactly how it happens between different provinces in Canada!!!

This is a clear example of a red herring.

 

[Integrity]

What's the big deal? Any douche can learn medicine from british medical journal - best practice and emedicine, + by downloading the basic books, as long as you have a job opportunity allowing for a gradual introduction to work requirements. Just like anyone educated in, I dunno - chemical engineering, often needs some new training to properly work in a special environment? Just shape the USMLE to be as clinically relevant as possible, and dump all the irrelevant stuff. Who cares what the core structure of a virus is, or what the blasts are called that start angiogenesis. What matters is: can u tell whether it is asthma or copd exacerbation, and do you know how to work your steps to discover that it is vasculitis instead? Shape the tests for clinically relevant theory, learn the clinical work at work, and study at home, in aruba, in siberia, wherever.

 

[lipomas]

Another explanation I can derive is from an example from the book 'freakonomic' ---on how the slaves and exiles in Siberian concentration camps , for fear of personal persecution would not only routinely carry on living under the cycle of bullying ; but they would also snitch on anyone who would not slog off like others.

Offcourse, the 'foreigners' who do not follow the party line or point out the obvious flaws in the system ---are not following the dictats of the Führer and need to chucked out.

Did it really take until post #210 to get to a Nazi reference in this thread? You folks are slipping!

 

[Rabbit Hole]

Another explanation I can derive is from an example from the book 'freakonomic' ---on how the slaves and exiles in Siberian concentration camps , for fear of personal persecution would not only routinely carry on living under the cycle of bullying ; but they would also snitch on anyone who would not slog off like others.

Offcourse, the 'foreigners' who do not follow the party line or point out the obvious flaws in the system ---are not following the dictats of theFührer and need to chucked out.

Did it really take until post #210 to get to a Nazi reference in this thread? You folks are slipping!

Godwin's Law:
"As an online discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches 1."

 

[FreakofMeds]

This my friend is somewhat flawed thinking. Just because you studied for USMLEs for a year and scored a 250 doesn't mean you are more qualified than an AMG. We only get 6-8 weeks to study for the exam, some times even less. You even admitted in your post that America provides better opportunities for training, and AMGs are products of this system, hence more qualified by default to work in this system.

Sorry, but AMGs don't study 6-8 weeks. You study for two years for Step1. Your entire system is geared towards passing Step 1. Your courses teach you all the ins and outs of Step 1. After two years of doing that, you take 6-8 weeks of just reviewing what you had already studied for.

IMGs on the other hand mostly study for Step 1 after they graduate, and many years after they had completed their last basic sciences course. Let alone the fact that their courses are quite different than those AMGs receive, and most definitely not geared towards passing Step 1.

So to give the impression that an average AMG could achieve in few weeks what an average IMG could achieve in a few months because they are inherently more capable is misleading. I'd like to see some average AMGs attempting to pass licensing exams in India or the middle east (where the exams are provided in English) in 6-8 weeks.

Otherwise regarding the topic, I completely agree that AMGs should have the priority in all fields. But having 5% of the positions in the most competitive fields filled by exceptional IMGs, even if those positions were sought after by "lesser" AMGs (and by lesser I don't mean just scores, but a package of scores, publications, character, dedication, etc) should not be banned.

 

[Speculatrix]

Sorry, but AMGs don't study 6-8 weeks. You study for two years for Step1. Your entire system is geared towards passing Step 1. Your courses teach you all the ins and outs of Step 1. After two years of doing that, you take 6-8 weeks of just reviewing what you had already studied for.

IMGs on the other hand mostly study for Step 1 after they graduate, and many years after they had completed their last basic sciences course. Let alone the fact that their courses are quite different than those AMGs receive, and most definitely not geared towards passing Step 1.

So to give the impression that an average AMG could achieve in few weeks what an average IMG could achieve in a few months because they are inherently more capable is misleading. I'd like to see some average AMGs attempting to pass licensing exams in India or the middle east (where the exams are provided in English) in 6-8 weeks.

Otherwise regarding the topic, I completely agree that AMGs should have the priority in all fields. But having 5% of the positions in the most competitive fields filled by exceptional IMGs, even if those positions were sought after by "lesser" AMGs (and by lesser I don't mean just scores, but a package of scores, publications, character, dedication, etc) should not be banned.

Fortunately, you're wrong. No LCME school "teaches to the boards" and every dean of every American medical school will vigorously defend this. We are forced to learn to "think like the boards" on our own, with the same study materials available to foreign graduates. I wish I had a 2 year course in the "ins and outs of step 1". That is simply not the case. You are likely thinking of Caribbean schools where teaching to the boards is the standard, and perhaps some selected schools like Rosalind Franklin.

The 5% quota is also a terrible idea. People who are already all-stars in other countries with extensive publications and research often find a way to shine and get residencies here - I have seen this in competitive fields like dermatology and radiology. Nevertheless, any formal quota would only disenfranchise American seniors who may not necessarily have had time to buff up their full application portfolio to the level of a foreigner with that extra time.

 

[FreakofMeds]

Fortunately, you're wrong. No LCME school "teaches to the boards" and every dean of every American medical school will vigorously defend this. We are forced to learn to "think like the boards" on our own, with the same study materials available to foreign graduates. I wish I had a 2 year course in the "ins and outs of step 1". That is simply not the case. You are likely thinking of Caribbean schools where teaching to the boards is the standard, and perhaps some selected schools like Rosalind Franklin.

The 5% quota is also a terrible idea. People who are already all-stars in other countries with extensive publications and research often find a way to shine and get residencies here - I have seen this in competitive fields like dermatology and radiology. Nevertheless, any formal quota would only disenfranchise American seniors who may not necessarily have had time to buff up their full application portfolio to the level of a foreigner with that extra time.

Denying that US medical schools cater to MLEs is like denying Caribbean schools cater to cash. Both are false.

Additionally, I have never suggested any quota. Read my post again. I am simply commenting on the current statistics. According to NRMP around less than 10% of Non-US seniors match into competitive specialties. That is including older US graduates and IMGs. Those statistics look reasonable to me and I don't see why some people wish to change the way NRMP works (except for abolishing prematches, which I agree with).

If someone suggests that regardless of the quality of the AMG vs the quality of the IMG, the AMG should always take precedent in competetive specialties, then essentially the competitive specialties will be comprised entirely of AMGs, which I think would be a loss for those specialties.

 

[Speculatrix]

Denying that US medical schools cater to MLEs is like denying Caribbean schools cater to cash. Both are false.

Additionally, I have never suggested any quota. Read my post again. I am simply commenting on the current statistics. According to NRMP around less than 10% of Non-US seniors match into competitive specialties. That is including older US graduates and IMGs. Those statistics look reasonable to me and I don't see why some people wish to change the way NRMP works (except for abolishing prematches, which I agree with).

If someone suggests that regardless of the quality of the AMG vs the quality of the IMG, the AMG should always take precedent in competetive specialties, then essentially the competitive specialties will be comprised entirely of AMGs, which I think would be a loss for those specialties.

You are an IMG. What would you know about my American medical education? Zilch. For example, many of my lectures about microbiology were regarding the latest (abstruse) research into viral genomics. I had essay-style questions on my exams. Biochemistry was a blur of the organic chemistry of sphingolipidoses. If you take any reputable LCME school and poll students (or even look at the Allopathic forums), you'll see people worried about Step 1, because it's nothing like what the first two years of school were like. I had to completely retrain my mindset to adjust to the boards. Fortunately there were things like USMLEWORLD to help out. "School studying" and "boards studying" were two completely different entities in my head when step 1 was looming.

Also, there is no hard and fast rule that programs will take the AMG over the IMG (except at programs which don't interview IMG's). There are cases, especially at the top 10 programs, where program directors will take the exceptionally qualified IMG applicant over the AMG.

 

[Eta Carinae]

Denying that US medical schools cater to MLEs is like denying Caribbean schools cater to cash. Both are false.

You've attended a US Med school? or otherwise have evidence of this?

 

[Eta Carinae]

then essentially the competitive specialties will be comprised entirely of AMGs, which I think would be a loss for those specialties.

Again, you have evidence of this?

 

[Captopril]

At the end of the day, all a PD/Hospital cares about is who can treat patients. All of the AMG/IMG bulls*** aside, if I'm a PD, I'm hiring an applicant who is an absolute machine regardless of what his entitlement issues are. I could give a **** if he went to school at Harvard or some place in India, or about his debt situation. I need a dude who will be on point day in and day out for the 3-4 years I have him, then he can **** off to wherever he wants.

 

[Rokitansky]

You are an IMG. What would you know about my American medical education? Zilch. For example, many of my lectures about microbiology were regarding the latest (abstruse) research into viral genomics. I had essay-style questions on my exams. Biochemistry was a blur of the organic chemistry of sphingolipidoses. If you take any reputable LCME school and poll students (or even look at the Allopathic forums), you'll see people worried about Step 1, because it's nothing like what the first two years of school were like. I had to completely retrain my mindset to adjust to the boards. Fortunately there were things like USMLEWORLD to help out. "School studying" and "boards studying" were two completely different entities in my head when step 1 was looming.

Also, there is no hard and fast rule that programs will take the AMG over the IMG (except at programs which don't interview IMG's). There are cases, especially at the top 10 programs, where program directors will take the exceptionally qualified IMG applicant over the AMG.

You cannot have it both ways. You make grand pronouncements about the quality, content and scope of education in other schools, which you have not attended (e.g. Caribbean), without even the hint of self-doubt, and yet you do not allow anyone to make any inferences about US schools. (Those demanding logically sound, intellectually rigorous and cogent arguments of others should hold themselves to similar standards.)

Looking more broadly on the topics that have been raised in this thread, the following points stick out.

1. US taxpayer funding of residencies is often brought up as a powerful argument against allowing foreign-trained doctors to compete with AMGs. However, this argument is never retracted when discussing US citizen IMGs, who themselves and whose families are these very same US taxpayers funding residencies. This certainly reeks of bias - not simply against "foreigners", but against anything not "iso-" or, at the very least, "allo-" to the AMG "self". If people were perhaps a little more introspective and honest with themselves, they might recognize that the greatest motivator of their dislike for FMGs/IMGs is self-interest.

2. Costs of educating and training AMGs are not disclosed here in totem. If we are, as some people have attempted, to frame the argument against FMG/IMGs in terms of costs/benefits to the US taxpayer, we must honestly view the entire financial picture. A majority (how large, I do not have the time to research at the moment) of medical students pay for their education with funds borrowed from the US taxpayer. The interest on these loans, until very recently, was quite low, which made the loans a less than optimal investment for the taxpayer (better returns could be attained through most other investment vehicles). Furthermore, many of these students begin medical school with previous federal loans from their undergraduate years. During the years that these students are in school, most of their loans accrue no interest. If we view this in strictly financial terms, the US taxpayer is losing a lot of money funding US citizens through undergrad and med school.

By contrast, an FMG arrives in the United States having cost the US taxpayer nothing up to that point, begins working as a resident, providing services and paying taxes on all of his earnings, from day one. Yes, his salary and training are subsidized by the US taxpayer, but the US taxpayer is certainly getting something in return immediately. Although I do not have the statistics to back this up at the moment (I invite anyone to find relevant statistics to prove or disprove this), I think it is safe to assume, for a variety of reasons, that the vast majority of FMGs seeking residency positions in the US, do so with the express aim of remaining in the US throughout the rest of their professional lives, continuing to provide services and paying taxes.

Therefore, if we follow and complete the economic arguments made here by earlier posters, we may discover that FMGs are the more sound financial choice for the US taxpayer. Let us be careful, or we may start digging our own graves!

So far the points I have made have been an exercise in rational and honest discourse on my part. Here is the point that reflects my personal feelings on the subject.

3. The rampant and escalating attempts by mid-levels to usurp the position of a trained medical doctor throughout the US health care system should be uniting physicians AMG/IMG/FMGs, who have spent years of their lives learning and internalizing the science and art of medicine (NOT the philosophy of nursing, or the algorithms of assisting), to stand shoulder to shoulder in defense of their profession. If we do not address the real, or perceived, physician shortage by allowing trained and competent physicians to enter residency and practice in the US, we are de facto surrendering our profession to mid-levels.

My grandparents, in their 80s, are currently under the care of a superbly competent FMG. Their previous 2 doctors, over the last 10 years, were an AMG who moved away and a DO who retired. It will be a very cold day in h-ll before I allow a mid-level to supervise their care. My parents are currently in good health and need minimal medical attention. However, I certainly hope that there will be enough physicians, AMG or IMG or FMG, to care for them as they get older. I am afraid that this may not be the case if we continue in-fighting and pushing FMG/IMG physicians out.

A final side note regarding AMG children of FMG/IMG parents vehemently arguing against allowing current FMG/IMGs access to residencies in the US. I hope you realize that the very reason you are an AMG, the very source of your current position of privilege, is the opportunity that was afforded to your FMG/IMG parents when they arrived in the US. I hope you can have enough intellectual honesty and integrity to take a step back and realize that your staunch opposition to affording the same opportunity to the future children (no less special than you) of current FMGs (no less deserving than your parents) is ethically indefensible. IMHO, the "I got mine and screw the rest" position is morally hollow, to put it mildly.

 

[sugardad]

Fortunately, you're wrong. No LCME school "teaches to the boards" and every dean of every American medical school will vigorously defend this. We are forced to learn to "think like the boards" on our own, with the same study materials available to foreign graduates. I wish I had a 2 year course in the "ins and outs of step 1". That is simply not the case. You are likely thinking of Caribbean schools where teaching to the boards is the standard, and perhaps some selected schools like Rosalind Franklin.

My school certainly does. In fact it seems that the entire curriculum comes straight from BRS and First Aid (not that there is anything wrong with that).

 

[JVMD]

who cares, NPs are going to rule the world anyway

 

[Speculatrix]

You cannot have it both ways. You make grand pronouncements about the quality, content and scope of education in other schools, which you have not attended (e.g. Caribbean), without even the hint of self-doubt, and yet you do not allow anyone to make any inferences about US schools. (Those demanding logically sound, intellectually rigorous and cogent arguments of others should hold themselves to similar standards.)

Without addressing the rest of your wholly specious (well, frankly ridiculous) arguments (you claim that it's more beneficial for the US taxpayer to widen our trade deficit and send its citizens off to other countries to be educated, then return to our country as residents, hence "saving a quick buck"?! the "rationalization" self-defense mechanism is pretty obvious)...

I do want to say that US schools are set to a standard. If you know anything about ACGME site visits for residency programs and how that makes administrators quake in their feet, you can appreciate that the LCME conducts similarly oriented site visits on all American schools. They are held to an objective standard and there is a gigantic set of goals, objectives and requirements that have to be met during both preclinical and the clerkship years. There are no standards for Caribbean schools. Schools in other countries train physicians for their own countries, and hence would be reasonably expected to set their own bar for their students. (I think this explains why the state of California has made certain Caribbean school graduates personae non gratae for licensing... compared to people trained in, say, Bolivia). Your diploma mill is accountable and set to no standard. It is simply a conduit for people to take USMLE Step 1, then move on to rotations at community hospitals with widely-varying standards for teaching and curricula. I can most definitely "have it both ways", because I know that US schools have standards and ones in the Caribbean do not.

 

[jdh71]

Without addressing the rest of your wholly specious (well, frankly ridiculous) arguments (you claim that it's more beneficial for the US taxpayer to widen our trade deficit and send its citizens off to other countries to be educated, then return to our country as residents, hence "saving a quick buck"?! the "rationalization" self-defense mechanism is pretty obvious)...

I do want to say that US schools are set to a standard. If you know anything about ACGME site visits for residency programs and how that makes administrators quake in their feet, you can appreciate that the LCME conducts similarly oriented site visits on all American schools. They are held to an objective standard and there is a gigantic set of goals, objectives and requirements that have to be met during both preclinical and the clerkship years. There are no standards for Caribbean schools. Schools in other countries train physicians for their own countries, and hence would be reasonably expected to set their own bar for their students. (I think this explains why the state of California has made certain Caribbean school graduates personae non gratae for licensing... compared to people trained in, say, Bolivia). Your diploma mill is accountable and set to no standard. It is simply a conduit for people to take USMLE Step 1, then move on to rotations at community hospitals with widely-varying standards for teaching and curricula. I can most definitely "have it both ways", because I know that US schools have standards and ones in the Caribbean do not.

 

[thedrjojo]

Wow, it has been a while since I posted on this thread (page 1, maybe 2) but it hasn't gone much of anywhere.

Anyone who supports a true free market (tea baggers) and anyone crying about Obamacare (also tea baggers...) should be sick at the thought of putting any sort of limits on the residency market and forcing FMG/IMG's out. The converse is not necessarily true (those that want socialism or love obamacare) should not necessarily support AMG only policies.

I think AMG's shouldn't be the only ones allowed to dance, but I can understand why PD/Residencies give preferrential opinions/rankings to AMG's over FMG's (due to socialization/immigration status/language issues, as well as some deficiancies in education/standards) and AMG's over US IMG's (due to deficiances in education standards/experiences and a track record of being less qualified applicants when applying for medical school - the perceived 'why'd they have to go to the caribbean for med school?' mentality that has some validity to it). These are generalizations and clearly there are exceptions in these circumstances, and don't agree with programs that refuse to interview or consider non AMG's, but don't feel too sorry about and FMG/US IMG whose only selling point is a high USMLE score (which was not designed for its current use and in 2013 is being phased out into a different test format).

And for the argument that residencies cost tax payers money, there have also been many conversations on whether residents are a financial burden or boom for hospitals, I believe that residents actually bring much more value to the hospital considering they'd each have to be replaced with 2 PA's, eaching making more for 40hrs/wk + overtime, attendings would have to be paid more because they'd have to put in more time too, etc...

 

[Eta Carinae]

Originally Posted by Rokitansky
You cannot have it both ways. You make grand pronouncements about the quality, content and scope of education in other schools, which you have not attended (e.g. Caribbean), without even the hint of self-doubt, and yet you do not allow anyone to make any inferences about US schools. (Those demanding logically sound, intellectually rigorous and cogent arguments of others should hold themselves to similar standards.)

Without addressing the rest of your wholly specious (well, frankly ridiculous) arguments (you claim that it's more beneficial for the US taxpayer to widen our trade deficit and send its citizens off to other countries to be educated, then return to our country as residents, hence "saving a quick buck"?! the "rationalization" self-defense mechanism is pretty obvious)...

I do want to say that US schools are set to a standard. If you know anything about ACGME site visits for residency programs and how that makes administrators quake in their feet, you can appreciate that the LCME conducts similarly oriented site visits on all American schools. They are held to an objective standard and there is a gigantic set of goals, objectives and requirements that have to be met during both preclinical and the clerkship years. There are no standards for Caribbean schools. Schools in other countries train physicians for their own countries, and hence would be reasonably expected to set their own bar for their students. (I think this explains why the state of California has made certain Caribbean school graduates personae non gratae for licensing... compared to people trained in, say, Bolivia). Your diploma mill is accountable and set to no standard. It is simply a conduit for people to take USMLE Step 1, then move on to rotations at community hospitals with widely-varying standards for teaching and curricula. I can most definitely "have it both ways", because I know that US schools have standards and ones in the Caribbean do not.

Tell 'em, spec!

 

[142348]

A final side note regarding AMG children of FMG/IMG parents vehemently arguing against allowing current FMG/IMGs access to residencies in the US. I hope you realize that the very reason you are an AMG, the very source of your current position of privilege, is the opportunity that was afforded to your FMG/IMG parents when they arrived in the US. I hope you can have enough intellectual honesty and integrity to take a step back and realize that your staunch opposition to affording the same opportunity to the future children (no less special than you) of current FMGs (no less deserving than your parents) is ethically indefensible. IMHO, the "I got mine and screw the rest" position is morally hollow, to put it mildly.

You're cry of this being ethically indefinsible is ridiculous. As a AMG child of FMG parents let me give you a little perspective. My parents came to this country 35 years ago. At that time, there was a shortage of physicians, and the number of residency positions outnumbered the number of American graduates. My parents, and the many FMG's accepted at that time, were not accepted out of the generosity of this country but because they served a purpose. WIth the number of US graduates approaching the number of US residencies I don't see that need being there anymore. So it's not "I got mine and screw the rest" but simply put a need was present and is no longer.

 

[Rokitansky]

Without addressing the rest of your wholly specious (well, frankly ridiculous) arguments (you claim that it's more beneficial for the US taxpayer to widen our trade deficit and send its citizens off to other countries to be educated, then return to our country as residents, hence "saving a quick buck"?! the "rationalization" self-defense mechanism is pretty obvious)...

First, by dismissing the arguments in my post with a couple of cheap adjectives you have simply underscored the fact that you do not have logical counter-arguments. Nowhere in my post did I claim that it would be beneficial to widen our trade deficit nor did I advocate for sending our citizens to other countries to be educated. I merely took the arguments made by others and followed them to a logical conclusion.

I do want to say that US schools are set to a standard. If you know anything about ACGME site visits for residency programs and how that makes administrators quake in their feet, you can appreciate that the LCME conducts similarly oriented site visits on all American schools. They are held to an objective standard and there is a gigantic set of goals, objectives and requirements that have to be met during both preclinical and the clerkship years. There are no standards for Caribbean schools. Schools in other countries train physicians for their own countries, and hence would be reasonably expected to set their own bar for their students. (I think this explains why the state of California has made certain Caribbean school graduates personae non gratae for licensing... compared to people trained in, say, Bolivia). Your diploma mill is accountable and set to no standard. It is simply a conduit for people to take USMLE Step 1, then move on to rotations at community hospitals with widely-varying standards for teaching and curricula. I can most definitely "have it both ways", because I know that US schools have standards and ones in the Caribbean do not.

You swung very hard and yet missed the point entirely. I was not making a comparison between US schools and any other schools (so your rant about ACGME site visits, California and the Caribbean was completely off topic). Nor did I claim to have data about other schools (even US schools, other than my own). I was pointing out the massive fallacy in a previous poster's argument, who claimed that someone who does not attend a US school cannot make statements about US schools, while he/she freely made judgments about schools in other countries without ever having attended them. Not only did you not stop to evaluate the logical flaw in the "I say so therefore it must be true, but what you say cannot be true because you are not allowed to say it" argument, but you proudly upheld it in your own post. Generalizations are manifestations of intellectual laziness. We need data and specifics. Since you appear to be convinced that your opinions are the absolute and immutable truth, I presume you have some data to back up those opinions, and I would love to see your references. Let us begin with the Caribbean schools. Kindly list links or citations that provide evidence of lack of standards and accreditation for each of the schools in the Caribbean (my cursory review tells me that there are at least a half dozen, not including LCME-accredited schools in Puerto Rico).

One last thing, you seem to think that I own or attend (not sure what you meant by "Your diploma mill") a medical school inferior to yours. My LCME-accredited allopathic school is ranked in the top 5 in the US, so the probability that you are attending a higher ranked school is fairly low. Can we step off our high horses now or should we compare the sizes of our appendages first?