working with FMGs/IMGs

[mlw03]

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Here's a topic I haven't seen discussed, and it's more germane in path than other fields due to the demographics. On a day to day basis, what's it like working with non-American FMGs? By this I mean do the cultural differences affect the working relationship? I don't mean this to be insulting or inflammatory, but you obviously spend a lot of time with your fellow residents, and it'd be nice to be friendly with them (of course I realize AMGs can be jerks - that's not the point here). So for someone with weak English and a completely different upbringing, does that make for a good or bad working environment.

I suppose that on a very similar note, does pathology have a higher than other specialties percentage of non-American faculty, and if so, does that affect their abilities as a teacher. I'm sure we all had foreign faculty someone in med school, and I'll admit that their heavy accents and mispronounciations made things more difficult sometimes.

Please recognize I'm not trying to start a "I hate foreigners" discussion - I'm geniunely interested in current residents' opinions on whether having a lot of FMGs in a program is a good or bad thing from the communications perspective.

 

[DruidDoc]

If you don't like the idea of working with FMGs, you could always try your hand in a different profession:

 

[Louisville04]

If you don't like the idea of working with FMGs, you could always try your hand in a different profession:

Are you nuts!!!!....not after spending all that time in undergrad and med school.

I don't think the poster said he didn't like working with FMGs...you are reading to much into it.

 

[DruidDoc]

If you don't like the idea of working with FMGs, you could always try your hand in a different profession:

Are you nuts!!!!....not after spending all that time in undergrad and med school.

I don't think the poster said he didn't like working with FMGs...you are reading to much into it.

Seeing as how we are unfamiliar with sarcasm, I will clarify: IT WAS A JOKE!

 

[mlw03]

thanks Louisville for getting my back, and Druid, yeah, I could tell that was a joke - I always enjoy a Southpark reference to the dude who works at City Wok. I don't have an intrinsic problem with the idea of working with an FMG, but I am curious if the language and cultural differences affect the ability to work with, socialize with, and learn from someone. I assume there are some sort of standards to prove any FMG can speak English (especially important in the clinical world of course), but in path where all the communication is with other healthcare workers, it's easy to imagine a foreinger never having to master the language as well as an internal med doc. I shall await the wise words of some of the residents that frequent this forum.

 

[beary]

I am curious if the language and cultural differences affect the ability to work with, socialize with, and learn from someone.

IMHO, yes. Half of my class is FMGs, and the language barrier is a big issue.

I hope I don't need my flamesuit.

 

[quant]

IMHO, yes. Half of my class is FMGs, and the language barrier is a big issue.

I hope I don't need my flamesuit.

Heya Beary!
Its been a longtime!

Regarding your post, I am really curious about this, is even normal social communication of english a trouble to them?

How are things with you Beary? How are your rotations going on? Is Pathology everything you expected it to be? 🙂 🙂

 

[uhoh!]

I am an FMG myself, and yet nobody seems to ask if I have any trouble "getting" what is being said to me...Short answer: sometimes. I even have some trouble understanding what FMGs from other countries, and even from other parts of my country say...and I hope it not only because I'm a bit thick/slow!

I am very conscious that people have a problem understanding the way I pronounce certain words/use cretain phrases which are unfamiliar to them. I make a conscious effort to speak slowly and deliberately as far as I can.

It isn't really a problem with english as a language, as I have been speaking english since I was born. In my country (India) my entire education, upto and including Med School, has been in english. I even speak a mixture of english and my mother-tongue at home. This is very different from people who come from countries where the medium of instruction is not english.

Even if it may not seem like it, almost all FMGs are conscious of their language being an impediment, and are making efforts to be as understandable as possible. But hey, it is also a struggle for me to decipher the accent of a lot of americans, as it is very different among different parts of the country, and waaaaay different from whatever I have ever heard back home. FMGs are usually polyglots, and have to think in Language-X, translate it mentally to english before speaking. Its not easy, esp for certain turns of phrase. But its a part of the educational experience, I guess...
This is not a rant, but is more to show that its a two-way problem, and has many layers to it.
🙂
And Beary, Quant!!! How are you guys?? It has been so darn long!!🙂

 

[beary]

Heya Beary!
Its been a longtime!

Regarding your post, I am really curious about this, is even normal social communication of english a trouble to them?

How are things with you Beary? How are your rotations going on? Is Pathology everything you expected it to be? 🙂 🙂

Quant man!!!! Hey! How are you? It has been a long time. Are you doing ERAS again soon?

For the folks I am specifically thinking of, yes, normal social communication is a problem. I don't just mean an accent or something.

Things are going ok. Residency has been a bit harder of an adjustment than I expected. Some of path is really cool so far, other parts of it totally suck. 🙂 I'm taking a vacation the week of Labor Day, so I think that will really help me a lot - getting away for a bit and spending time with family.

 

[beary]

This is not a rant, but is more to show that its a two-way problem, and has many layers to it.
🙂
And Beary, Quant!!! How are you guys?? It has been so darn long!!🙂

Hey uhoh! Thanks a lot for your thoughts and perspective. I definitely appreciate what you said and understand that it is a two-way situation. 🙂

Things are ok with me. How are things going for you?

 

[veo1]

user deleted

 

[Faebinder]

Not going into pathology here but I saw the thread and I was thinking. In the last couple of years the requirement for the ECFMG certificate switched from CSA + TOEFL to Step 2 CS. Now back in those days, passing the TOEFL was a joke... It's a test that can be taken in centers outside the US and doesn't rely much on spoken English. The CSA exam was very simple and didn't hit hard on the spoken language.

Now Step 2 CS is one third based on your ability to communicate and from what I understand, that exam is getting harder and harder. (They just increased the average to pass this July.)

I think you will see less and less FMGs with too hard to understand accents in the future (not now obviously, it hasn't been 4 years yet since hte implementation.)

 

[yaah]

It's hard to talk about this topic without getting people upset and/or defensive. The majority of FMGs, in my experience, have no trouble doing the workload or communicating sufficiently to get things done, or understanding the culture, whatever. There are occasional FMGs who have very little clue though, and simple communication is a barrier and effects how they do their job. I can't imagine trying to do my job if I couldn't communicate effectively, so I am not sure how they handle it personally. It becomes difficult for clinicians who have to interact with them (and occasionally patients).

I have seen attendings more cautious at giving responsibilities of interpersonal interaction (such as blood bank call) to residents who do not express themselves well - it's as if they have to "prove" themselves more. To some extent, as said above, it is a valid concern - one can be touchy feely and respectful of other cultures but yet realize that there are certain conditions one has to meet to do their job effectively. In general though, programs are good at making sure they don't rank people who aren't going to be able to do the job. The only times I have seen it become an issue are where, on occasion, programs can look the other way if the candidate has a superior research record or something like that.

The main issue I see with most FMGs is a more difficult ability to interact effectively and understand the culture we are in. Usually this does not result in bad things happening or difficulties in the department, it's more that it just makes things difficult. I would say though that this is the minority of FMGs, most, as I said, do not have any trouble and where one notices the difference is simply in social situations where they don't understand a pop culture reference or something.

That being said, of course, there are innumerable pain in the ass american med school grads as well. Stupidity knows no geographical or cultural boundaries.

 

[deschutes]

I'm very impressed that the thread didn't degenerate overnight 🙂 So often these discussions end up being defensive exchanges that it gets a bit repetitive. So with all the usual caveats that an FMG thread entails...

I'm geniunely interested in current residents' opinions on whether having a lot of FMGs in a program is a good or bad thing from the communications perspective.

I think the # of FMGs is a side-issue, because every FMG is different. People generally don't lump British or Canadian FMGs in the same category as say, mainland Chinese or Indian FMGs.

I think the real issue is the individual applicant's ability to communicate, which you'd think an interview would be able to sort out. But interviews are short, and both applicants and programs have their own agenda, transparency not necessarily being one of them. And historically, staff from a variety of institutions in and out of the country have told me stories about how in the past it would be suggested to struggling clinical residents to go to the basement and see if the pathology department would be willing to take them in.

Perhaps in the past, surgical pathology (which is a relatively new field to medicine) lacked would-be trainees and therefore took whoever they could get. I dunno.

My class is half and half FMG/AMG, which is reflective of the overall program as well. There are stories about the odd individuals in the past who clearly didn't fit, but I'm racking my brains now and can't think of anyone in the program who is really incomprehensible. Weird yes, but not incomprehensible.

Culturally... it's Minneapolis, but we draw people from all over the Upper Midwest where it sometimes seems like people are married with 3 kids by the time they're 25 and don't hang out after work because they're rushing home to be with family 🙂 And holy crap everyone is so "nice". I've learnt to disbelieve whenever people come up and tell me "good job!", because I suspect some of them are blowing smoke up my ass.

I give more weight to the opinion of the person who tells me "You seem like the kind of resident who has a clue" than the person who is "nice".

Anyway.

As an applicant, your bottomline is going to be, "What are the residents at this program like (whether FMG or AMG)?" I wish I could tell you a shortcut.
But I think in general, especially at competitive programs, trainees are selected in this order:

1. Super AMGs
2. Not-so-super AMGs and Super FMGs
3. Not-so-super FMGs
4. everyone else.

unless the Scramble is involved in which case it's all bets off.

So unfortunately, we have no way of deciding who we want our classmates to be - be they AMG or FMG. I've met horrible PSFs, and I've met PSFs that any program would die to have. And But unless this gets communicated to the admissions committee and upheld, who is to say what happens.

 

[mlw03]

It's hard to talk about this topic without getting people upset and/or defensive. The majority of FMGs, in my experience, have no trouble doing the workload or communicating sufficiently to get things done, or understanding the culture, whatever. There are occasional FMGs who have very little clue though, and simple communication is a barrier and effects how they do their job. I can't imagine trying to do my job if I couldn't communicate effectively, so I am not sure how they handle it personally. It becomes difficult for clinicians who have to interact with them (and occasionally patients).

I have seen attendings more cautious at giving responsibilities of interpersonal interaction (such as blood bank call) to residents who do not express themselves well - it's as if they have to "prove" themselves more. To some extent, as said above, it is a valid concern - one can be touchy feely and respectful of other cultures but yet realize that there are certain conditions one has to meet to do their job effectively. In general though, programs are good at making sure they don't rank people who aren't going to be able to do the job. The only times I have seen it become an issue are where, on occasion, programs can look the other way if the candidate has a superior research record or something like that.

The main issue I see with most FMGs is a more difficult ability to interact effectively and understand the culture we are in. Usually this does not result in bad things happening or difficulties in the department, it's more that it just makes things difficult. I would say though that this is the minority of FMGs, most, as I said, do not have any trouble and where one notices the difference is simply in social situations where they don't understand a pop culture reference or something.

That being said, of course, there are innumerable pain in the ass american med school grads as well. Stupidity knows no geographical or cultural boundaries.

this is the type of information I was after, so thanks yaah. at the end of the day I'm most concerned with an ability to get the job done - social stuff is far less important, but over 4 years can make for a more or less pleasant working environment. there's even cultural differences within the US that can probably be noticeable (I like to joke with the residents from the midwest when I hear them say 'pop' - we say 'soda' in Florida). but like yaah said, not getting a pop culture reference isn't important - what's important to me is stuff veo discussed - is signing out with a particular senior resident or attending a poor learning experience because you can't understand what they're trying to say? also, thanks to uhoh - you also make a very valid point. i don't doubt that the majority of foreigners work to improve their English skills, and I can only imagine the difficulties a Brazilian and Russian doc might have trying to communicate through a language that's foreign to both of them. I suppose this underscores the importance of chatting with the current residents at programs one is considering since they're the ones you're going to be working with and learning from for a few years.

thanks to all that have replied - nice to see we're able to have a civil discussion about a potentially touchy subject (knock on wood).

 

[quant]

I'm very impressed that the thread didn't degenerate overnight 🙂

Amen

 

[quant]

Quant man!!!! Hey! How are you? It has been a long time. Are you doing ERAS again soon?

Yep
I am up for the ERAS thingy again! I have set the ball in motion....asking for LORs, banging my head over the SOP etc....fun times are here again!...🙂 🙂

It HAS been a long time. Hope you have fun over the labor day weekend.
Quant

 

[Blue Fish]

thanks to all that have replied - nice to see we're able to have a civil discussion about a potentially touchy subject (knock on wood).

This is a touchy topic. Glad to see some benign discussion here.

The fear of working with IMG has something to do with expections. I notice people in New York do give much shxx to this. 99.99% people speak spoken English. To survive, you'd better learn to comprehend their ****ty English.

 

[deschutes]

I was just thinking that Rosai has got an accent that is pretty hard to understand!

 

[torero]

The fear of working with IMG has something to do with expections. I notice people in New York do give much shxx to this. 99.99% people speak spoken English. To survive, you'd better learn to comprehend their ****ty English.

😕

 

[LADoc00]

I was just thinking that Rosai has got an accent that is pretty hard to understand!

Yep.


One thing about IMGs: We all know that foreign docs are all over many residency programs like white on rice , but in interacting/interviewing with pathology practices rarely filter out to private prac groups, beggin the question where do they all end up.....

 

[deschutes]

One thing about IMGs: We all know that foreign docs are all over many residency programs like white on rice , but in interacting/interviewing with pathology practices rarely filter out to private prac groups, beggin the question where do they all end up.....

Keep in mind that many of these residents are on J-1 (i.e. foreign exchange visitor) visas. They are required to return to their country of last permanent legal residence for a period of two years after their training is over before they can apply for an H-1B type work visa or green card. (Which peripherally is related to why some IMGs do fellowship after fellowship in a bid to extend their stay on a J-1.) I'd venture to say most don't come back.

There is the extremely rare J-1 visitor who manages a J-1 visa waiver - this involves going to underserved areas of the US often invoking the VA system. There are few openings and therefore there are few who do this.

 

[dermpathlover]

Yep.


One thing about IMGs: We all know that foreign docs are all over many residency programs like white on rice , but in interacting/interviewing with pathology practices rarely filter out to private prac groups, beggin the question where do they all end up.....

Reference labs and academics would be my guess.

 

[LADoc00]

Keep in mind that many of these residents are on J-1 (i.e. foreign exchange visitor) visas. They are required to return to their country of last permanent legal residence for a period of two years after their training is over before they can apply for an H-1B type work visa or green card. (Which peripherally is related to why some IMGs do fellowship after fellowship in a bid to extend their stay on a J-1.) I'd venture to say most don't come back.

There is the extremely rare J-1 visitor who manages a J-1 visa waiver - this involves going to underserved areas of the US often invoking the VA system. There are few openings and therefore there are few who do this.

Very interesting....anyone have numbers on current pathology trainees:
1.) foreign medical grads vs. AMGs
2.) ethnic make up
3.) US vs. Non-citizens

 

[deschutes]

...academics would be my guess.

i.e. the people who teach future generations of American med students. Hmm. I had a point but I forget what it is.

 

[TangataManu]

I'm a foreign grad and I think I've been through each and every situation you guys have mentioned. Cultural differences, language problems, and so on. In general I have no problems with whatever comments are made about foreign grads, as long as they don't reflect total ignorance and are not based on pure prejudice.
What sometimes p**es me off is that some people have strong opinions about things they know nothing about. Comments on the quality of medical education in other countries is one good example. Some people seem to think that all foreign med schools are crappy old dumpsters forming second class doctors, not realizing that many, if not most of these schools have a level of competitiveness before, during, and after med school which is unheard of in this country, reflecting the generalized fierce competition for extremely limited resources that you see in these places. In fact, compared to all countries I know, the US medical education is pretty avarege as far as med school training. In most countries, training is much longer (6-7 years), usually with a couple of years of an internship type thing after the regular 2 yrs or so of clinical rotations. Education is generally more strict and way more practical. Residency programs, on the other hand tend to suck, and this is one of the reasons many people come here.
Great physicians in a foreign country, however, may be extremely unsuccessful in the US because of their failure to become familiar with the language and the cultural aspects of gringoland. I've seen that countless times.
Having said all this, I think the first point to consider in this discussion is the fact that most FMG's are living in foreing soil, trying to "compete" for a place in the sun with people who have been paying taxes from the minute they were born, who's families have built this nation with their labor, and who will almost invariably have astronomical loans at the end of their training. If giving preference to US grads for a training position is not fair, I don't know what is. Second, I think any foreigner who complains about having a hard time in the US should be awarded a one-way ticket back home and a visa cancellation. The reason I say this is very simple: NO country in the world is as open to foreigners as the United States. If you think it's hard to become a practicing physician in the US, just try anywhere else. Even the most sh***ty third world countries won't even allow foreigners to apply for training or licensing. A US trained physician, just out of their 4-yr med school, is not even eligible for residency training in most countries, including nearly all of Europe and the rest of the American continent.
Third, there is a lot of prejudice in the US, against everything and everyone. Nearly everybody is discriminated for one reason or another, you just have to deal with it. Being a FMG is just one reason for people to label you. But here's what I love most about this country: money speaks way, way louder than prejudice or anything else. If you are good enough to generate $$$ around here, be it for your ability as a researcher, diagnostic skills, talent in the porn industry, or whaterver, all prejudices will magically disappear and everybody will love you. People will even start understanding what you say and may even find your accent charming. Uncle Sam himself will then come and hug you, saying "welcome to America, my son... have a hamburger".

 

[deschutes]

Very interesting....anyone have numbers on current pathology trainees:
1.) foreign medical grads vs. AMGs
2.) ethnic make up
3.) US vs. Non-citizens

I'm sure the data is sitting in the ECFMG files waiting to be crunched. Someone might be able to get a poster at CAP/USCAP from this 😉

 

[djmd]

In fact, compared to all countries I know, the US medical education is pretty avarege as far as med school training. In most countries, training is much longer (6-7 years), usually with a couple of years of an internship type thing after the regular 2 yrs or so of clinical rotations. Education is generally more strict and way more practical.

Isn't that 6-7 years because a number of Other countries have people go to medicial school straight out of their High school level system??


Not that I am going to defend the american school system in general...

Man what we like bottom 5 of top 30 industrialized nations?

 

[TangataManu]

That's right, 6-7 yrs of med school straight out of regular school. Undergrad is a huge waste of time and money. Don't get me wrong, I also went to college before med school for a couple of yrs. The good thing about it was that I could party and go surfing almost every day, the bad thing was... well, everything else.

 

[dermpathlover]

i.e. the people who teach future generations of American med students. Hmm. I had a point but I forget what it is.

Well yeah I came across a ton of FMGs when being interviewed for residency. Some of them were the biggest names in path like the dudes on the cover of Robbins. I'd say half the people that interviewed me were FMGs. Some were no name staff faculty. Others were big shots. But that's cool.

 

[pathdoc68]

That's right, 6-7 yrs of med school straight out of regular school. Undergrad is a huge waste of time and money. Don't get me wrong, I also went to college before med school for a couple of yrs. The good thing about it was that I could party and go surfing almost every day, the bad thing was... well, everything else.

Great!!!! I am really sooo happy to hear that you think a physician should not be a broadly educated person. Sadly, standards are now so low. Are you really proud of spending your undergrad surfing? Give me a break, not at all surprising this comes from an FMG.

 

[yaah]

I also think the american system is preferable, of course I am biased. I don't think though that that implies someone who comes from another system is too narrowly focused or whatever.

I just appreciated the ability to have four years of college - when I started I sure as hell wasn't convinced medicine was the right career for me. More power to those who "know for sure" when they are in high school, but I always have felt people who know for sure when they are in high school haven't seriously considered other options.

Whether this makes me a better doctor I have no idea. I feel it gives me more of an appreciation for the world (both inside and outside of medicine), but that also might stem from parts of my personality.

In regards to the above, I would wager that american undergrads tend to waste far more time than the average nation.

 

[TangataManu]

Great!!!! I am really sooo happy to hear that you think a physician should not be a broadly educated person. Sadly, standards are now so low. Are you really proud of spending your undergrad surfing? Give me a break, not at all surprising this comes from an FMG.

Hey, I just gave my personal opinion about the system in this country as I see it, compared to other educational models I've seen in other parts of the world. But perhaps I'm wrong. I can see that your broad education has really served you well. You sound like a polite, sensitive, and open-minded young doctor. You'll do great in the multicultural world of pathology. Congratulations.

 

[LADoc00]

Hey, I just gave my personal opinion about the system in this country as I see it, compared to other educational models I've seen in other parts of the world. But perhaps I'm wrong. I can see that your broad education has really served you well. You sound like a polite, sensitive, and open-minded young doctor. You'll do great in the multicultural world of pathology. Congratulations.

I can tell you now from 20/20 hindsight and my own experience with Pathologists in large clinics in Northern Germany and England that there is ZERO question in my mind the Undergrad--->M.D. system is superior. A broad undergraduate education allows not only a better cultural indoctrination but prospectives beyond the often myopic healthcare world and science. Americans trained as such as far FAR better entrepreneurs than our counterparts across the big pond or in Asia. Anyone can read slides, only a chosen few will have a successful career doing it. Calling our undergrad a waste of money when docs in Germany or India or Pakistan or China doing the same thing (and working harder and longer hours) I do YET pull down 1/5 to 1/20 the wages is laughable and amusingly naive.

Congratulations, you saved a few thousand dollars in educational money only to be a lifetime biotch of big government healthcare.

Go back to school and try a class called "Economics and Finance."

Personally I would disallow medical degrees from other countries for licensure for this very reason. I have found these are often the pathologists that get used and abused by corporations and commericial labs and in the end lower the wages for everyone. A simple solution in my mind still is disallowing any funded residency slots for non-AMGs, given that residency salaries are paid for by the Social Security trust, something an IMG and his family would not have previously invested in.

 

[yaah]

Why is it that the US allows foreign credentials, whereas most other countries seem to not? This has always been something that confuses me - if I wanted to go work in Sweden I doubt I would have any success, right?

 

[quant]

Why is it that the US allows foreign credentials, whereas most other countries seem to not?

For the same reason that USA is the most powerful nation in the world, outpacing the nearest economy in size by as much as three times in GDP in spite of having a population size far less compared to others.

 

[quant]

Personally I would disallow medical degrees from other countries for licensure for this very reason. I have found these are often the pathologists that get used and abused by corporations and commericial labs and in the end lower the wages for everyone. A simple solution in my mind still is disallowing any funded residency slots for non-AMGs, given that residency salaries are paid for by the Social Security trust, something an IMG and his family would not have previously invested in.

Wouldnt work, since the very system which affords you to pull in 5 to 20 times more than your non USA government biotches, also gives the opportunity for corporations and commercial labs to compete against you.


In other words, Cant have your cake and eat it too...."Economics and finance 101"

 

[pathdawg]

I'm a foreign grad and I think I've been through each and every situation you guys have mentioned. Cultural differences, language problems, and so on. In general I have no problems with whatever comments are made about foreign grads, as long as they don't reflect total ignorance and are not based on pure prejudice.
What sometimes p**es me off is that some people have strong opinions about things they know nothing about. Comments on the quality of medical education in other countries is one good example. Some people seem to think that all foreign med schools are crappy old dumpsters forming second class doctors, not realizing that many, if not most of these schools have a level of competitiveness before, during, and after med school which is unheard of in this country, reflecting the generalized fierce competition for extremely limited resources that you see in these places. In fact, compared to all countries I know, the US medical education is pretty avarege as far as med school training. In most countries, training is much longer (6-7 years), usually with a couple of years of an internship type thing after the regular 2 yrs or so of clinical rotations. Education is generally more strict and way more practical. Residency programs, on the other hand tend to suck, and this is one of the reasons many people come here.
Great physicians in a foreign country, however, may be extremely unsuccessful in the US because of their failure to become familiar with the language and the cultural aspects of gringoland. I've seen that countless times.
Having said all this, I think the first point to consider in this discussion is the fact that most FMG's are living in foreing soil, trying to "compete" for a place in the sun with people who have been paying taxes from the minute they were born, who's families have built this nation with their labor, and who will almost invariably have astronomical loans at the end of their training. If giving preference to US grads for a training position is not fair, I don't know what is. Second, I think any foreigner who complains about having a hard time in the US should be awarded a one-way ticket back home and a visa cancellation. The reason I say this is very simple: NO country in the world is as open to foreigners as the United States. If you think it's hard to become a practicing physician in the US, just try anywhere else. Even the most sh***ty third world countries won't even allow foreigners to apply for training or licensing. A US trained physician, just out of their 4-yr med school, is not even eligible for residency training in most countries, including nearly all of Europe and the rest of the American continent.
Third, there is a lot of prejudice in the US, against everything and everyone. Nearly everybody is discriminated for one reason or another, you just have to deal with it. Being a FMG is just one reason for people to label you. But here's what I love most about this country: money speaks way, way louder than prejudice or anything else. If you are good enough to generate $$$ around here, be it for your ability as a researcher, diagnostic skills, talent in the porn industry, or whaterver, all prejudices will magically disappear and everybody will love you. People will even start understanding what you say and may even find your accent charming. Uncle Sam himself will then come and hug you, saying "welcome to America, my son... have a hamburger".

This is an excellent post. I agree with you that most foreign medical schools are indeed more competitive than U.S. schools in terms of selecting out the "creme de la creme". The issue many have with foreign schools (in general) is the varied standard(s) of care that a given country may practice relative to that of the U.S. The standard of care in the U.S., with the high level of litigation and the unsurpassed scrutiny under which we function is far different than most other countries. This may be a greater adjustment than language and cultural behavior.

I think this discussion is fascinating in that it reveals alot of prejudices, such as the above "not at all surprising this comes from an FMG" quote. Its a pretty simple mind that denegrates others simply to elevate oneself.

 

[DruidDoc]

I can tell you now from 20/20 hindsight and my own experience with Pathologists in large clinics in Northern Germany and England that there is ZERO question in my mind the Undergrad--->M.D. system is superior. A broad undergraduate education allows not only a better cultural indoctrination but prospectives beyond the often myopic healthcare world and science. Americans trained as such as far FAR better entrepreneurs than our counterparts across the big pond or in Asia. Anyone can read slides, only a chosen few will have a successful career doing it. Calling our undergrad a waste of money when docs in Germany or India or Pakistan or China doing the same thing (and working harder and longer hours) I do YET pull down 1/5 to 1/20 the wages is laughable and amusingly naive.

Congratulations, you saved a few thousand dollars in educational money only to be a lifetime biotch of big government healthcare.

Go back to school and try a class called "Economics and Finance."

Personally I would disallow medical degrees from other countries for licensure for this very reason. I have found these are often the pathologists that get used and abused by corporations and commericial labs and in the end lower the wages for everyone. A simple solution in my mind still is disallowing any funded residency slots for non-AMGs, given that residency salaries are paid for by the Social Security trust, something an IMG and his family would not have previously invested in.

 

[TangataManu]

This is an excellent post. I agree with you that most foreign medical schools are indeed more competitive than U.S. schools in terms of selecting out the "creme de la creme". The issue many have with foreign schools (in general) is the varied standard(s) of care that a given country may practice relative to that of the U.S. The standard of care in the U.S., with the high level of litigation and the unsurpassed scrutiny under which we function is far different than most other countries. This may be a greater adjustment than language and cultural behavior.

I think this discussion is fascinating in that it reveals alot of prejudices, such as the above "not at all surprising this comes from an FMG" quote. Its a pretty simple mind that denegrates others simply to elevate oneself.

Thank you Pathdawg. You are right about the different standards for the medical profession in different countries. One of the reasons why I came to the US was because I thought the medical care provided to patients in public/county hospitals in my homeland was suboptimal, and I did not feel comfortable with it. Over there, it all comes down to something very simple: you can only do what the very limited budget for healthcare allows. I agree that the standards are different here, but most of it is spent in a way so that your ass is covered, but that not necessarily translates into better patient care. Nice private hospitals in the US provide excellent medical care (which is true almost anywhere), while many county hospitals, including the ones I've worked as a medical resident, provide patient care that is not much better than that provided in much poorer countries. But they still spend money to cover their asses relatively well, because that's absolutely necessary in the US.
Fascinating discussion, I agree. Simple minded individual... certainly. Maybe he didn't take undergrad seriously enough.

 

[TangataManu]

I can tell you now from 20/20 hindsight and my own experience with Pathologists in large clinics in Northern Germany and England that there is ZERO question in my mind the Undergrad--->M.D. system is superior. A broad undergraduate education allows not only a better cultural indoctrination but prospectives beyond the often myopic healthcare world and science. Americans trained as such as far FAR better entrepreneurs than our counterparts across the big pond or in Asia. Anyone can read slides, only a chosen few will have a successful career doing it. Calling our undergrad a waste of money when docs in Germany or India or Pakistan or China doing the same thing (and working harder and longer hours) I do YET pull down 1/5 to 1/20 the wages is laughable and amusingly naive.

Congratulations, you saved a few thousand dollars in educational money only to be a lifetime biotch of big government healthcare.



About your idea of disallowing funding for non-AMG, it doesn't even make sense. Other countries invest their money to form qualified professionals, and the minute they're ready, the US gets the best of them for free. How stupid would it be to refuse a deal like that? Let me tell you something about your own country: way too many people are just like you, i.e. only care about money, and hiring foreign doctors is lucrative business for the nation - highly especilized professionals trained at no cost. Whether you like it or not, money screams too loudly for the voice of prejudice to be heard.

On a separate note, not everyone is in medicine for the money. As incredible as it may sound to you, there are people out there who are still genuinely interested in medicine and in science. From what I can see, this may never have crossed your mind. But I guarantee you, such people still exist. I won't go back to school or take economics classes for a very simple reason, I don't give a s##t about those things. The money any of us will make as physicians is more than enough to satisfy the needs of any sound human being. If you need more, it's your problem, I don't. People like you should be doing something else. Medicine is not the most lucrative "business" by any stretch of imagination, didn't you learn that in your economics class? or have they told you you'd get rich in medicine? even someone who didn't even complete undergrad like myself knows that. The other thing is, why would I take any advice from a loser who spends countless hours every single day posting crap on some random internet forum? Get a life, bro. I would also highly suggest some female company, that's a far better way of spending your free time. You'll have to trust my word on that one.

 

[deschutes]

Why is it that the US allows foreign credentials, whereas most other countries seem to not? This has always been something that confuses me - if I wanted to go work in Sweden I doubt I would have any success, right?

Why not? I don't know what you mean by "allows foreign credentials". For most countries you'd write the necessary licensing exams and meet the requirements of the national medical board and apply for a job. It's anyone's guess why Americans don't usually. Language, adaptability, monetary reward?

As Tangata alluded to in the previous post, the US does get a lot of fresh blood on short-term work visas, the terms of which I outlined in my last post. (But the US is not alone in this. And the effects of the infusion can obviously go either way.) A great deal of America's attraction is its large continguous landmass, a single predominant language, a relatively large population and a favourable exchange rate compared with many parts of the world.

I admit I'm a little mystified as to what the current discussion is about.
Is it about which is superior, the (North) American medical school system or other "foreign" med-ed systems? Does the world have to be uniform to be unified?

 

[malchik]

This discussion is about a lot of things, all of them interesting. But just to comment on Tangatu’s idea that college is a waste of time and money. The subsequent rebuttals to this statement were almost as absurd, suggesting the reasons it is not a waste is that it prepares students to function better in the business world. Look, the economic prosperity, high standard of living, progress in science, culture, and quality of life that the Western world currently enjoys is essentially a result of enlightenment ideas broadly adopted by an entire society because of liberal education. Not just learning a trade, but liberal education in the classic sense. If you doubt this, go visit the other thread about the sorry economic and cultural shape of northern Florida, and the entire American south by extension. It is a culture that does not value liberal education and this colors the entire economic and social landscape in such a way that provokes the kind of comments by northerners found in that thread. The best argument for college education is that it has the potential to produce a citizenry that is familiar with the world of ideas and knows how to think and read.

 

[pathdawg]

The best argument for college education is that it has the potential to produce a citizenry that is familiar with the world of ideas and knows how to think and read.

Word. Very well said.

 

[LADoc00]

On a separate note, not everyone is in medicine for the money. As incredible as it may sound to you, there are people out there who are still genuinely interested in medicine and in science. From what I can see, this may never have crossed your mind. But I guarantee you, such people still exist. I won't go back to school or take economics classes for a very simple reason, I don't give a s##t about those things. The money any of us will make as physicians is more than enough to satisfy the needs of any sound human being. If you need more, it's your problem, I don't.

Hahahahaha. Yes of course you didnt come to U.S. for the money or lifestyle, no FMG does right?? They come for pure love of medicine, right?
Do you just spout that crap or do you actually believe it?

Let me give you a reality check, if doctors do not pay attention to the business side of medicine, there is NO medicine. 9 hospitals in the greater Los Angeles area alone have closed in the last 10 years. Numerous hospitals are on their way to bankruptcy. Pathology at one point had an astronomical 20% unemployment rate, almost 4x the national average. Reimbursement for many things in healthcare are now lower than their 1973 rate, even before adjusting for inflation.

See, EVERYTHING crosses my mind, but you have really proved my point of the stereotype of the myopic naive FMG.

You are not back in the socialized medical world of the motherland, you are in America, a small decaying bastion of a once great capitalist dream. Welcome to the Jungle.

Peace.

 

[mlw03]

Well this has gotten a little on the nasty side. I think all have made a lot of good points, and I can see multiple perspectives. My personal opinion is that undergrad life is important because 1) I'm a helluva lot more mature now than I was at 18 and 2) other knowledge is helpful (arts, sociology, economics, religion, etc) in making you a well-rounded human being, which I believe makes for happier doctors.

 

[DMD-2-B]

This is an excellent post. I agree with you that most foreign medical schools are indeed more competitive than U.S. schools in terms of selecting out the "creme de la creme". The issue many have with foreign schools (in general) is the varied standard(s) of care that a given country may practice relative to that of the U.S. The standard of care in the U.S., with the high level of litigation and the unsurpassed scrutiny under which we function is far different than most other countries. This may be a greater adjustment than language and cultural behavior.

I think this discussion is fascinating in that it reveals alot of prejudices, such as the above "not at all surprising this comes from an FMG" quote. Its a pretty simple mind that denegrates others simply to elevate oneself.

I also agree about the greater selectivity of foreign medical schools. My husband went to medical school in Egypt. They start a seven year program staight out of highschool. The standardized test for highschool grads is a mega-final exam, cumulative for all four years of high-school covering all topics. Your future is based on your score - plain and simple. The required score for students to enter medical school is a 98.5%. That's the equivalent of a 4.0 and from what I've seen, being born, raised and educated in the American system but having many many friends who came straight from Egypt, their schooling seems WAY harder. Succeeding here in highschool or college pretty much entails being focused and organized - time management and determination. Over there it takes even more than that - huge self sacrafice. For examples, all his exams back home were essay questions that often required 15 - 20 page responses (with biological diagrams that were also graded), not multiple choice!

But I also agree that the undergraduate education (4 year college) is a way better system. I am a lot more mentally trained to ponder certain aspects of society and the world, heck even mathematics, than my husband is simply because he didn't study as broad a range of topics as I. I wouldn't go so far as to disallow peoeple who've had such an education from practicing here though. My husband is extremely intellegent and has a sincere love for medicine. He's a great doctor, regardless of how his undergraduate system was structured.

As for my own experience, where I went to undergrad there were A LOT of foreigners and foreign teachers. I studied mech engineering, which had even a higher percentage of foreigners. I remember one professor who couldn't get the name of our validictorian correct. Even on the last day of class he referred to her as "Vanilla" in stead of "Vanessa." And trust me - he wasnt trying to be funny - he was dry as bone this guy! Anyway - I came to learn how to focus in on their accents until I was able to clearly interperet any teacher that was talking regardless of how thick their accent was. I applied the technique to some classmates who I had otherwise just ignored, and soon started making very interesting friends who have helped expand my view of the world by sharing their experiences of life in other countries.

 

[DMD-2-B]

Hahahahaha. Yes of course you didnt come to U.S. for the money or lifestyle, no FMG does right?? They come for pure love of medicine, right?
Do you just spout that crap or do you actually believe it?

Let me give you a reality check, if doctors do not pay attention to the business side of medicine, there is NO medicine. 9 hospitals in the greater Los Angeles area alone have closed in the last 10 years. Numerous hospitals are on their way to bankruptcy. Pathology at one point had an astronomical 20% unemployment rate, almost 4x the national average. Reimbursement for many things in healthcare are now lower than their 1973 rate, even before adjusting for inflation.

See, EVERYTHING crosses my mind, but you have really proved my point of the stereotype of the myopic naive FMG.

You are not back in the socialized medical world of the motherland, you are in America, a small decaying bastion of a once great capitalist dream. Welcome to the Jungle.

Peace.

I think you have a very narrow minded attitude. You probably dont know very much, or have too limited an imagination to truly wrap your heart and mind around, what life is like in some other countries. Many foreigners come to America to chase the American dream, but the motivations are hardly as shallow as simply more $. There is real oppression in other places - people are silenced, robbed by their gobvernments, treated like animals, killed. All these things really happen and its human nature to seek security in our lives. Also - you try practicing medicine outside the US. Just try it. Imagine working at a hospital that's so undersupplied because the government robs its people, so undersupplied that latex gloves need to be recycled and worn from one patient to the next. Imagine having only 100,000 vaccines and 200,000 people who need them. Now imagine administering them with only 50,000 syringes. Imagine a hosptial where the MRI machine works sometimes, other times not. The lab work you send in that comes back negative, yet your patient is exhibiting CLEAR signs of illness. Man, u have no idea about conditions in other parts of the world... It is VERY possible, I would say even likely, that foreign doctors come to America holding the desire to practice better medicine as one of their main reasons.

Also - how on earth can you stereotype a typical FMG? It's impossible, especially being that they come from different countries all over the world. I think you have a seed of hatred in your heart that taints your perspective of foreigners. I've seen this quality in others through out my life, and have never really understood it. I mean first of all, it's self-limiting. And when I refer to self, I mean the possessor of the prejeduce. You cast your hatred on someone before even trying to learn a little more about who they are. You trap yourself in a cage because you miss out on what could potentially be a rewarding relationship. Furthermore, it eats you up inside. I cant imagine what it must feel like to have that kind of hatred boiling under your skin, but I imagine it to be very difficult. I pity angry people, as much as they scare me. I grew up in a very white affluent town, and yes everyone was rich and had a mercedes or bmw, but seeing the hatred in some people made me realize I would rather be poor than be like them. On the other hand, the financially accomplished citizens of my town who possessed an open mind and heart, who had love in their hearts, my hat's off to them. They are truly beautiful people.

Also - I'm not sure who needs to be reminded more of the fact that he/she is in America, you or the poster you were responding to. Do you remember what the founding fathers worked so hard for? The oppression that they faced by the british? Freedom for ALL, not just for citizens of the US my friend. The concept is bigger than the boundaries of nations.

 

[LADoc00]

I think you have a very narrow minded attitude. You probably dont know very much, or have too limited an imagination to truly wrap your heart and mind around, what life is like in some other countries. Many foreigners come to America to chase the American dream, but the motivations are hardly as shallow as simply more $. There is real oppression in other places - people are silenced, robbed by their gobvernments, treated like animals, killed. All these things really happen and its human nature to seek security in our lives. Also - you try practicing medicine outside the US. Just try it. Imagine working at a hospital that's so undersupplied because the government robs its people, so undersupplied that latex gloves need to be recycled and worn from one patient to the next. Imagine having only 100,000 vaccines and 200,000 people who need them. Now imagine administering them with only 50,000 syringes. Imagine a hosptial where the MRI machine works sometimes, other times not. The lab work you send in that comes back negative, yet your patient is exhibiting CLEAR signs of illness. Man, u have no idea about conditions in other parts of the world... It is VERY possible, I would say even likely, that foreign doctors come to America holding the desire to practice better medicine as one of their main reasons.

Also - how on earth can you stereotype a typical FMG? It's impossible, especially being that they come from different countries all over the world. I think you have a seed of hatred in your heart that taints your perspective of foreigners. I've seen this quality in others through out my life, and have never really understood it. I mean first of all, it's self-limiting. And when I refer to self, I mean the possessor of the prejeduce. You cast your hatred on someone before even trying to learn a little more about who they are. You trap yourself in a cage because you miss out on what could potentially be a rewarding relationship. Furthermore, it eats you up inside. I cant imagine what it must feel like to have that kind of hatred boiling under your skin, but I imagine it to be very difficult. I pity angry people, as much as they scare me. [nice nice] I grew up in a very white affluent town, and yes everyone was rich and had a mercedes or bmw, but seeing the hatred in some people made me realize I would rather be poor than be like them. On the other hand, the financially accomplished citizens of my town who possessed an open mind and heart, who had love in their hearts, [classic, Im glad you possessive the mystical ability to see that] my hat's off to them. They are truly beautiful people.

Also - I'm not sure who needs to be reminded more of the fact that he/she is in America, you or the poster you were responding to. Do you remember what the founding fathers worked so hard for? The oppression that they faced by the british? Freedom for ALL, not just for citizens of the US my friend. [bravo, what PAC should I contribute to??] The concept is bigger than the boundaries of nations.

Please spare me your neo-leftist feel good speech. My point is extremely valid. The commericial medical system in the US as it currently stands heavily profits off FMGs especially in pathology, who train here and get snapped up by corporations who know they will work for cheap and keep quiet. Im not blaming FMGs AT ALL, they are hardworking honest people, but as it currently stands they are:
1.) impacting the already tight and highly competitive US medical labor market
2.) seriously comprising the medical expertise of their home country by contributing to a brain drain

If conditions are in the rest of the world are as bad as you say, and I dont necc. doubt you, then why the hell arent these FMGs working to improve them?! Why flee? FFS, whatever country you come from at least have the pride to stick it out there and struggle/fight for change.

I'll admit some of my ancestors came here fleeing Imperial England and frankly that is ***** way out. But still, when you are doctor in a comfortable arrangement in say Pakistan or Egypt or wherever, and there are people THERE who's very lives friggin depend on you and you BAIL, dont come here and post all self-righteous. Its a serious insult to our readers intelligence. It must eat YOU up I actually see through the B.S. smokescreen and recognize the dollar signs in their eyes.

I will be the first to profess the absolute unbreakable determinism and sheer willpower most FMGs have, but please please dont give me Hillary Clinton-esque soapbox crap about how much they love "Freedom", whatever the hell that is.

Did you really write that or just cut and paste from a Howard Dean email??

 

[DMD-2-B]

Please spare me your neo-leftist feel good speech. My point is extremely valid. The commericial medical system in the US as it currently stands heavily profits off FMGs especially in pathology, who train here and get snapped up by corporations who know they will work for cheap and keep quiet. Im not blaming FMGs AT ALL, they are hardworking honest people, but as it currently stands they are:
1.) impacting the already tight and highly competitive US medical labor market
2.) seriously comprising the medical expertise of their home country by contributing to a brain drain

If conditions are in the rest of the world are as bad as you say, and I dont necc. doubt you, then why the hell arent these FMGs working to improve them?! Why flee? FFS, whatever country you come from at least have the pride to stick it out there and struggle/fight for change.

I'll admit some of my ancestors came here fleeing Imperial England and frankly that is ***** way out. But still, when you are doctor in a comfortable arrangement in say Pakistan or Egypt or wherever, and there are people THERE who's very lives friggin depend on you and you BAIL, dont come here and post all self-righteous. Its a serious insult to our readers intelligence. It must eat YOU up I actually see through the B.S. smokescreen and recognize the dollar signs in their eyes.

I will be the first to profess the absolute unbreakable determinism and sheer willpower most FMGs have, but please please dont give me Hillary Clinton-esque soapbox crap about how much they love "Freedom", whatever the hell that is.

Did you really write that or just cut and paste from a Howard Dean email??

Your sarcasim is completely immature. Its not the conversation of adults.

But anyway, you CLEARLY don't know much about living in other countries. You say that its the ***** way out to leave? I agree with you only in SOME cases. In cases where the governments don't lock up or execute those who speak. The system is bigger than one person, and when the army will break up protests with machine guns clearly it's bigger than the masses too. Sometimes, no wait - MOST times, the doctors are helpless to make changes.

And listen, where a person is born has nothing to do with where his/her loyalty lies. Perhaps loyalty lies with a principle and decree rather than with some nationality that we were born into with out choice.

They don't necessarily contribute to a brain drain either, although I'll admitt I like the catchy description. There are usually plenty of intellegent people who stick around and you know what - check back on them around retirement time. Ask them how much of a difference they were able to make.

Your entitled to be frustrated, if you insist to be, on the tight market. But if that's how you feel why don't you take it up with the immigrations office. It is they afterall, and not the FMGs they allow to enter, that pre-determine the quotas based on what they think would be best for the American economy (and whatever other intricate considerations they take into account). Don't take it out on the FMGs man, they're not the policy makers here.

And just wondering, what makes you think you know anything about the lifestyles in Egypt or Pakistan? My guess is you know NOTHING.