What makes US MDs think they're superior?

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H

Hypochondriac

I've been reading up on IMG topics lately and am under the impression that lots and lots of people think that the US MDs are somehow "superior" to IMGs (be it from the UK, Ireland, Oz, NZ..etc.). I mean, that may only be true if you intend to practise medicine in the US.

If given the chance to study at a Caribbean school or to study at a top British school like Oxford, Cambridge, Edinburgh, or even Birmingham and Bristol, would you still consider Carib. schools???

We should all realise that the entire American medical education was founded by British-trained (or more precisely, Edinburgh-trained) doctors. British medical education has existed for well over 500 years (even longer for Universities like Oxford). The USA wasn't even a nation back then!!!!

US MDs, please wake up.

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This argument is similar to trying to show the little rich kid the error of his ways. Pointless and you will fail anyway ;)

You're wrong anyway hypochondriac, everyone knows that in US med schools they teach you secret stuff (like the Colonel's spicey recipe) that only people who practice 'American medicine' would understand. God I love that term.. American medicine. I think it pretty much sums up the whole American attitude ;)
 
Hmm...can you elaborate on what you meant by "secret recipe"? Do you mean American-trained doctors possess skills that their counterparts don't??
 
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it was a joke.

BTW speaking of clinical skills, someo f the best out there are taught by the british; I had the pleasure on some rotations there.

If you are seriously asking the question though, the answer is this: human nature. Everyone needs to feel better about others in someway. Case in point: look at IMGs who dump on other IMG schools with more of a sense of superiority than you'll find from most US allo students to IMGs. But I suspect you really know the answer to your own question.
 
Ign'ance.

As an existentialist, I wouldn't personally consider anything human nature per se, but this is probably just a difference with stephew in semantics.

On ignorance of quality of foreign schools/training:
http://forums.studentdoctor.net/showthread.php?s=&threadid=79668

On ignorance of individual reasons for foreign school/training:
http://forums.studentdoctor.net/showthread.php?s=&threadid=79848

On ignorance of individual reasons for IMG MD over US DO:
http://forums.studentdoctor.net/showthread.php?s=&threadid=86788

On ignorance of foreign med degrees:
http://forums.studentdoctor.net/showthread.php?s=&threadid=87057

-pitman
 
Dude, England just won the world series....no way!!!
 
Hypoc. wrote:
If given the chance to study at a Caribbean school or to study at a top British school like Oxford, Cambridge, Edinburgh, or even Birmingham and Bristol, would you still consider Carib. schools???

I wasn't aware of the fact that Oxford Uni offered medicine??
 
Singh - check out study.medicine.ox.ac.uk to find out about Oxford's med school.
 
In my experience, there are American MD's that would tell you they can beat Michael Jordan in a game of 1 on 1 if you asked them, many American DO's would do the same. It has nothing to do with any real belief that our brand of medicine is better than any other civilized western European country, it's just the arrogant psyche of the average American medical professional. Does this mean they are bad people? Hell no, most are wonderful people, it just means that we have a chip on our shoulder, and rightfully so, look at what we do for a living. Look at the siginificance of the role we play in so many people's lives. I'm sure doctors have the same chip in Britain. Hell, I completely admit that I have a little bit of arrogance and a chip on my shoulder.... I love it! I love what I do, and I would do anything for my patients.
So for the record, it's more of an attitude than a reality... our brand of medicine and our training is no better than most western euopean countries. But think before you criticize the psyche of American physicians or Americans in general... in my experience the British are just as arrogant, and we all know about the French.
So let's all get together and do what's right. Let's pick on those jerks up north --the Canadiens.
 
Again my "objective" experience..I had an American housemate this term and I just think its the country that makes them think this way....quote:

"Wow, they actually have X-ray machines and other fancy stuff at the hospitals?" <==WTF??

IN response to my prompt that for a western nation america has a surprisingly high number of uninsured ppl.

"But I thought that if you were American you have a right to go to whatever hospital you want, and they'll pay for you...isn't that in the constitution?" <==is it?

Who knows...maybe it's just the propaganda that we are all subjected to at some point in our life.
 
Originally posted by RockandRolldoc
So let's all get together and do what's right. Let's pick on those jerks up north --the Canadiens.

HAHAHA! That's a good one :). I'm sure you know you are probably outnumbered in this International Forum. But I'll cheer you on. :clap: Go get them! Show them their place!
 
It's harder to get in to Canadian schools than to most of the US med schools combined (with the exception of the top-notch schools like those of the Ivy League).

Lots and lots and lots and lots of Canadians travel down south for med schools every year. It's their best alternative if they can't get in to Canadian schools.
 
I don't think it's a matter that "US" MD's think they are superior -- I think part of it is the nature of country. The US is a country of rankings -- we rank ourselves in comparison to EVERYONE on EVERYTHING. Read these posts. "What is the best UK school?" Britons, Aussies, etc. don't THINK like Americans do. We have to have a winner, a competition. Either you like it or you don't. If you don't like it and don't work here or want to work here, don't worry about it because it doesn't affect you. In the US, most pre-meds look at uni's and apply based on what's "safe and secure" -- too many "what if's" -- especially on the stigma around IMG's. I say f*** all that. I believe most IMG's are just as good if not better than average American medical schools. And there are loads of average American medical schools.
 
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I believe the correct ranking as who is better than who when it comes to physicians working in the US is as follows:

1.US DO
2.US MD
3.IMGs
;)
 
Texasblue, I believe your analysis was right on the money. Likewise in Ireland if you are lucky enought to gain admission to med school, people will not comment on or rank your school. It is impressive enough that you are in a medical program. Now if certain medical programs were turning out inferior doc's or something similar then of course there would be an issue. This simply is not the case. In which regard I cannot understand ( nor do I care to) people obsessed with program rankings. It all seems a bit " look at me, look what I did". Maybe I am wrong but that type of gratuitous attention seeking reeks of insecurity and/or immaturity. If you have an MD or a DO after your name and have passed the relevant licencing exams then in my humble opinion you have done well enough. What else do you need to prove and why? I mean we are doctors for god's sakes, not candidates in a high school popularity contest. just my $0.02 for what its worth.
 
We're definitely on the same page, Irisheyes. If you've achieved an MD or a DO, good on you, as long as you are practicing good medicine. And the schools give the same education, it's how you use it. Doesn't matter where you learned it. . .and for that matter, I'd rather be overseas, enjoying myself on several levels than safe and sound in some med school in the US in the middle of nowhere JUST to be in the US. Absolute crap. And it will be lovely to come back to the US to practice and be on par with all my friends who've only done the US thing and can't branch out due to fear.
Well, all that pending a certain school accepting me. . . ;)
 
Just keep in mind that with DO you are limiting yourself compared to MD when it comes to practicing overseas (particularly locum tenens, where moving from one country to another is the norm). I'm not claiming MD is better, but following texasblue's post, this caveat seems warranted.

-pitman
 
i think it is in part due to our isolation from other first world/western countries (except canada) and the limited amount of exposure most americans have to life in other countries. so many americans have not been to other countries and have no idea that other countries have good things about them that we may or may not have. americans tend to focus on what we do well and tend to forget that other countries might also do these same things well (or even better).
if you watch the american news, you will see that there is hardly ever a mention of other countries unless a war is going on or something. we are raised in a culture that leads us to believe that america is #1 at everything.
 
Originally posted by lola
we are raised in a culture that leads us to believe that america is #1 at everything.

Thats the real problem right there. Most ppl. haven't seen any other country except the one that they live in...but no one goes around saying "Wow I thought New York was filled with a bunch of Hobos" especially if they've never been there before.
 
Well, except there are plenty of ppl in other countries who assume you're an arrogant imperialist pig just b.c. you're an American (while not having visited you before). But no one ranks on NYC precisely b.c. everyone knows it kicks every other city's ass, and b.c. everyone knows since 9.11 that American freedom is righteous and if you mess with her you will deservedly be subordinated into an American-style capitalist colony and we will squash your puny substandard culture as stilleto heels stomping on a French scrotum sack in a wine vat. Resistance is futile.

-pitman
 
uhhh spk for urself pitman...

and go marlins...
 
I thought I just did.

Go Sox...

-pitman
 
Sorry pitman, what did you expect? If they beat the cubs, of course they will beat the sox. :)

Anyway, back to the main topic here, I was actually trying to reply to a thread in the archives that asked for facts. Obviously I could not post, but one of the links apply here:

http://www.aamc.org/meded/edres/workforc/aamc.htm

Talks about over-supply of doctors in US, FMG policies recommended by the dreaded AMA/AAMC... and has a statement which I'll quote:

But let's not be coy. Open competition for a limited number of available positions will likely favor, as it should, graduates of U.S. medical schools. After all, this country has invested heavily in creating a medical education system that is the envy of the world. It has created an accreditation system for U.S. medical schools that maintains standards of educational quality that very few countries in the world can even come close to. U.S. medical schools recruit college graduates of exceptional ability and hold them to exacting standards of achievement throughout their education. Faced as we are with a pending oversupply, why in the world would we not want to give preference for training to our own, known, high-quality medical school graduates in whom we and they have already invested so much. Indeed, sound public policy demands that we do so.

I guess it's in the whole system in US that US students are the best. So, what makes US MDs think they're superior? Well... it's all over the place in US. Too bad, he doesn't realise that while US might have the best schools (ok, debatable), it also has the most schools (>120!!!) where the standards do differ greatly enough.

BTW, AAMC/AMA was reevaluating the needs for doctors (yes, we have excess... but what is excess? 1 doctor:1000 patients? Who says that's enough? So, now they try to change the requirements...) Check: http://www.aamc.org/newsroom/reporter/sept02/workforce.htm

Maybe that's good news for FMGs. No news on this after that article though.
 
I'm not exactly sure why it comes about that US MD's think they're the best in the world. I definitely agree that it's because we're our generation at least was brought up to think that we're the best at everything, and the fact that we have at the moment the most advanced technology/resources in more numerous supply than other countries that contributed. I don't really think this is a good thing because the basics are forgotten.

Going to school in Ireland (primary reason being exactly because of sentiments Texasblue made in his/her post) where there are a lot of Americans has really made the contrast with US thinking obvious. Fortunately in my class all the north americans are rather open-minded and humble. But in some of the other years, the americans who come over are exactly the type of stereotypical med student you find in the US, with the USA #1 mentality and the arrogance, isolationism, etc. that comes with it. And that attitude causes a lot of resentment, plus really changes the social dynamics of the class.

It's very unfortunate, and I think one of the things that really helps us get by the attitudes towards stereotypical Americans is the ability to laugh at ourselves and laugh at aspects of our country/government/whatever while at the same time remaining proud to be American. It sounds weird, but I get very annoyed at those who come here who are blatantly overwhelmingly "American," which means they're one-dimensional people.
 
Originally posted by texasblue
I don't think it's a matter that "US" MD's think they are superior -- I think part of it is the nature of country. The US is a country of rankings -- we rank ourselves in comparison to EVERYONE on EVERYTHING. Read these posts. "What is the best UK school?" Britons, Aussies, etc. don't THINK like Americans do.

I think texasblue is right on spot here. Interesting that I've recently been drafting (still in draft stage, so be nice) something exactly along these lines for submission to a mag, so I thought I'd post it here. I hope some find it both insightful and explicitive of the American psyche texasblue points to...and an enjoyable read too!


---------------------------------------------------

No Lords but Us
Stephen Ewen

"In cool mornings, before the sun was fairly up, it was worth a lifetime of city toiling and moiling, to perch in the foretop with the driver and see the six mustangs scamper under the sharp snapping of a whip that never touched them: to scan the blue distances of a world that knew no lords but us."

That is how Mark Twain, after ruminating on his past experiences up against the ones he was having in Nevada at the time, constructed them for his contemporary readers. First published in his book Roughing It in 1872, his true-ish creation was deftly tailored to hit a chord among his mostly Eastern, urban audience. It was a chord that his perceptive mind well knew existed, since he had only to look within himself to find at least a fair measure of it. In a world of urban ?toiling and moiling,??of busyness and schedules, of clutter and crowding, and of trying provide for loved ones amidst what, for far too many, had already become a growing exploitation at the hands of various ?bosses??Twain knew precisely the antidote to prescribe. It was to create something that would strike at a chord in human nature, with its desire for unfettered freedom and the need to in way or another pioneer something; it was to depict a place for his audience where, if they would only but allow hope to prevail over fear, they too could say, ?We are in a world that knows no lords but us.?

No lords but us. Interfacing with a part of natural human desire, it is a phrase that perhaps best sums up the underlying past and present impetus that so fed and continues to feed the myth of the American West. But it is also much more. Those who created ?the world,? the place of the American West, and constructed a certain sense about it within their larger culture, were only following the much more gravid precedent of which they were heirs. Indeed, the myth of the American West is much more than just the sense of one particular place perpetuated during a certain era of the American Experience. In its underlying motif, the myth of the American West is a driving force that has energized the whole of the American Experiment.

The myth of the American West sought and still seeks to instill its telltale signposts in the minds of its consumers. These signposts say to them, ?This is the American West?: John Wayne-like men who sport guns that never run out of bullets; strong-willed but enchanting women with obedient children at their sides, both within the protection of covered wagons; idyllic though challenging expanses that beckon all to come and live the dream, and many more could be mentioned.

Similarly, the broader brush of other eras in American history had their own markers?markers where, it should be added, the lines between myth and reality were not always so clear.

When early European settlers came to the shores of the American continent to form colonies, many were cultural heirs of Europe?s feudalism, with its attendant lords and serfs. Many were also heirs of persecution from synthesized State-religious authorities. The hidden message that drove them to a place where they could at last exercise liberty of conscience was, No lords but us.

As abuses later mounted from across the shores, stirrings arose amongst the colonists for independence. They organized and debated, organized more and then articulated a vision. When Thomas Jefferson penned the Declaration of Independence, and detailed ?the causes which impel[ed] them to the Separation;? when the Declaration?s signers pledged their lives, fortunes, and sacred honor in support of each other and the document, they one and the same were declaring, in a word, No lords but us. Excluded from the Declaration during the time were of course the hoards of enslaved Black Africans, who were held by their white oppressors under a message that said, No lords but us.

Shortly, the new American State sought to carve out its place among the community of nations, and sought to uphold its security therein. Meanwhile, competing European powers were still trying to make a foothold within the Americas. Giving a reply that has since laid precedent for every succeeding president, Monroe declared it ?impossible that the allied powers should extend their political system to any portion of either continent without endangering our peace and happiness,? and that it was ?equally impossible? that the U.S. ?should behold such interposition in any form with indifference.? When Monroe declared his doctrine, he was saying, in a word, No lords but us.

After time, Andrew Jackson set lustful eyes toward the West. He forced ?in the way? inhabitants along the ?Trail of Tears.? He was saying, in a word, both to those he drove along and those who followed as the displacement left a void, No lords but us. Through two World-Wars and many proxy conflicts abroad during the Cold War, the U.S. at root, was declaring, No lords but us. In later creating institutions to incorporate the world into a single economic system, and in maintaining her hegemony through them, the U.S. is today saying, again and in just a word, No lords but us.

When Jimmy Carter decreed that ?an attempt by any outside force to gain control of the Persian Gulf region will be regarded as an assault on the vital interests of the United States of America, and such an assault will be repelled by any means necessary, including military force??the deepest motive beneath the present war with Iraq?the U.S. was saying, as before, No lords but us.

From America?s roots in Europe?s feudalism with its lords and serfs to the early American colonial experiences; from the signing of the Declaration of Independence and its exclusion of Black Africans, to the displacement of peoples during ?the great Westward expansion;? from the declaration of the Monroe Doctrine to the global hegemony America maintains today?through it all, and more?we have intractably declared to ourselves and all others, and have seemed to deeply believe it ourselves, that there will be No lords but us.

The myth of the American West lies in more than just the images and writings that drove a myth of a particular era. It traces back to idyllic images of Pilgrims in tight-knit communities; to noble men who declared Independence and the ideal type young men who fought for it. It continued on to ?noble war efforts? on behalf of other ideal type soldiers, and later to efforts to advance ?democracy and free markets for the good of the world.? What amount of myth has and continues to be a driving force in America? What amount of its influence was and is truly for the good or for the ill? Can such things even be completely untwined? What is sure is that the myth of the American West is just part of a larger myth?a myth that has, and continues to drive so much of America: No lords but us.

-----------------------------------------------------
Copyright 2003 by Stephen Ewen
 
:clap: :clap: That's rather well-written, and is just the truth. I think what's interesting to think about is why some of us (like the ones who go abroad or contemplate living/studying abroad) want to explore a culture other than this no lords but us culture, and why we are more receptive to accepting ideas/thinking new to us while others are perfectly happy to remain buried in this American society without even the curiousity of experiencing anything new.

After talking to some people back home, they don't understand the concept of having all schools in a country at the same level with the same standard, while each having its own set of deficiencies and benefits. They can't understand how one school isn't "the best," and it's true - a completely different way of social perception and thinking.
 
Stephen -- very insightful piece. Let us know where it gets published. Plenty of us seem to know WHAT is wrong with the big picture, but you have asked WHY, and I think you've traced an important, distinctly American thought historically. Good job!

Oh, and I've gotta say, I'm not American, so I really appreciate hearing American voices on American values - makes more sense than me bellyaching about what I don't like. Now if only all of you insightful people could get yourselves elected president...
 
Stephen...a very nice piece of writing. It is extremely difficult for me to articulate exactly how I view the american mindset, but I think your "No Lords but us" idea captures it well. It is at once a very liberating and dangerous course which requires a deliberate and steady hand at the helm. I cannot help but wonder if certain parts of the globe, given that the U.S has troops in ~114 countries of the world, are beginning to join together in defiance of this mindset. And if so, should they not? It would seem the "No Lords but us" idealism has an insatiable hunger, and is partial to oil apparently. As an American and a European ( dual citizenship) it is both comical and frightening to view the disparity of opinions on the current global political climate, with the majority of americans feeding the "no Lords but Us" lamb, while the majority of europeans remain wary of a lambskin clad wolf. Would you agree that such suspicion is warrented?
 
That's a good point, irish eyes. I don't have time at the moment to add anything further, but this: STEPHEN EWEN FOR PRESIDENT! :) :) (ahem ahem. when you have to select your cabinet....ahem) hehe
 
LOL :laugh: . I can see the ad now.

It is time for NEW leadership in Washington.

For someone who worked his way through college, and competed for his slot apart from legacy preference.

For someone who consistently flies coach class, and is happy with it.

For someone who knows that "Diamond" is also the name of a brand of plastic spoons.

It is time for someone who received the highest marks in elementary school for "Works Well with Others," and who can apply this expertise today.

Stephen Ewen for President!

Stephen Ewen: Because just about anybody would be better than Bush.


:D

But seriously, you-all's comments are right on spot, I think. I think foreign policy should most definitely be the kingpin issue in this upcoming election, and you-all show you are keenly sensitive to this already.

I'll write more later in the week because I think it would be great to discuss more the things brought up here.
 
I know this view, in light of the resounding positive response, might meet with some flack but. . .

One must be careful when interpreting history and to do it in light of the times it was implemented in. Yes, nation-states have arisen who have abused power, in fact, every country since the earliest hunter/gatherer society has thought of themselves as lords of their own destiny. This thought process always has a tendency to bleed over state lines and is based on the principle of legitimacy/authority. This is the most basic principle (law) of the nation/state. It stipulates that a country who is legitimate in the eyes of its populace garners authority, authority breeds the necessary tools to maintain authority (i.e. laws and those who enforce them). Authority w/o legitimacy is a despotic gov't. Legitimacy with no authority is a paper tiger. So you must have both to be a viable nation/state the principle goes. Problems arise when the nation/state's legitimacy goes beyond it own borders. This is not always a bad thing as was the case for post-war US which through its lend-lease programs brought an earlier end and the downfall of three tyrants but due to it NOT being the "lord" it needed to be another tyrant grew stronger and went beyond its borders (CCCP). Which led to a "ideology" struggle and the cold war. We could have stood down and maybe the bloodshed of Stalin and Mao, etc would have dissipated after time or maybe not. Or maybe something worse could have arisen. In light of history for that time, the Treaty at Versaille was ignored and the agenda became appeasement and ignoring of facts. It took the German forces crossing into Poland and the deaths of many innocents to give us a true view of what a "lord" needs to be. Three powers working jointly (France, Britain and the US) failed to guard the gate so to speak and Hitler crossed into Sudentenland and then into Poland and beyond. There were those who spoke the same philosphy as written here and we paid a terrible cost for our errors.
The Declaration of Independence did include the slaves. The issue was, looking at history, one of the lesser of two evils. In 1784 prior to the Constitutional Convention the King Resolution was nearly unanimously voted in by the, then, powerless Continental Congress. The resolution called for the freedom of all slaves by 1802. Then other matters, sorry to say, of more importance came about. Those being the forming of a unified country so as to be able to garner support and freedoms for all peoples. The Continental Congress could not do this if their was no consensus among the states so they compromised on many things, slavery being one. Hence Article 1 section 2 para 3 of the Constitution or the 3/5th voting rule. This was a "fix it" addendum to the base Constitution to reduce the powers of large land holders (many of whom were in congress at that time) using their slaves as tools of the vote (yes, slaves could vote at that time).
So we were left with a legacy due to compromise but to have done otherwise would have caused greater harm to a country just starting out and who later fought a war to repair this recessive legacy and still this legacy lingers on.
Sure the Monroe Doctrine was a behemoth and also quite ambiguous in it powers but during that period it was a necessary issue in dealing with a country whose military forces were quite limited. So the premise was to stretch the forces that were had and extend our influence out as far as possible to give the illusion of greater force. The same philosophy is used in all countries who trade internationally only today it is done economically, however then the infra-structure for economic sanction was not in place (hence naval blockades vs lockdown of funds).
Sorry to say that the 60's era brought in many ideologies that are based on non-quantifiable sciences. Feelings play a larger part in philosophies and sciences today than they did prior to this period (I am using the 60's as the clearest delineation, the changes happened over a much greater period of time). Pretending that the "no lords but us" philosophy is something abnormal to good society is showing me that this person is ignoring human nature and the whole idea of norms and structure. Our world is always seeking out a "moral consensus" to reduce the chaos of multiple agendas and laws. That is why we saw such growth spurts during the days of the empires and colonialism (single world gov't). The problem wasn't the "no lords but us" mentality but the way in which it disenfranchised whole countries of peoples (Rome almost had it down). There will always be those who refuse to follow the logical path. They will always fight against the machine even if it means more good than bad or betters their predicament. There will always arise those Hilters, Khans, Stalins, Maos, King Georges, and on and on who will fight for "their" best interests instead of the whole. We can only do so much in our imperfection and seeing as the future is impossible to read, we will still make bad choices with the best intentions.
So if you are considering running for president and think that Bush has made more mistakes than you or anyone would ever make then you are saying what you profess to be so negative on, no lord but I.
As George Santyana said regarding history repeating itself or what Solomon said in regards to nothing new under the sun you ideology is nothing new and it has been tried and failed as has Bush's, and his predecessors and on and on et al.
You showed excellent prose in your essay but that's all it is, excellent prose.

Rick
 
I very much appreciate and admire your analysis. In my experience your level of understanding is quite atypical of the great majority of US graduates, although I have no knowledge of your background.

But then again Mohandis Ghandi was not a US graduate either, was he?

Then again some of the worlds most gifted people have had little formal education




Believe in yourself as much as you doubt
 
Actually, educated in the US, born in Europe and live in Central America Where the Monroe Doctrine held much influence in the early part of the 20th.
If you read many of the early Generals' writings from many of the great world empires and powers you see the same sentiment so it is not an atypical or US-centric ideology. It is for all those control freaks (many doctors fit this bill) who see something wrong and say they can fix it. The issue resides in the moral agenda that the control is based on. Is it based only on the economic satisfaction of the "lord" or on the ethical stance and the economic satisfaction? I know this might appear Machiavellian, which it is in a small way, but it also has the "moral" agenda not found in his treatise.

Ghandi's (or even ML King's) use of peaceful civil disobedience was useful intranationally but not useful internationally. As mentioned in the previous post even with three nations over-seeing the Sudentenland buffer zone and League of Nation inspectors in Germany territory seeing the build-up of ships, tanks, personnel and so on the appeasement and ignoring of the signs did not stop WWII. It took attacks in Eastern Europe and the loss of most of Europe in general before the "lords" arose to stave off their antithesis. And I would say they were not very good "lords" seeing as they were reactive as opposed to proactive in their endeavors. How many lives could have been saved if the three would have stopped Hitler in the buffer zone?

Maybe SDN should open a political forum??
 
I will reply when I have time.
 
Originally posted by lola
i think it is in part due to our isolation from other first world/western countries (except canada) and the limited amount of exposure most americans have to life in other countries. so many americans have not been to other countries and have no idea that other countries have good things about them that we may or may not have. americans tend to focus on what we do well and tend to forget that other countries might also do these same things well (or even better).
if you watch the american news, you will see that there is hardly ever a mention of other countries unless a war is going on or something. we are raised in a culture that leads us to believe that america is #1 at everything.

Well said. That is exactly the reason I have started reading and watching BBC News whenever I get a chance
 
From the mouth of a professor of theory as opposed to men who have lived through those times? I would prefer your own opinion than that of a theorist, who may or may not be correct. Sometimes it is best not to tie one's own opinions to anothers unless he is adequately sure of the other person's motives.

We are no longer fighting a country but a philosophy, which according to history can never be won. When we fought communism it was based on the principle of the "dominoe theory" not on the philosphy per se. The idea being that if we bolster the country we win the battle. This worked for fascism and communism (though, it lives on today in various forms) but not todays battle. Mr Ryn is correct in his observation that this is the "ideology of empire" but that is simplistic at best. The roots of empire were not about security for the most part but conquest and power. I am assuming, according to Mr. Ryn's theory, that Alexander the Great was only protecting Mesopotamia?? No, he was on pure ego and power. It was even mentioned in the writings of his conquests that his was a driven heart to gain more power than his great father through conquests of territories his father could not conquer. So no, this is not about building "empires" though that is the appearance to many (probably due to its similarity to the Byzantine model). Does anyone with the information currently out there really believe that Bush's motivation is world domination and the rise of the Roman empire (I am not talking to those who "feel" but those who quantitatively believe this)?
How does one perform a surgical and limited response when no borders exist? When the enemy is without country? Mr. Ryn fails to remember the US revolutionary war and how guerilla tactics so damaged Britain's staunch military tactics and strategies. This is the war the world fights today except that it is truly international.
Seeing as Mr. Ryn likens the Bush agenda to Rouseau's "Social Contract" and the Jacobins then one must wonder where the ideology of "appeasement" arose from that Mr. Ryn subscribes to. It is the same mentality that allowede the deaths of 30 million political, ethnic, race, sex and so on deaths under Stalin. It was the same mentality that allowed Polpot to continue his "killing fields" for years. It was the mentality that allowed the caste system to remain in India, the starvation in Africa, the civil wars and strife around the world. And guess what? What has the world done together to fix these problems. It takes on Ryn's and your attitude that it is someone elses problem. It's not my country or they are heathen or uneducated or just plain lessor people than I, or what about what could happen to us and our way of life. We could be like the UN that sits on its hands but when strife hits they pull their forces out, usually over the people they are there to protect (Srebrenica where Dutch armored vehicles ran over and killed innocent people to protect UN assets. This is the mentality of appeasement). I guess if more people had the motivation to do something in the world other than vacillate maybe we wouldn't have as many of the "predicaments" that we have. Or maybe more? Whose to know but usually the easiest street followed is not the correct one.
I can not vouch for Bush's motives nor can Mr. Ryn. The right exists to bad mouth anyone you disagree with but please do it with an objective mind. Research as much as possible and if you do not have the time to research then do it by saying "this is the way I 'feel' about this issue." This at least let's one know that it is based on some psychic power or discernment that you may or may not have regarding international conflict resolution/politics.

I guess to make this a credible argument for this forum I need to add something about medicine:
I do not expect thanks for what I do or will do when I become a physician. It is a duty that I "felt" driven to do. Maybe to wipe away all my past miserable deeds or maybe because I am tired of all the selfish, sociopathic, uncaring agendas I see in the world (or both). The only thing that separates me from the peacenicks is that I know it cannot be done peacefully all the time. That's my Machiavellian side it also follows the historical model. It is also why I am in Central America instead of in America or the Western countries. The only thing I know is that it is better than doing nothing or little at all. . .

Rick
 
Will reply when I get time to this, but gave you a Private Message on another matter.
 
Excellent piece, Stephen (and, if I'm not mistaken, I believe you are Canadian, correct?... not that that matters).

To understand the American esprit de corps that dictated the times and certainly charted our course of history throughout the past 200 or so years, you have to understand the concept of "manifest destiny" that pervaded and, indeed now, still pervades our cultural, moral, and ethical ideals as a predominately white, predominately European, predominately puritanical nation. While we understand your criticisms, Rick, I think that Stephen's piece is fully keeping with this ideology. It is also an example of excellent writing.

-Skip
 
Do you guys really have to ask why US grads often think they're superior? How many people in the US went to school's in the caribbean after getting into a US med school? The answer to slim to non. Of course, since many people who don't get into US med schools go overseas as a last resort to get into medicine, it's OBVIOUS why some US grads will use that as a reason to think their education is superior.

I don't believe being a US grad says you're a better doctor. But all else being equal, I'd probably opt for a doctor that was able to make it into a US med school, instead of coming from a place where the standards are unknown to me.

Many of our foreign grads come from places where it's no way near as hard to get into medical school (eg my old roommate from India told me it wasn't that hard to get into his med school, and few failed out), but I don't know how it is in europe since most of our foreign grads don't come from there. So when you hear US grads talking about IMG's, it generally doesn't pertain so much to Ireland or elsewhere in Europe, but more to the places where our IMG's come are more likly to come from. We sort of stereotype IMG's, similar to how europeans stereotype americans.
 
Once again, there are a multitude of international relation/political forums out there so maybe should add one on SDN or start a new thread but I guess I have always had a tendency to buck the system. . .

Firstly, I agree, Mr. Ewen's piece is excellent in writing and prose. A rare trait in writers today, I only wish historical relativism was so rare a trait (sad to say an onerous by-product of the 60's emotionalism).

True, Skip, Manifest Destiny as it was defined in the 1840's (or more clearly by O' Sullivan) was a driving force for the nation and I would say it began with the Pilgrims who went there, many as indentured slaves. However, every nation beginning with the first hunter/gatherer society has progressed through "manifest destiny." The issue I took with Mr. Ewen was what I interpreted, whether correctly or incorrectly, as a negativism towards a country being a proactive force in world issues. From my perspective, and I believe history attests to this, that those nations who "strive" to make a difference are the countries that make a difference. We can argue that FDR was a godsend for the US during the dark days of the Pearl Harbor bombing but one must remember he was having our naval forces follow Axis military shipping radioing their coordinates, or placing US troops on Greenland replacing British troops, or the lend-lease program which were among about 13 other acts of war he committed prior to Pearl. Was this residual manifest destiny? He did tell the American people quite a few times that they would not enter the war but he felt that they were needed to help stop a trend of fascism and empire building (and I am not a fan of FDR by a long shot).
I really do not want to get into a long debate on history. I only want to point out that manifest destiny or "no lords but us" or war-mongering or whatever "fill in your own terminology here" has it pros and cons. The US (colonists) came into a new country controlled by, mostly, aggressive tribes (mostly against those other indigenous peoples) who fought over land among themselves and now because the newcomers did a similar thing on a grander scale it becomes something of an atrocity (but it also created a great power that helped stop a despotic juggernaut. The Middle East is another example of two groups fighting over a piece of soil (rock) that has no worth except it being the site of three religion's beginnings. Two religions fighting over a small piece of property that could destabilize a whole region if not the world due to similar treaties and agreements that led to WW I. It's about the "no lords but us" ideology. Who will win? From an historical perspective, it is the group that needs to win. Interesting that the major empires throughout history have become calming entities over a chaotic world when it was needed, though always short lived (Rome had seven up and seven down centuries). . .

You know I hate to leave people hanging but I just came to the realization that I need a life and I guess it shows that I agree with Einstein that there is one unifying equation out there which kind of shows that we are not "lords" but pawns in a much bigger picture.

Rick
 
Originally posted by Hypochondriac
I've been reading up on IMG topics lately and am under the impression that lots and lots of people think that the US MDs are somehow "superior" to IMGs (be it from the UK, Ireland, Oz, NZ..etc.). I mean, that may only be true if you intend to practise medicine in the US.

.
I don't think that's representative of US physicians in general.
The data on CSI, do not support people making these statements either. People here that are making those statements are probably pre-meds, or just plain *****s

The established training programs in America sre superior to other places, which I can see from firsthand knowledge, and from talking with numbers of IMG's who trained in other countries.
This does not mean that the caliber of docs produced here is better.
In fact, the IMG's that shine in various countries are excellent, and would only excel , if exposed to the training programs available in the USA

I worked with an excellent Austrlian peds surgeon, who came specifically to America to learn about penetrating trauma......a sad commentary on our society, but nonetheless, here he was looking to better his skills.

We should all respect the excellent forein docs doing great work on other countries, especially given the fact that their training programs may not be equivalent
 
Interesting thread bashing America. As a US senior browsing through some of the links I would otherwise never visit, it's quite alarming to see all these negative attitudes. Let me explain why we don't like IMGs.

1) Attitude - in many countries (especially Asian), doctors belong to the upper caste of society. As these doctors come to the US, they carry their self-proclaimed royalty into our society and into our clinics/hospitals. As a society that really does not believe in aristocracy (despite the Trumps, the Hiltons, and the Bushes), that kind of attitude ("i've never done my own laundry" is the most common thing I've heard) does not go well with many US grads who have had to pay for their own education/training. The Holier-than-Thou attitude in clinic makes the IMGs rather obnoxious both to patients and the American medical students who have to train with IMG as residents. We in the US are trained to offer advice to patients, but let them make the final decisions. We approach patients as equals, not as Gods. (this section doesn't necessarily apply to many western European countries and Australia)

2) Length of training - many IMGs will have only graduated from college to get their MD degrees, while US students have to get a college degree in most instances and go through hell to get to US medical school (volunteering, research, good grades, MCAT) which are super costly. You cannot blame US students for remembering that they would be working for/along college grads instead of US graduates who hold graduate school equivalent training and degrees. It's just like seeing someone cut in line at the movies.

3) No reciprocity. When many US students think about practicing in other DEVELOPED countries (I don't know how it is in underdeveloped countries, since licensing in those countries has never been talked about among my colleagues), it is often said that these countries offer much resistance in terms of connections, licensing, and citizenship requirements. While US has certain requirements for IMGs, the US is probably the most open country to allow foreign trained MDs to practice medicine (perhaps Canada is similar as well). If there were sufficient reciprocity (such as the case of many US grads going to Ireland for med school), there would be much less sentiment against IMGs.

4) Simple labor issue. While most US students (I hope) do not go into medicine for money, the cost of American medical education has gone through the roof and the average graduation debt is a major consideration now for students from middle class families seeking a medical education. It takes 10-20 years to pay off the student loans from college (see 2 above) and medical school, and there are arguments that allowing IMGs into the residency system ALLOWS hospitals to keep salaries low (as in the case of graduate schools across the country) AND introducing IMGs into the physician workforce keeps declining physician salaries at an all time low (even with insurance and other problems in the health care system). Just like the American blue collar workers are not pro-immigration because unskilled immigrants usually take jobs from them, the American medical students/graduates are not for this import of physician labor to take a piece of our already small pie.

5) Allocation. One of the thoughts of hiring IMGs was that they would serve as the supply to meet one major demand of American medicine, the underserved populations. Granted, many IMGs do go to some of these hospitals to work as residents and staff. However, many more aim to go for the top institutions in this country with a sense of entitlement (I'm the best in my class back home, therefore I only deserve the best here) that even the proudest in the US detest. Statements from IMGs who have become residents along the line of "(insert hospital name here) is not that great. You Americans are full of it" certainly do not help the situation.

That said, I have had plenty of positive experience with many IMGs. I worked with a great IMG surgeon in college who had to go through residency again to practice here even after having operated for many years in his home country (although at the same time I met 2-3 other really bastard-like IMGs who treated students like **** but brown-nosed the attendings to death). I had quite a few IMG colleagues who introduced me to various cultures I would have never been exposed to, and some even showed me their different styles of practice which was complimentary to my own training. I really think that there are too many bad apples in the basket for US students to think highly of IMGs as a group, even though there are plenty gems in the basket as well hidden among the bad apples. As with Affirmative Action, there will always be those who take advantage of the system and those who are truly good. Sadly, the American hospital system focuses more on the productivity of residents instead of the virtue they bring with them, and it will be very difficult to keep out even the majority of the bad apples in the current health system.

The concept of America is to get the best of the world and to bring them together so they can do what they do best in a protected, enriched environment. However, I am sure that many of you can give me more examples of how some of your countrymen and -women have gotten into this country to work in less than honorable or undeserved fashions. I have heard of cases where credentials are entirely made up, including medical school Dean's letter and official papers including transcripts, etc. Perhaps the problem does not rest entirely with the US, but rather each country sending IMGs *should* ensure their quality.
 
tofurious ,
I am an IMG myself and i too agree with most of what you said.
US students contribute the most to the medical system here in terms of tuition and many other things , so they should get the bigger chunk of the pie. The residency positions are funded federally , and who pays the taxes ? the US citizens.
This is my HONEST opinion.
I do not want to hurt the feelings of my IMG FRIENDS , Well i am a foreign born IMG myself , but there are certain things we should accept and understand.
I know certain things from my experience and i also posted it on the forum about why IMGs come to the US?
I am an IMG from India with medical education from one of the best places and residency experience from a very prestigious institute.
Majority of IMGs come here because they could NOT compete for the residency spots in India and everyone there has ambitions of rads , ortho , surg etc. The usmle exams are easier to score so they come to the US and take residencies here , mainly in int med and peds. These people should not complain. If they were so good and deserving they should have competed for the top residencies in India.
I have met many people who are doing competitive residencies in India , all surgical fields , OBG, rads , ent , ophtho etc . Let me tell you they do not want to leave India. At the most , they do some fellowships in UK , US or europe and practice in India.
There was a time when i was doing a neurosurg residency and i told my peers about trying for this field in the US. I came to know that many of them had already cleared cleared usmle , but decided to work and train in india , which has excellent training . According to them and I ALSO AGREE that ' there is nothing like your own country to provide you , AND EVERY COUNTRY SHOULD FAVOR ITS CITIZENS FIRST'.
Many IMGs with internal med experience come here for money , SO they should also not complain because they will make good money here.
IMGs should not come here and try to compare with AMGs . WE WILL HAVE TO ACCEPT THAT THIS IS THEIR TURF .
From personal experience , i had the same feeling in my country as hopkins or harvard grads have here . But the recognition of different institutions in different places is different, so we should not compare.
For any such IMGs who had those feelings , once you complete your residencies and fellowships , you can have the same feelings if you choose to return to your country.
Many of those IMGs who complain of favoritism should also know that many of these were not competitive enough in their own country. However there are always some exceptions.
I ALSO PERSONALLY KNOW OF SOME BRILLIANT IMGs who did good residencies and fellowships and returned to India and have great careers.
I would only ask one question from all imgs?
Put yourself in the shoes of an AMG. Would you allow some foreigners to take away the prime positions when you have contributed in tuition and taxes to the same system?
My answer would be ' NO' .
Remember , i am a foreign born IMG myself and i am second to none in being proud of my medical education and lineage.
I would suggest to many IMGs that if we want the same feeling as AMGs have here , do your residencies and fellowships and return to your countries and people. Depending on where you are from , you may or may not earn a fortune , but you will certainly have the same feeling as AMGs have here and also earn good money . In every country doctors earn well with respect to existing living standards and enjoy good status in society.
Yes , if you want the kind of money doctors earn in the US , then stay here and MAKE SOME COMPROMISES.
For many people great money may not bring happiness but good money can. IT DEPENDS ON WHAT CHOICES WE MAKE.
Finally , we chose this direction and if we accept the pros , we should accept the cons.
 
I should also add that I have the upmost respect for IMGs who came here because their special career interest is not available anywhere else in the world, AND those who DO return to their home countries such that they can make the fields of medicine better at home (the one country that comes to mind right away is Japan).
 
Just out of curiousity, what is your attitude toward USIMGs?

Miklos
 
I guess it depends on where they went to med school (and the reason why they left the US). I know quite a few people who have gone to med school in Ireland where the standards are in line with American requirements. Those schools are probably better than many of the lower-tier US med schools. I have reservations about the Carribean schools, or schools in general that accept students based on their ability to pay rather than abilities.
 
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I should also add that I have the upmost respect for IMGs who came here because their special career interest is not available anywhere else in the world, AND those who DO return to their home countries such that they can make the fields of medicine better at home (the one country that comes to mind right away is Japan).
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There are many from India too who are doing very well there in academics as well as in private practice.
India has over 130 med schools which vary from excellent to good , average and bad. I guess every country has this variation in med education.
Medical Competence has a lot to do with social and geographical factors.
For instance I have seen that tropical neurosurg is one which is a very important part of training in India. This includes tuberculomas , basal arachnoiditis and related hydrocephalus and many other things.
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I DO NOT WANT TO OFFEND ANYONE.
Just like many american students who were not able to get into med school in the US and went abroad instead , Most people who come from India to the US or UK , do so because they were unable to compete with the good candidates there. Only a minority come here for special career goals.
This is not being disrespectful to Indian IMGs , but the fact is that majority of the best indian doctors still choose to work in India. Those guys are very good and comparable to the any of the good doctors in any part of the world.
 
Originally posted by tofurious
I guess it depends on where they went to med school (and the reason why they left the US). I know quite a few people who have gone to med school in Ireland where the standards are in line with American requirements. Those schools are probably better than many of the lower-tier US med schools. I have reservations about the Carribean schools, or schools in general that accept students based on their ability to pay rather than abilities.

Interesting.

Are you concerned that USIMGs will compete with you and that you are entitled (as an AMG, who has paid their dues) to "better" positions, etc...?
 
I DO NOT WANT TO OFFEND ANYONE.
Just like many american students who were not able to get into med school in the US and went abroad instead , Most people who come from India to the US or UK , do so because they were unable to compete with the good candidates there. Only a minority come here for special career goals.
This is not being disrespectful to Indian IMGs , but the fact is that majority of the best indian doctors still choose to work in India. Those guys are very good and comparable to the any of the good doctors in any part of the world.

I disagree. How much money does the average Indian doctor make?

Let us be quite frank about it. The opportunities for new Indian graduates (and graduates from many other counties) are limited, unless they have connections, etc. The U.S. is the rational choice, as it has the most open market for postgraduate medical training.

Look at the numbers of Indian graduates receiving ECFMG certs at http://www.ecfmg.org/annuals/2002/certstan.html

(BTW, tofurious, the Canadian market is firmly closed to IMGs.)
 
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