Foreign MD option no longer possible by 2016?

[iguodala76ers]

http://forums.studentdoctor.net/showthread.php?t=681809

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[RKNY]

You're right in that it's going to get much more harder to match into a residency as an IMG by that year. It is not impossible but already US medical schools have increased their enrollment. Now we can't really say if all those students will choose the specialty that you want to choose (primary care) but I think most of those students will end up there.

If you do choose to go foreign just be careful to not get delayed graduating (needing to take a class over). You have to factor that in as well as factor in the time that you would need to prepare for your board exams. Currently it's hard to say what the future holds but it's good that you're thinking about it thoroughly.

The MSN/DNP route is not a bad way to go either but is it something that you really want to do honestly? Or is it just for the financial security? What would be the motive behind you choosing that route if you do. Just ask yourself that and you should be able to decide yay or nay to that.

If it's your dream to be a physician though and you have the resources to do so I say go ahead and do it. Make sure you go prepared and ready to take on what's coming to you. Med school isn't easy obviously but it's harder because you're not as close to home.

 

[lmesina]

Isn't the fact that there are thousands of empty primary care resident seats In the US almost a guarantee that a FMG from say, the Philippines who has a strong record of sending physicians here, a spot in at least primary care?

I guess that US med schools are offering more seats but is it enough to compensate for the many (I've heard around 8000 unfilled primary care spots) seats available not even being filled after letting FMGs in?

I'm interested in getting my education abroad, but I want to be realistic about the prospects of actually being able to return to the US to practice. And finally, a FMG with an MD, or a U.S. Educated DO? Not quite sure what specialty yet, but wouldn't mind primary care.

 

[RKNY]

Isn't the fact that there are thousands of empty primary care resident seats In the US almost a guarantee that a FMG from say, the Philippines who has a strong record of sending physicians here, a spot in at least primary care?

I guess that US med schools are offering more seats but is it enough to compensate for the many (I've heard around 8000 unfilled primary care spots) seats available not even being filled after letting FMGs in?

I'm interested in getting my education abroad, but I want to be realistic about the prospects of actually being able to return to the US to practice. And finally, a FMG with an MD, or a U.S. Educated DO? Not quite sure what specialty yet, but wouldn't mind primary care.

Actual match results from the NRMP show that there are more applicants than residency spots. Then again there are lots of factors in these numbers such as the applicants (which specialty they chose, location, hospital).

IMGs (citizens/non-citizens) are at a slight disadvantage in applying for residencies. In 2010, 50% of IMGs were able to match and the others were left to scramble at other locations they didn't choose or have to delay a year and try again which can be very cumbersome.

Nothing is really guaranteed nor impossible...just make sure to do your homework before you decide in whatever you choose to do.

For landing a residency spot in the US...a US educated D.O. will always put you at an advantage compared to schools in the Philippines at least.

 

[pr0j3ktm]

just wanna put my two cents in. i dont think there's gonna be slim pickings for residency at all..ive attached two articles regarding the issue.

the future looks bright

A health care "disaster" is brewing in the United States, according to El Monte doctor Ignacio de Artola.
Twenty-five percent of Americans have health problems that dramatically increase their risk of developing heart disease and diabetes. Among Latinos, that incidence jumps to 50 percent.
But disaster can be averted if these people get access to regular primary care, according to de Artola, who is director of the Cleaver Family Wellness Clinic in El Monte and a professor at the University of Southern California.
Like all things in health care, that is easier said than done.
The federal health care reform approved earlier this year attempts to address half of the equation by providing health insurance to millions of Americans.
The other half is making sure everyone has access to primary care doctors.
So far they don't.
The nation as a whole is suffering a primary care doctor shortage to the tune of 16,000 doctors, according to the U.S. Department of Health and Human Services. By 2025, that shortage will jump to 125,000 doctors, according to the Association of American Medical Colleges (AAMC).
Locally, the shortage is more severe in some economically disadvantaged and minority communities - the very communities that experts say will be hardest hit by chronic diseases like heart disease and diabetes.
"We are going to have a much bigger problem once everyone is insured. Already there are not enough doctors to see patients, especially in Latino, African-American and rural communities," said Assemblyman Ed Hernandez, who has sponsored legislation to address the shortage on a state level. "What good is it going to do to have health insurance if you don't have access? It is not going to save any money, or improve anyone's health." While parts of federal health care reform could temporarily exacerbate the shortage, portions could help.
So San Gabriel Valley hospitals, doctors, clinics and long-term care providers are teaming up in an unprecedented partnership to find ways to provide patient care under a new reform paradigm.
"We are all looking at a need to change, transform. It is not going to be business as usual anymore, and that is being driven by this new law ... there is this new sense of urgency to truly transform and find more effective ways to partner," said Allen Miller, vice president of strategic planning and corporate development of Citrus Valley Health Partners.
A diversity of solutions have been proposed - from starting a residency program in the San Gabriel Valley to restoring affirmative action policies in University of California schools to developing Kaiser Permanente-like partnerships between doctors and hospitals in the San Gabriel Valley.
"We are looking at health care reform as this freight train coming at us, and we are trying to prepare. We have to become more efficient," said Dr. Cristian Rico, regional medical director of AltaMed clinics.
Training for care
The doctor shortage begins with a deficit of space at medical schools and in residency programs to produce the necessary number of primary care doctors.
For decades, physicians organizations warned of a surplus of doctors and encouraged policies to avoid a glut. Then in 2002, the AAMC reversed that long-standing view with the statement: "It now appears that those predictions may be in error."
The AAMC quickly set a goal of increasing the number of medical school graduates by 30 percent by 2015. But even that ambitious goal will not close the gap, considering increased demand and a large number of doctors retiring.
Despite significant population growth, in California the number of medical school graduates hasn't increased in 15 years. California has 17 medical school slots per 100,000 people, compared with 30 per 100,000 in the rest of the nation, according to Dr. Richard Olds, founding dean of the new medical school at the University of California, Riverside.
That school, slated to open in 2012, is part of the state's solution to addressing the shortage. In addition, the University of California has plans to expand enrollment in its five existing medical schools, and is developing a new medical school at UC Merced.
Once medical students complete their schooling, they need hospitals to perform their residencies. And where doctors do their residencies can be a deciding factor in where they stay to practice medicine.
But the San Gabriel Valley has no residency programs. Previous federal policies aimed at avoiding a doctor surplus made establishing a program very difficult, experts say.
Health care reform appears to have changed that, Miller said.
So the local partnership of hospitals, doctors and clinics is working to establish a residency program in the San Gabriel Valley.
"There are now opportunities that there weren't before," Miller said.
Diversity desired
Addressing the primary care doctor shortage in the San Gabriel Valley isn't just about producing more doctors, it's also about the type of doctors produced.
More culturally sensitive doctors, particularly Latinos, who are willing to work not only in primary care, but also with underserved populations, are needed, according to experts. And if the current deficit is any indication, that is a tall order to fill, they say.
Producing one might produce the other. Ethnic physicians are more likely to serve in underserved areas than their white counterparts, and more likely to work in primary care, according to a study by the UCSF Health Workforce Center.
Still, decades of efforts to increase diversity among doctors have produced few results. Only 5 percent of doctors in Los Angeles County are Latino, though 47 percent of the population is Latino.
"Giving the changing demographics in California, we would have to fill the entire medical school enrollments with people who are committed to the Latino community in order to begin to match the growth there," said Lawrence Doyle, executive director of UCLA's PRogram in Medical Education (PRIME).
The PRIME programs are one effort by the UC system to train future physicians to work in underserved communities.
Though small, evidence shows the programs work, Doyle said.
So UC is expanding the programs from an estimated 200 students statewide this year to 300 within two years. Still, they represent only a fraction of all UC medical students.
Universities and hospitals are also placing hope in pipeline programs aimed at attracting students from diverse backgrounds into the medical profession when they are young, and providing appropriate guidance through medical school and their residencies, such as that at Charles R. Drew University in South Los Angeles.
Citrus Valley Health Partners has developed its own program to attract students in the San Gabriel Valley. College students and mid-career adults are introduced to health professions by working as volunteers at Citrus Valley hospitals. The hope is that, when they complete their schooling, they will stay to provide care in the community, whether it is as a doctor, nurse or technician.
And that program, too, is working, according to leaders.
"This is where I learned I want to be in nurse, so it is where I will stay. It's where I want to be for the rest of my life," said program participant Tanya Su, 28, a Rowland Heights resident.
Forcing diversity
A handful of programs aimed at increasing diversity and inspiring people into primary care can't alone produce the necessary sea change to meet the shortage and close health care disparities, according to Olds.
Increasing the number and diversity of doctors willing to work in primary care in disadvantaged communities will take medical schools fundamentally reforming the way they evaluate applicants in the highly competitive selection process, according to Olds.
Instead of focusing exclusively on test scores and grades, medical schools need to consider students who show the highest likelihood of working in the neediest sectors, Olds said.
And that is precisely what he said he will do at Riverside's new medical school - a policy that Olds said will help the San Gabriel Valley.
Only about one out of every five qualified applicants is accepted into a California medical school, Olds said.
"The question is, among the five Californians, are we picking the right one?" Olds asked. "I would argue that if you want an outcome of someone working in Riverside, maybe we don't want the kid with the best MCAT score. Given our mission, do we want someone from San Francisco, or do we want someone from Riverside?"
But Olds admits his proposal is "a pretty radical idea." He is hoping UC Riverside will serve as a model to others.
And Doyle says since UC's are partially funded by the state, they should pay attention.
"Given that we are paid for in part by the state of California, part of our obligation is to create physicians that serve the people of the state," Doyle said.
Assemblyman Hernandez wants deans to more than just chose to change their admittance policies. He is floating an idea to reform Proposition 209, the initiative passed by voters in 1996 outlawing affirmative action policies in public institutions. Hernandez has sponsored legislation that would authorize the University of California and California State University to consider "race, gender, ethnicity, national origin, geographic origin and household income" in undergraduate and graduate admissions, until 2020.
Money talks
While efforts to increase diversity among doctors will help the shortage, the best answer is to pay more for doctors to deliver primary care, and pay more for them to deliver it in underserved communities, according to de Artola.
"I don't want to be negative about humanity, but my experience, after 50-something years, is that people respond to money," he said.
Primary care doctors sometimes earn half or one-third what some surgeons and specialists do. For example, according to a 2009 physician compensation survey by the American Medical Group Association, internal medicine doctors in the Western United States earn $215,000 annually, while cardiac and thoracic surgeons earn $570,000.
That disparity is even worse in underserved communities, where a disproportionate amount of people are on MediCal, whose reimbursement rates are notoriously low.

via: Diverse proposals aim to address doctor shortage, avert care crisis - Whittier Daily News http://www.whittierdailynews.com/news/ci_15706161#ixzz0wCcozU60

and

The new federal health-care law has raised the stakes for hospitals and schools already scrambling to train more doctors.
Experts warn there won't be enough doctors to treat the millions of people newly insured under the law. At current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges.
That shortfall is predicted despite a push by teaching hospitals and medical schools to boost the number of U.S. doctors, which now totals about 954,000.
The greatest demand will be for primary-care physicians. These general practitioners, internists, family physicians and pediatricians will have a larger role under the new law, coordinating care for each patient.
The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007.

A shortage of primary-care and other physicians could mean more-limited access to health care and longer wait times for patients.
Proponents of the new health-care law say it does attempt to address the physician shortage. The law offers sweeteners to encourage more people to enter medical professions, and a 10% Medicare pay boost for primary-care doctors.
Meanwhile, a number of new medical schools have opened around the country recently. As of last October, four new medical schools enrolled a total of about 190 students, and 12 medical schools raised the enrollment of first-year students by a total of 150 slots, according to the AAMC. Some 18,000 students entered U.S. medical schools in the fall of 2009, the AAMC says.
But medical colleges and hospitals warn that these efforts will hit a big bottleneck: There is a shortage of medical resident positions. The residency is the minimum three-year period when medical-school graduates train in hospitals and clinics.
There are about 110,000 resident positions in the U.S., according to the AAMC. Teaching hospitals rely heavily on Medicare funding to pay for these slots. In 1997, Congress imposed a cap on funding for medical residencies, which hospitals say has increasingly hurt their ability to expand the number of positions.
Medicare pays $9.1 billion a year to teaching hospitals, which goes toward resident salaries and direct teaching costs, as well as the higher operating costs associated with teaching hospitals, which tend to see the sickest and most costly patients.
Doctors' groups and medical schools had hoped that the new health-care law, passed in March, would increase the number of funded residency slots, but such a provision didn't make it into the final bill.
"It will probably take 10 years to even make a dent into the number of doctors that we need out there," said Atul Grover, the AAMC's chief advocacy officer.
While doctors trained in other countries could theoretically help the primary-care shortage, they hit the same bottleneck with resident slots, because they must still complete a U.S. residency in order to get a license to practice medicine independently in the U.S. In the 2010 class of residents, some 13% of slots are filled by non-U.S. citizens who completed medical school outside the U.S.
One provision in the law attempts to address residencies. Since some residency slots go unfilled each year, the law will pool the funding for unused slots and redistribute it to other institutions, with the majority of these slots going to primary-care or general-surgery residencies. The slot redistribution, in effect, will create additional residencies, because previously unfilled positions will now be used, according to the Centers for Medicare and Medicaid Services.



Some efforts by educators are focused on boosting the number of primary-care doctors. The University of Arkansas for Medical Sciences anticipates the state will need 350 more primary-care doctors in the next five years. So it raised its class size by 24 students last year, beyond the 150 previous annual admissions.
In addition, the university opened a satellite medical campus in Fayetteville to give six third-year students additional clinical-training opportunities, said Richard Wheeler, executive associate dean for academic affairs. The school asks students to commit to entering rural medicine, and the school has 73 people in the program.

"We've tried to make sure the attitude of students going into primary care has changed," said Dr. Wheeler. "To make sure primary care is a respected specialty to go into."
Montefiore Medical Center, the university hospital for Albert Einstein College of Medicine in New York, has 1,220 residency slots. Since the 1970s, Montefiore has encouraged residents to work a few days a week in community clinics in New York's Bronx borough, where about 64 Montefiore residents a year care for pregnant women, deliver children and provide vaccines. There has been a slight increase in the number of residents who ask to join the program, said Peter Selwyn, chairman of Montefiore's department of family and social medicine.
One is Justin Sanders, a 2007 graduate of the University of Vermont College of Medicine who is a second-year resident at Montefiore. In recent weeks, he has been caring for children he helped deliver. He said more doctors are needed in his area, but acknowledged that "primary-care residencies are not in the sexier end. A lot of these [specialty] fields are a lot sexier to students with high debt burdens."

via:http://online.wsj.com/article/SB100...75180331528424238.html?mod=wsj_share_facebook

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[Saipan]

the future looks bright

Slow down there cowboy!!!!

A thorough reading of both articles reveals no major plans to substantially increase the number of residency spots. IMGs need residency spots...without more spots, we have a lot of IMGs competing for a limited number of slots.

Both articles amount to a lot of fluff. A few residency positions here, an proposal to deny spots to Caucasians and give them to Latinos there...but nothing that substantially changes the residency opportunities for IMGs (or anybody else).

 

[RKNY]

It's a nice and different perspective to bring those articles up but there are still issues that need to be addressed concerning IMGs.

1. More US AMGs are being accepted - yet there are no plans to increasing residency spots which increases the competition for IMGs more.

2. The primary care field...which many IMGs fill are being compensated with the increase in hospitals using Nurse Practitioners and PAs.

3. The US healthcare system is going through some changes that many people favor and oppose but we can all agree that we just don't know what the future will hold.

 

[pr0j3ktm]

true.

let's just hope for the best.