That bill was passed last week
Have to disagree. I’d take a fully licensed MD from the UK or Italy or Lebanon who has completed what’s usually a much longer residency than the US and been practicing independently in their home country for 3 years, over a US-trained midlevel any day. Just for further safety, these docs still have to practice under some supervision for 2 years in the US at a teaching hospital and get signed off that they’re safe to practice.This is a disaster and is the first step towards something that will be 10000x worse than mid level independent practice
How about an HCA GME location? Find the original TN bill and follow the money!Have to disagree. I’d take a fully licensed MD from the UK or Italy or Lebanon who has completed what’s usually a much longer residency than the US and been practicing independently in their home country for 3 years, over a US-trained midlevel any day. Just for further safety, these docs still have to practice under some supervision for 2 years in the US at a teaching hospital and get signed off that they’re safe to practice.
That’s a lot more scrutiny than midlevels where you can do an online NP and shadow for a few months and voila you’re ready!
The teaching hospital provision will also limit the reach of this a bit. Only a few residency programs in the state.
It’s not like they’re handing out licenses to Caribbean grads with no residency training.
Just for further safety, these docs still have to practice under some supervision for 2 years in the US at a teaching hospital and get signed off that they’re safe to practice.
They only have programs in a few specialties but presumably they have the infrastructure in place to supervise and sign off on these foreign docs.How about an HCA GME location?
I think every single state should do this for especially primary care with the stipulalion that these physicians have to work for 2-3 years in designated rural areasHave to disagree. I’d take a fully licensed MD from the UK or Italy or Lebanon who has completed what’s usually a much longer residency than the US and been practicing independently in their home country for 3 years, over a US-trained midlevel any day. Just for further safety, these docs still have to practice under some supervision for 2 years in the US at a teaching hospital and get signed off that they’re safe to practice.
That’s a lot more scrutiny than midlevels where you can do an online NP and shadow for a few months and voila you’re ready!
The teaching hospital provision will also limit the reach of this a bit. Only a few residency programs in the state.
It’s not like they’re handing out licenses to Caribbean grads with no residency training.
Somewhat, though these docs would have much more experience in practice than a typical resident.Isn’t this basically a resident in their final years?
How so? If they can pass the USMLE and can't get a full license until after working for several years in rural areas, how is this worse than an unsupervised nurse practitioner with an online degree practicing alone in a rural emergency department?This is a disaster and is the first step towards something that will be 10000x worse than mid level independent practice
Well I’d say maybe wait and see how it goes for TN first, but yes if it works out then worth expanding.I think every single state should do this for especially primary care with the stipulalion that these physicians have to work for 2-3 years in designated rural areas
Maybe over time, but I don’t think the pace of this program will be fast enough to have a big market effect. The hoops these docs have to jump through are massive. The caveat is if HCA and the like just keep these folks provisional while paying them peanuts.I think the care would be far better but physician salaries would plummet. Would be like EM for all specialties. Doing 3+ fellowships just to get a job
Yeah it will be interesting to see. I suspect that the cost of living in the major areas plus the higher salaries just outside them may drive many of these docs out of the saturated markets.I don't see why foreign docs would gravitate to rural areas. Even academic US salaries are pretty high compared to most of their home countries, combined with much less, if any debt. And cultural/social factors depending on the area.
Because for them, living in rural TN is an improvement over practicing in, say, Yemen, Burma, Cambodia, either Sudan or Guatemala.I don't see why foreign docs would gravitate to rural areas. Even academic US salaries are pretty high compared to most of their home countries, combined with much less, if any debt. And cultural/social factors depending on the area.
Wouldn’t hospitals like hca go above and beyond to sponsor them if it meant saving money on laborThis isn't going to be some "open the floodgates fearmongering" type of deal because the FMG needs to be a US citizen/PR/have a work permit when they apply. That's a significant bottleneck, and for those who haven't gone through the USCIS it is an absolutely huge time sink and PITA.
This is absolutely not going to cause physician comp to plummet because the number of FMGs getting through USCIS over time will be inconsequential to the total # of new physicians graduating per year. There isn't a "physician spot" for immigration, since IIRC USCIS currently works based off quotas and caps for each country (ofc this may change, but unlikely).
Wouldn’t hospitals like hca go above and beyond to sponsor them if it meant saving money on labor
Plenty of FMGs come over here and don't end up practicing but still get citizenship through other means. I met several in the Army who were serving in healthcare adjacent jobs (like environmental health or medical logistics) but had been doctors in their home countries.This isn't going to be some "open the floodgates fearmongering" type of deal because the FMG needs to be a US citizen/PR/have a work permit when they apply. That's a significant bottleneck, and for those who haven't gone through the USCIS it is an absolutely huge time sink and PITA.
This is absolutely not going to cause physician comp to plummet because the number of FMGs getting through USCIS over time will be inconsequential to the total # of new physicians graduating per year. There isn't a "physician spot" for immigration, since IIRC USCIS currently works based off quotas and caps for each country (ofc this may change, but unlikely).
Plenty of FMGs come over here and don't end up practicing but still get citizenship through other means. I met several in the Army who were serving in healthcare adjacent jobs (like environmental health or medical logistics) but had been doctors in their home countries.
What’s to stop a few “degree mills” from popping up around the world with no central accrediting agency? Seems like a lot of people would pay $$ to practice in the US. Seems like a slippery slope
ECFMG certification is getting big changes for 2024's match. I imagine that those applying to this program will likely have to obtain this certification as well.What’s to stop a few “degree mills” from popping up around the world with no central accrediting agency? Seems like a lot of people would pay $$ to practice in the US. Seems like a slippery slope
It likely will if HCA sees success with it.Ya this pretty much seems like a disaster if it spreads to other states
Just give it timeWould these docs be eligible for board certification though?
Because for them, living in rural TN is an improvement over practicing in, say, Yemen, Burma, Cambodia, either Sudan or Guatemala.
It's very expensive to sponsor foreign workers and they can't just sponsor EVERYONE. The company needs to show that they have exhausted their options trying to fill the employment spot with US workers and that the foreign worker is the best option given the situation. It's not something they can do willy nilly.
Why wouldn’t hospitals and or boards just change their policies. Would insurance possibly be able to pay less for these physicians? If so why not just alter their own rules. What if Medicare decides to reimburse them at similar rates?Being able to practice and being able to bill are two entirely separate things. Someone with no residency training will not be board certified and thus ineligible to bill for most services under most insurance policies. You can give people medical licenses all you want, but they are worthless without actually being able to charge for their services. The other major issue is that privileges at most hospitals require board certification or board eligibility, something that would be impossible to get for someone using this pathway. Finally, no insurer would cover someone that hasn't completed US training. It's a proposal that looks good on paper but which does nothing in reality, aside from allowing uninsured physicians to run cash-only practices if they can find a hospital system that will let them practice for two years while not being able to bill a dime first.
Creating a second payor class would be legally and ethically dubious. Can you imagine the headlines painting systems as racist for underpaying foreign workers while pushing for NP pay parity?Why wouldn’t hospitals and or boards just change their policies. Would insurance possibly be able to pay less for these physicians? If so why not just alter their own rules. What if Medicare decides to reimburse them at similar rates?
Do other countries charge 400k for medical school at 8.5%The rest of the world has similar systems to recognize foreign educated physicians and allow them to intregrate.
If somebody:
Then that person has the same competency to practice as their american counterparts
- Graduated from an accredited university
- Passed the same medical license examination like anybody else in the US
- Holds a legal permit to live in the country
- Has completed a medical residency deemed equivalent by the respective american board
I think many people don't even know how rigorous the Accreditation Policy of the ECFMG is. It took my university 4 years to achieve the recognition of the WFME after the ECFMG announced such policy change. They even take into consideration things like how wheelchair accessible the campus is.
Many people in the US disregard the rest of the world's education as sub-par and think that the US healthcare system is the best in the world. When important figures such as accesibility and mortality rates say otherwise. Sure, salaries are ridiculously better than in any other country, but that's a symptom of systemic problems, a whole can of worms that I don't want to open right now.
Some people comparing international graduates that have completed 6 years of medical school + 5 (in many cases) years of residency and have years of experience, to mid-levels in the US. You need a psych consult, STAT.
I'll quote myself . "symptom of systemic problems, a whole can of worms that I don't want to open right now"Do other countries charge 400k for medical school at 8.5%
Don’t residents work like 30 hours per week in Europe. In what world is that equivalent to US trainingI'll quote myself . "symptom of systemic problems, a whole can of worms that I don't want to open right now"
The cost of education isn't an argument against recognizing foreign professionals
Don’t residents work like 30 hours per week in Europe. In what world is that equivalent to US training
It isn't about whether it is good or not, it is about whether it is a known quantity or not. There are absolutely countries with lower quality GME than the United States, or even programs within countries that otherwise have high-quality GME. There's a lot of countries where greasing palms with cash can turn failure to a pass. We have no idea what the local reputations of given programs are, nor what their training standards are, nor whether these standards are directly comparable to those in the United States. This represents an unknown quantity. A foreign physician may be a superstar, or they may be hot garbage, we have no standardized way of knowing. We at least know that those completing ACGME training have met a certain standard of competence and that their program was of a reasonable level of quality. Even within the United States, AOA programs were considered an unknown quantity and many employers would not hire graduates from these programs in fields like radiology or anesthesia, and these were people that were trained domestically.The rest of the world has similar systems to recognize foreign educated physicians and allow them to intregrate.
If somebody:
Then that person has the same competency to practice as their american counterparts
- Graduated from an accredited university
- Passed the same medical license examination like anybody else in the US
- Holds a legal permit to live in the country
- Has completed a medical residency deemed equivalent by the respective american board
I think many people don't even know how rigorous the Accreditation Policy of the ECFMG is. It took my university 4 years to achieve the recognition of the WFME after the ECFMG announced such policy change. They even take into consideration things like how wheelchair accessible the campus is.
Many people in the US disregard the rest of the world's education as sub-par and think that the US healthcare system is the best in the world. When important figures such as accesibility and mortality rates say otherwise. Sure, salaries are ridiculously better than in any other country, but that's a symptom of systemic problems, a whole can of worms that I don't want to open right now.
Some people comparing international graduates that have completed 6 years of medical school + 5 (in many cases) years of residency and have years of experience, to mid-levels in the US. You need a psych consult, STAT.
Excellent points.Creating a second payor class would be legally and ethically dubious. Can you imagine the headlines painting systems as racist for underpaying foreign workers while pushing for NP pay parity?
Hospitals would open themselves to liability by bringing in unknown quantities. When you bring in someone board certified and trained in the US, you are putting it on those systems that these are competent practitioners, thus the liability falls on them until proof can be shown that the system neglected indications they were a problem. For a foreign-trained doctor the liability would be entirely on the hospital in a legal setting, as they would be the ones attesting to the doctor's competence rather than a board and the ACGME. That's a big can of worms to open. For similar reasons, liability coverage won't be obtainable because they represent an unknown quantity and insurance is all about calculating the risks of known quantities.
As to insurance companies, they want less doctors on their payrolls, not more. More doctors means more claims. They want the lowest legally justifiable number of physicians on their payroll that they can get away with, which is why their panels are often closed to join in many areas.
Now, on to Medicaid and Medicare. Medicare is very US-focused, for obvious political reasons. Changing it to favor foreign physicians would be a death knell for Republican lawmakers, as they would both be encouraging immigration and disadvantaging American workers. I was in DC recently advocating for the Conrad 30 to be extended and expanded and was told by one of the senior policy advisors for a member of the house that it's very touchy right now due to immigration in general abs the GOP wanting to be viewed as tough on immigration. I was like, "so you're telling me they would rather waste hundreds of thousands of dollars sending physicians we've already paid to train back to their home countries and let their own constituents go without care just because that care happens to be provided by an immigrant?" And the answer I got was, "unfortunately that isn't how their constituents see it, but yes, that's the ultimate effect."
The sky isn't falling, this will likely end up like the "Assistant Physician" law that got passed and resulted in basically no one practicing under its auspices for similar reasons.