What makes US MDs think they're superior?

[JoeNamaMD]

Most of the arrogrance with US MDs has to do with the fact that the US academic infrastructure is the largest of any country in the world which gives it a major research advantage. The government spends billions of dollars to support research efforts at the country's medical schools. This coupled with the fact that medicine is treated like a business and a lucrative one at that, gives a lot of US MDs this attitude. Then again you will see this attitude among other professionals in the US, lawyers and Wall Street bankers.

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[tofurious]

For one thing, I don't think we should let any IMG with America-hating attitudes into the market. That only says that 1) he/she hates the colleagues he/she will have and both the medical field and patients will suffer; and 2) he/she wants to become what he/she hates the most. That says a lot about the person and may frankly make this person a security risk in the post 9/11 era.

To answer Miklos question, I can see two issues with regards to USIMGs. One, why did they leave the US to attend medical school when they were at the land of opportunities already? If it's an issue of family, can't-miss opportunities, or some other special circumstances, sure, they should be treated as US seniors (and the quality of their medical school will place them in the right tier of US seniors/graduates applying from within US). However, I imagine the number of USIMGs who fall into this category is few. The other question is, what TYPE of medical school did they go to. This is also associated with the first issue. There are many fee-for-service medical schools where it's relatively easy to attend. When I was in college, I received flyers advertising medical schools south of the border "designed for children of US physicians who otherwise would not be admitted to US medical schools given the high levels of competition". Those schools are just crap, and graduates from those schools should be treated as poorest quality physicians ever since they did not even go to a REAL foreign medical school. On the other hand, there are people who for one reason or another did not do well in college, but somehow excelled in a foreign medical school of average to above-average quality. In that case, these folks definitely deserve a second look.

Overall, I do not believe USIMGs should become a trend. My fear is not that USIMGs would increase so much in number and compete with US graduates. Rather, I fear that IF USIMGs become a trend, medical training will go through what has happened to many other technical jobs: the export of what makes America great. Since it costs much less to train a medical student in other countries, it would make financial sense to train US doctors there (or just import doctors from those countries). The argument that American training will always be the most thorough and up-to-date comes to mind, but I can also see the money-conscious managers of health care go for a sacrifice in quality in order to save the $$$ (until he is himself sick). So in a way, I foresee the NEED to close down or restrict the number of IMGs overall, perhaps to create a system similar to Canada (I thought they allowed a strict number of slots for IMGs), such that the American way could be preserved under increasing economic pressure.

 

[Miklos]

Originally posted by tofurious
For one thing, I don't think we should let any IMG with America-hating attitudes into the market. That only says that 1) he/she hates the colleagues he/she will have and both the medical field and patients will suffer; and 2) he/she wants to become what he/she hates the most. That says a lot about the person and may frankly make this person a security risk in the post 9/11 era.

To answer Miklos question, I can see two issues with regards to USIMGs. One, why did they leave the US to attend medical school when they were at the land of opportunities already? If it's an issue of family, can't-miss opportunities, or some other special circumstances, sure, they should be treated as US seniors (and the quality of their medical school will place them in the right tier of US seniors/graduates applying from within US). However, I imagine the number of USIMGs who fall into this category is few. The other question is, what TYPE of medical school did they go to. This is also associated with the first issue. There are many fee-for-service medical schools where it's relatively easy to attend. When I was in college, I received flyers advertising medical schools south of the border "designed for children of US physicians who otherwise would not be admitted to US medical schools given the high levels of competition". Those schools are just crap, and graduates from those schools should be treated as poorest quality physicians ever since they did not even go to a REAL foreign medical school. On the other hand, there are people who for one reason or another did not do well in college, but somehow excelled in a foreign medical school of average to above-average quality. In that case, these folks definitely deserve a second look.

Overall, I do not believe USIMGs should become a trend. My fear is not that USIMGs would increase so much in number and compete with US graduates. Rather, I fear that IF USIMGs become a trend, medical training will go through what has happened to many other technical jobs: the export of what makes America great. Since it costs much less to train a medical student in other countries, it would make financial sense to train US doctors there (or just import doctors from those countries). The argument that American training will always be the most thorough and up-to-date comes to mind, but I can also see the money-conscious managers of health care go for a sacrifice in quality in order to save the $$$ (until he is himself sick). So in a way, I foresee the NEED to close down or restrict the number of IMGs overall, perhaps to create a system similar to Canada (I thought they allowed a strict number of slots for IMGs), such that the American way could be preserved under increasing economic pressure.

tofurious,

Allow me to share my perspective. I do not believe in the illusion that US med schools offer admission strictly based on merits. My personal experience suggests otherwise. I know who among my University buddies was admitted to US med schools, their GPAs, MCATs, etc... (my stats with the one exception below were comparable)

The year I applied, the illusive thing that med schools were looking for in the ideal applicant was proving that they were dedicated to medicine. The best way of showing that dedication was volunteering in medicine. What such a standard does not take into account is that you need free time in order to spend time volunteering. So, if you pay for your own education as an independent student (unless you are financially independent as well), you tend to work to earn money to pay for your education. This leaves precious little time to study, never mind finding time to volunteer to prove that you are dedicated to medicine. I had a difficult enough time staying awake for morning lectures after working a grave shift. To make a long story short, I did not get admitted. So, I took a look at my options and went abroad.

Unlike US med schools, schools here in Hungary practice brutal, old school medical education. Selection takes place not upon admission, but through basic sciences. Up to 50% of students don't make it. Mentoring and such things simply do not exist here. If you fail, you fail. Now that I am on the verge of returning, I find that the system has put up barriers left and right to make my return more difficult. I won't detail the barriers here, but believe me when I tell you that licensing boards and residency program directors alike tilt the playing field grossly into the AMGs favor.

More disturbing is the attitude from some AMGs, who believe that they are God's choosen simply because they gained admittance into a US school. Among my buddies, one was most probably a legacy admission, as there were a couple graduates of the medical school in his family. Another was an underrepresented minority and thereby was put on a completely different admission track. No one can convince me that I was a less competitive applicant based on my stats.

I harbor no ill-feeling, but nevertheless, I find the attitude disturbing. Regardless, I will return, complete my residency and get licensed. I will be part of the roughly 25% of US physicians who were educated elsewhere. Truth be told, I will be a colleague and unless you really look for it, you won't know that I graduated from a foreign med school.

I would keep that in mind, if I were you.

Miklos

 

[IMGforNeuro]

Originally posted by Miklos
I disagree. How much money does the average Indian doctor make?

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

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

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

------------------------------------
If you calculate the earning vis a vis the expenses and taxes , then the quality of life is the same or similar. Just to inform you that malpractice premiums are very minimal in India and malpractice law suits are very uncommon which makes surgical specialities and OBG very lucrative.
If a burger in the US costs a dollar , a similar burger will cost less than a third there.
I have come from that system and i know. Most of these usmle takers are unable to compete for competitive specialities and come to the US with big ideas only to curtail them when they see the situation here. Then finally they grab what they get (they would not have landed in a competitive field in India anyway) and they express this frustration by accusing america of favoritism. You will be surprized to hear this from a foreign born IMG like me , but i am with IMGs all the time and this is true.
I am very honest about these views. Almost all my friends and acquaintances are foreign born IMGs or practising doctors in India.
Regarding earning , if you earn $100 on paper and get almost half to spend , a lot of it on living expenses then it comes to the same as earning $40 with low cost of living.

 

[Winged Scapula]

Originally posted by tofurious


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

A couple of points I felt compelled to comment on.

While the traditional 6 year foreign medical education track may not provide as broad an education as a US undergraduate degree, these programs DO provide education on topics other than medicine.

Are these students/physicians really any less well trained than US students who majored in a Biological Science and took only the required basic education courses? What about the US programs which provide a medical degree after 6 or 7 years of training right out of high school? Are they any less worthy than students who completed the traditional 4+ 4 routine. What about students who don't complete a full undergraduate degree (after all, only 90 units are required)?

The US medical degree is NOT a graduate degree nor is it considered a graduate degree equivalent by most in academic medicine. No research requirement or thesis/dissertation (for starters) at most schools.

Finally, you may have underestimated the difficulty in getting into medical school in many foreign countries. How would you like to be evaluated SOLELY on your academic performance? What if you couldn't get into "A" level courses when in high school? Your chances of getting into medical school would be nil. Even if you did get into those courses and did well, there is little guarantee you'll get in. Obviously this is true in the US as well - however, here students have a chance to get in based on ECs, LORs, etc. Someone in the US with average scores/grades but great ECs, etc stands a good chance of getting into medical school. This is just not the case in many traditional foreign medical schools where entrance is based only on your high school grades.

A few years ago some schools in Australia started to institute an interview process for admission tol their 6 year medical programs. The uproar was likely heard around the world. Students (and their families) were appalled that someone who had worked hard all their life to attain extremely high grades/scores (they DO take entrance exams) might not be able to get into medical school because of an interview (matter of fact, one of the Dean's daughters did not get in when the interview process was started. Rumor has it that she was terribly bright but couldn't carry on a conversation to save her life.)

Some countries place a high premium on where you did your college (ie, high school in the US), who you know, etc. That may play a role in the US, but it is not as significant as it can be elsewhere.

This is not to say that the process into a US medical school isn't a difficult route but tgo imply that it is more difficult than in other countries, is to be misinformed, IMHO.

 

[tofurious]

TOo much to answer to, that I almost need to get some US seniors or USMGs to help me out.

On graduate degrees. At the NIH and other levels, the only people who qualify for POST-DOC are MDs and PhDs. That qualifies MDs as graduate degrees.

I personally try to avoid saying whether one country's medical education is harder than another's. US medical students prefer to not work under someone who is chronologically younger and/or has gone through fewer years of schooling, DESPITE what little work many IMGs seem to think we do in US colleges (I have my own issues with folks who waltz through college, but many of us have rigorous degrees that could get us well-paying jobs outside of biological sciences; the whole "pre-med" major has been eliminated by many to most prominent colleges).

I think as IMGs claim that they are misunderstood by US med students and medical graduates, IMGs do not have a full understanding of the American education system. When we are in college, we are encouraged by both career advisers and medical schools to study things OTHER than biology. That's why there is only a subset of courses you need to take/do well in to qualify for med school application. The GOAL of this is to create a group of future physicians who are skilled at other things - arts, physical sciences, engineering - that make them more complete as people and can bring fresh ideas into a otherwise restricted field. Getting a degree and doing a senior honor thesis on a specific topic of academic interests and value is definitely NOT on the same level as taking a course or two while you're focusing on your major. With that mentality, we don't object to working for a recent IMG because we think less of your medical capacities. Rather, we do not think you have had the same schooling philosophy/experience that US med schools claim make us better physicians. It's a simple matter of respect.

As you may see, the type of medicine we have been "brought up" to practice seems to be very different from what you perceive as American medicine. Everybody could order CBCs and LFTs and remember percentages, and I doubt that our college training makes us more competent than you at going over check lists. But what American medicine aims for is the exact reason why interviews are important - the highest scoring individuals may not have the X factor, whatever the X factor may be. Learning that there are forces beyond your control - factors other than your grades - at play in your training also turns us into appropriately humble practitioners instead of medical Gods. That, I think, is also what makes American medicine great.

In this forum, I will never convince you of the value of the American training. I am basically telling you how it is, and arguing that you are as equally competent as us will only perpetuate the negative relationship between IMGs and AMGs. Perhaps that's the root of it all, IMGs coming to this country and telling us how it is. I can imagine that when I become an attending, I would love to have a skilled IMG who has completed a residency elsewhere so that I won't have to worry about what could go wrong with my patients. But, remember this: every attending was a med student once, and it is as a med student when we first develop our feelings about IMGs.

(And to Miklos: Legacy and URM applicants open up another can of worms (see threads titled as "Rallying my Fellow URMs"; no white person would ever say anything like "Rallying my Fellow White Applicants"). It's best to stay away from those issues on this board and in US medicine...)

 

[Miklos]

Originally posted by IMGforNeuro
------------------------------------
If you calculate the earning vis a vis the expenses and taxes , then the quality of life is the same or similar. Just to inform you that malpractice premiums are very minimal in India and malpractice law suits are very uncommon which makes surgical specialities and OBG very lucrative.
If a burger in the US costs a dollar , a similar burger will cost less than a third there.
I have come from that system and i know. Most of these usmle takers are unable to compete for competitive specialities and come to the US with big ideas only to curtail them when they see the situation here. Then finally they grab what they get (they would not have landed in a competitive field in India anyway) and they express this frustration by accusing america of favoritism. You will be surprized to hear this from a foreign born IMG like me , but i am with IMGs all the time and this is true.
I am very honest about these views. Almost all my friends and acquaintances are foreign born IMGs or practising doctors in India.
Regarding earning , if you earn $100 on paper and get almost half to spend , a lot of it on living expenses then it comes to the same as earning $40 with low cost of living.

The basic question remains: Why are they unable to 'compete' for competitive specialties? I believe that it is not because they are not good enough, it is because they don't have the appropriate connections to get post graduate positions in Surgery and Ob/Gyn.

The reason those professions are so lucrative the world over is that they are fee for service and patients routinely pay on the side (or bribe as the case might be) their Obstetrician/Surgeon in addition to the money they pay into the public health care system.

Please don't tell me that the best Indian graduates end up in Surgery and Ob/Gyn locally, because I don't believe it. I do however believe that the most money hungry ones with the fewest scruples have a great shot. Same there, same almost everywhere.

 

[IMGforNeuro]

The placement of residencies is very foolproof in India.
You have to compete an all India entrance test after medical graduation and the placement is only on the basis of the rank in the tests.
So a deserving candidate from a not so prominent med school has an even chance of making it to the best residency because the only criteria used is the rank in the entrance exam.
There are 2 types of residencies - masters which the competitive ones go into and the post grad diplomas which the not so competitive ones get. These are again alloted on the basis of merit only. You can never get into a place even if you are pals with the dean. This is how the vast majority of doctors do residencies in India. There are very few places which have capitation seats , but again are not reputed , which are the same places that take foreign students outside the entrance.
You will be surprised that the 2001 entrance exam was taken by over 80,000 med students so only the best students do medicine in india.

 

[JoeNamaMD]

US Medical schools are among the most difficult to gain admission. All of the MD programs in the US require very high grades in an undergraduate program and a good MCAT score. Admission to Medical schools in most other countries are not as selective as in the US. Many take high school students who had high grades. US schools will only admit college graduates and those with superior academic capability. Also doctors in the US earn more than anyone else in the world but anyhow this includes IMGs who work in the US. The main reason many USMGs feel superior to IMGs is due to the far more stringent admissions criteria of US schools.

 

[neilc]

Originally posted by JoeNamaMD
US Medical schools are among the most difficult to gain admission. All of the MD programs in the US require very high grades in an undergraduate program and a good MCAT score. Admission to Medical schools in most other countries are not as selective as in the US. Many take high school students who had high grades. US schools will only admit college graduates and those with superior academic capability. Also doctors in the US earn more than anyone else in the world but anyhow this includes IMGs who work in the US. The main reason many USMGs feel superior to IMGs is due to the far more stringent admissions criteria of US schools.

first of all, it is not more difficult to get in because you have to have an undergrad degree. it is still difficult to get into school in england, and you don't need the degree! they just have different pre-reqs.

there are two simple reasons US grads feel superior:
1. they feel superior to all other nationalities because from day 1 we learn that the US is the best at everything. don't get me wrong, i love my home country...but, the fact is that we are not the best at everything. it took me living abroad for several years before i truly believed that.
2. they feel superior to us Americans that had to go abroad because they got better grades in undergrad. that is why i quoted the above poster. what a stupid reason to feel superior. do you use any of your undergrad in med school? no. the truth is that you can learn all you need to know about medicine in med school, so what you studied before is not neccessary. i have yet to see any correlation with undergrad performance and knowledge as a doctor.

the fact is, there are brilliant folks coming from everywhere. doesn't matter what country they were educated in or what their undergrad major was. they are very bright.

and then come the rest of us. yes, the vast majority of us are bright enough to do well, we will graduate and pass the boards with pretty good marks and get a residency. and we will be good (and sometimes great) doctors despite where we trained. it is not rocket science. it takes some intelligence (not too much) lots of hard work and compassion and empathy for your patients. this is how most doctors are, and, again, i don't think where you trained is going influence this a whole lot.

now, there are the few slackers that will be scary. normal distribution and all that. and, i will concede that many of these folks will come from abroad, may be some of us Americans that didn't get in. i mean, i am sure the admissions comittee's were right in some of the rejections they sent out! but, the US schools will have their fair share, and the indian schools, and all the other schools out there too...

my point is, most folks that make it through are at least pretty good at what they do. all this talk about who is better is really just padding for some poor fools ego. the scale is pretty big, from excellent to poor, but most of us are/will be somewhere in the fat part of the curve.

claiming superiority because of where you came from or how well you did in college is simply ignorant. in fact, you cannot even predict where on the scale you will fall, much less predict how somebody you don't even know will do. especially if you are basing these predictions on things such as country of education, or grades in undergrad.

 

[tofurious]

Do we use what we learn in college in medicine? Absolutely. Practicing medicine is NOT only about knowing what disease a patient has and what prescription you need to write. It's about connecting with patients through ways no medical school can prepare you for, and adjusting your med school style of approach to the individual patient based on the patient's ethnicity, culture, upbringing, education, and other life experiences. One of the best mental status exams I have seen is when a neurologist began talking music with a university music professor. Now no medical school teaches you about music, but it's outside skills and knowledge base in things like music, literature, history, cultural experiences, that allow you to be a complete physician not only FOR YOUR OWN GRATIFICATION but also for the patient.

Plus, for those interested in academic medicine, you learn next to NOTHING about research and teaching in medical school. You pick up bits and pieces from rotations and individual effort, and you build upon what you have learned in college on research and teaching. Medical school is like a trade school. Instead of defining everything you are, the US medical education adds all the essential skills of being a physician to an individual already with an education and the associated credentials.

I sense so much bitterness coming from USIMGs that I wonder who hates USMGs more, USIMGs or IMGs...

 

[neilc]

Originally posted by tofurious
Do we use what we learn in college in medicine? Absolutely. Practicing medicine is NOT only about knowing what disease a patient has and what prescription you need to write. It's about connecting with patients through ways no medical school can prepare you for, and adjusting your med school style of approach to the individual patient based on the patient's ethnicity, culture, upbringing, education, and other life experiences. One of the best mental status exams I have seen is when a neurologist began talking music with a university music professor. Now no medical school teaches you about music, but it's outside skills and knowledge base in things like music, literature, history, cultural experiences, that allow you to be a complete physician not only FOR YOUR OWN GRATIFICATION but also for the patient.

Plus, for those interested in academic medicine, you learn next to NOTHING about research and teaching in medical school. You pick up bits and pieces from rotations and individual effort, and you build upon what you have learned in college on research and teaching. Medical school is like a trade school. Instead of defining everything you are, the US medical education adds all the essential skills of being a physician to an individual already with an education and the associated credentials.

I sense so much bitterness coming from USIMGs that I wonder who hates USMGs more, USIMGs or IMGs...

so, are you saying that better grades in college make you better able to communicate with a patient? that only someone with an excellent undergrad GPA can discuss music with a patient? i think the argument can be made that by being exposed to a different culture, as i have been here, will make me a more wll-rounded person.

and, what is your point about learning research, blah, blah blah. this is a thread on why US doctors fell superior. you seem to agree with that statement. yet, i don't see anything to support that. why is the US system better? because it requires undergrad degree (well, 90 units). then what about the US 7 year programs? are us grads better than usimg's because they got by adcom? well, i think we both agree that there are lots and lots of folks deserving of spots that just didn't make it. are us grads better because they have the best medical education in the world? i agree that clinically us med students are well prepared, but the internationals catch up pretty quick with the soap notes once they hit residency. and the basic science. please. we all use the same books.

there is no hate here. i am saying that it there is no basis for your judgement that a US doctor is better prepared to be a good doctor. i think that undergrad is pretty much a game to get into med school. and i think that good docs can come from any school in the world. the science is pretty easy to learn, and i think most agree that it doesn't take too many special things to provide a decent medical education.at least there is no secret ingredient that the US has that is lacking everywhere else.

my point is that the decision about who gets into a US med school has little to do with how good of a doctor you may be. certainlly there are limited spots, so the adcom must draw the line somewhere. but, there are plenty of us on the other side of that line that will be excellent doctors, despite where we are educated.

us grads are fortunate that they got into a us school. if i could trade places, i would. and so would most internationals, especially we americans that are far from home. but, it is simply something that we will deal with, and if anything, we will be better doctors for going abroad.

now, don't get me wrong. i don't think that every single one of us is going to be the next dr. cushing. there are plenty of flunkies abroad. there are a few in the states too, but we have a bit more here i bet! however, those that get through have had to work a bit harder than the us counterparts, and will have to do a lot more to get to the same position. i think that is enough to deal with, without having the assumption that we are somehow inferior doctors simply because we did what we had to to achieve our goals.

so, no, there is no hate. i simply am stating the obvious. good doctors can come from anywhere.

 

[tofurious]

I think you are making the argument that how you did in undergrad and whether you got into a US med school have NO effect on your proficiency as a physician. I highly doubt that is true.

Most of the time, USIMGs point to the legacy and URM applicants to say, see, they are no better than me. How the hell did they get into med school? While that may be true, like I said before, they are not the MAJORITY of the USMGs. Most USMGs are people LIKE you who did not benefit from either legacy or URM status. They did well in college AND benefited from an EXCELLENT educational system. Saying that these folks are no better than you in an IMG forum is denying their accomplishments behind their backs. Such attacks will even alienate those USMGs who think you deserve another shot at the American medical system.

I will not personally do this, but if you truly feel that the USMGs are no better than you, I think you should bring this discussion to a US forum instead of here. There you will find many more people who will NOT even bother to read your arguments.

 

[neilc]

i am saying that the difference between a 3.8 undergrad and a 3.5 undergrad is not significant. i could care less about legacy or URM's. they got in, good for them. my argument is that, regardless of WHY they did not get in, many of the thousands of students that did not get in could do very well as doctors.

as for undergrad having NO effect...well, i don't know. there are lots of great docs that never had the benefit of an undergrad education. i know for a fact that ZERO of what i learned in undergrad is useful to me. what i learned in life has been helpful, but my college courses have not been much help at all. i could have started day one with no pre-reqs and still done fine. the only possible exception is biochem, which would be tough without some chem background. but, at my school, you do an intro to medical chem course that gets you right into the swing of things....so, i feel that any benefit of an undergrad education is primarily in the social skills learned, the life lessons. not the GPA in science classes, or whatever.

and, i am also saying that there is no way you can say who is better than anyone. you are in no position to judge that.

good docs come from everywhere. if it satisfies your fragile ego to say that you are better than others simply because you were one of the lucky (yes, lucky) ones that got in, while several thousand other deserving folks did not, then by all means do it.

something to think about: you claim that the US undergrad system will produce better docs...do you realize that the average 18 year old in europe speaks at least 2 languages well? that they are far better traveled than the average 18 year old in the states? that they typically have much more exposure to the arts, a better grasp of world history and current events?

simply put, the US is not the center of the universe. great things come from here. i would never want to live anywhere else. but, simply because something comes from the US does not make it the best.

if you have a point to make, then make it. back it up with something. don't just look to other US students for help. you are a product of a superior education, i should be no match for your intellect!

i will make it simple for you: what, in your opinion, is the single most important thing that makes the US so superior? and why is it so hard for you to agree that there are products out there that are superior, or at least equal, that did not come from here. and why can't you agree that those of us that went abroad can do as well as our colleagues from the states?

 

[tofurious]

I don't want to argue with you because there's no way to convince you what you firmly is not true.

European kids can speak an average of 2 languages at age 18 because geographically, there are many more languages spoken within a certain area than in the US. Don't ask me to provide evidence on this. You can count the countries.

European kids travel a bit more for the same reason. European countries are clustered together, and within the same amount of time it takes to go from New York to Miami you can travel through a whole bunch of countries. Once again, count the squares.

I agree that there are great physicians from elsewhere, especially those home-grown ones who come to this country for better training opportunities, but I just don't think it's you.

 

[neilc]

Originally posted by tofurious
I don't want to argue with you because there's no way to convince you what you firmly is not true.

European kids can speak an average of 2 languages at age 18 because geographically, there are many more languages spoken within a certain area than in the US. Don't ask me to provide evidence on this. You can count the countries.

European kids travel a bit more for the same reason. European countries are clustered together, and within the same amount of time it takes to go from New York to Miami you can travel through a whole bunch of countries. Once again, count the squares.

I agree that there are great physicians from elsewhere, especially those home-grown ones who come to this country for better training opportunities, but I just don't think it's you.

so, what makes you sure that it is not me?

a better question, since i am not claiming to be great....what will make you a better physician than me?

 

[tofurious]

By knowing which arguments are superfluous. You don't want to know my credentials, because it would be an unfair comparison. I will be a good physician because I have seen and worked with excellent individuals and I accept the idea that there are MANY people better than me despite my credentials, and the system that you strongly object to works.

I will end my argument with you here. When you end up at one of the top 5 residencies/hospitals in the country, perhaps we'll continue our discussion then.

 

[Purifyer]

I'm going to try really, really hard to understand that not all Americans fit the toofurious stereotype.

 

[tofurious]

Oh please, you only need to read what I wrote in this thread if you also think that no American medical graduate deserved to get into the worthless US medical schools and you will come back to the US and wow us all. Otherwise, if you are free of years of cumulative sentiments/hang-up, you're welcome to come back to compete on the open market with US grads and let your own records speak for you.

 

[devildoc2]

English doctors think their schools are better than Americans...

French doctors think their schools are better....

EVERYBODY thinks their school is better....

If I went to a US med school and then decided to try and practice in South America, the doctors down there would do the same thing the americans do up here.

BTW, beggars cant be choosers. The USA gets more applicants in terms of foreign doctors than all other nations COMBINED. The foreign nations like to rip the US healthcare system, but when it comes to their doctors, they dont seem to have a problem with it because they are coming over here in droves.

Whens the last time you saw multiple internet message boards about IMGs trying to practice medicine in Europe?

The bottom line is that the USA IS THE #1 TARGET OF IMG doctors. Everybody from all over the world wants to come here.

 

[Bobblehead]

Seems like there's a bit of sour grapes in this thread. Part of becoming a US trained MD (i.e. US medical school, US residency) is knowing that there is a game to play, accepting your role in that game and playing it without compromising your personal integrity. The game starts with getting into some type of undergraduate institution and doing "well" at that stage. Well enough to satisfy a particular medical school's admission committee that they should spend the money to train you to become a doctor. You can do this in the traditional fashion discussed ad nauseum on these boards or a number of other ways. Bottom line, there is a game, you play one way or another or you don't get in.

Going overseas is certainly one alternative and as a US citizen it's a grave you must lie in if you wish to return to the US. It's hard to get into a US residency as an FMG. "Top" residency training programs do accept non-US grads, but you will have to distinguish yourself above and beyond most US grads to even register on the radar. And I believe it should be this way. These are residencies funded by federal dollars which should benefit the country and its citizens in turn.

If you are a citizen of another country you're more than welcome to play at this level of the game. If you are a US citizen that went overseas for whatever reason you should have done so knowing you would disadvantage yourself. The first question would be, why were you unsuccessful in playing the game of getting into a US medical school. Why did you not try again? What were you convincing personal reasons to go overseas?

If the sole reason is that your 4 year undergraduate profile did not allow you to enter a US medical school that's too bad. You have made the decision that time is more valuable (and it is the most valuable commodity after all) and you are unwilling to wait the year(s) it will take to boost your application to the point where you will be accepted.

Does this make US doctors better? No. But it's our system. It changes slowly. It appears random at times yet the majority of the participants "get" the game. And if you want to circumvent the game by going outside the system then don't expect to be let back in with open arms.

 

[neilc]

bobblehead, i think you understand it perfectly...

i expect, and understand that lines for admission have to be drawn somewhere, and i (and many others) did not make the cut. no problem there, such is life.

i also understand that similar lines are drawn for admission to residency, and if i was a PD i would go with the known entity of a US grad most of the time as well.

so, i don't think that i am feeling particulary sour about that. such is life, i made my bed and am happy to lie in it.

what i disagree with is the sentiment that "we are better, we got in", or even worse "you must be a *******, you didn't get in".

that attitude is ridiculous, and nothing but arrogance.

the other thing i disagree with is the sentiment that a US education is the only way to educate a good doctor. that is patently untrue.

toofurious, i certainly won't get a top 5 residency, cause i am not even remotely interested. even if i was, i am comfortable with not being likely to get it. but, your condescending attitude and your ego are embarassing. trust me, even though you really will have a hard time believing this: your "credentials" will not make you any more or less of a human. i would say that who you are as a person (compassion, empathy, social skills) are at least as important to what type of doctor you will be as your precious credentials are.

thousands of well qualified people will be coming to the US each year from outside the US system. the majority will be excellent physicians. to look at us and say "they are below me because i got into a US school" is uniformed, ignorant and arrogant.

 

[BellKicker]

Originally posted by devildoc2
The bottom line is that the USA IS THE #1 TARGET OF IMG doctors. Everybody from all over the world wants to come here.

eoooooooeukay there big guy.........

 

[tofurious]

This is hilarious that I have to respond. Read what other IMGs have written: all the USIMGs have gotten into their respective foreign med schools based only on an entrance exam bypassing the requirements of US med schools. A significant part of these requirements - volunteer and clinical experience - IS the demonstration of "compassion, empathy, social skills", which you said make a great doctor.

The reason I even feel strong enough to continue this is that you and your colleagues seem to think that USMGs don't have anything more than you other than the fact that they played the game right. I totally disagree with that, because they have passed the first test that YOU say makes them great doctors - DEMONSTRATION of "compassion, empathy, social skills" BEFORE even starting medical school. The other argument is "how do you expect me to do all this in addition to getting grades?" The large number of applicants admitted to US med schools every year are the strongest evidence that it is doable and it is NOT unreasonable for US med schools to expect that.

I don't need to prove to you that I will be a great doctor because my patients have already told me that. What I am trying to do is to defend my colleagues who are NOT aware of what some IMGs are saying about them. Why do I talk about research and other things? Because like "compassion, empathy, social skills", those are also what make US medicine great. Otherwise, we would not be going to countries - Hungary included - to help hospitals start residency programs.

 

[neilc]

tofurious, you are right, this is hilarious.

you are amazingly judgemental. i am not saying american doctors are not great. i am saying it is ignorant of you to say that they are better than other docs simply because they got into a US med school.

you are right, i do think that for the most part those that got into a US school are not significantly different than those that went abroad. most of us had gpa's close to the school averages in the states, and have similar backgrounds to you. i don't see a large difference between me (or most folks that go abroad) and the average US student. maybe .2-.5 on the gpa, maybe we didn't do as well on the mcat, whatever. sure, we didn't get in. but, i don't see how you can feel so smug, so much better about yourself because of this!

do you not agree that thousands of qualified applicants get turned away from US med schools? and of the other group without the traditional background, what makes you think that they are so far behind you in quality?

the formula that is used in the states produces great docs...go to undergrad, do exceedingly well, and get into med school. fine. but, there are many other paths that can lead to the same result. there is no need to arrogantly assume that the way you have achieved your goals makes you any better than the others.

it is wrong to judge a huge group of people based on where they got into med school.

there are a lot of flunkies that go abroad. they fail out for the most part. the attrition rates are ridiculous. those of us that make it through are every bit as qualified as you.

international grads make great docs. just as good as any of you from the states. there are leaders in every feild from all over the world. many of the big-wigs in the states were recruited away from their countries. many great students go to places like dominica, grenada, ireland, australia, all over the world and return to the states to large practices. many of your colleagues in the future (i think around 25%) will be us "inferior" international grads.

i sure hope you are less judgemental with your patients.

 

[deleted36260]

Hypochondriac.... you are troll, who has made your hate for America clear in other posts. From this thread, I gather you are English, which leaves me wondering about your post of "[America] being too corrupt!" - You are from England for god's sake! You don't have room for THAT judgement.


Secondly, the medschool debate is tiresome and lame.
Dealing with the actual work force, I do wonder how many of you believe that access to higher tech equipment andmore money for extended life-long training factors into being a 'good doctor'??? If both of those weigh positively on the doctor's ability to do a his job, then economics alone will dictate that our medical system creates the best doctors simply by giving them better tools. (we spend more money, and more percentage of GDP than ANY other country on earth on medicine).

 

[neilc]

well, phatmonkey, i can agree in part with your argument. however, i don't know that it directly equates with better doctoring. sure, the equipment and the money are great, but other countries do pretty well with less technology.

and, i think that international docs will have similar access to the training materials/money as we are coming here for our jobs and post-graduate training.

my point is simply that the medical education system in the us is good, but good docs can come from anywhere. just getting into a US school is not going to automatically make somebody a better doctor. if you get into a US school, you certainly are very likely to graduate, do well, etc...and you are likely going to be excellent at what you do. i am just arguing that the opposite is not true for international grads. in fact, i think the vast majority of us that make it back are also going to be excellent docs. if you can show me evidence that internationals kill more patients, or practice worse medicine, then i will happily concede the point.

but, the current fact is that the vast majority of docs in the states are excellent, regardless of where they were educated.

 

[deleted36260]

Originally posted by neilc

my point is simply that the medical education system in the us is good, but good docs can come from anywhere. just getting into a US school is not going to automatically make somebody a better doctor. .

Fully agree!

 

[JoeNamaMD]

I know a couple who are both physicians. One spouse went to medical school in the UK and the other graduated with an MD from Columbia University in New York. The FMG is a Cardiologist and the Columbia grad is a Family Medicine practitioner. Can anyone guess who earns more money? I ask this question because when people talk about "prestige" they are usually indirectly referring to money and earning power. The Cardiologist who is the FMG earns more than 2.5 times the FM practitioner. My point is in the real world, your degree isn't going to limit you, only you can limit yourself.

 

[MacGyver]

Originally posted by BellKicker
eoooooooeukay there big guy.........

Show me one country that draws more IMGs than the United States.

The fact is that the USA, by far, makes up the biggest target of IMG applicants.

are you denying this fundamental truth?

 

[BellKicker]

Per capita the Scandinavian countries are probably close to the US but I have no numbers to back that up. Coming here includes learning a new language, though, so given a level playing field we might have more IMG applicants. FYI, more US doctors practice in Denmark than Danish docs in America.

Anyway, that wasn't my beef. Go back and read the initial statement ("Everybody wants what we have" or something). The whole they-want-what-we-have mentality is corrupting not just America but the entire post 9-11 western world.

 

[Purifyer]

Originally posted by phatmonky
Hypochondriac.... you are troll, who has made your hate for America clear in other posts. From this thread, I gather you are English, which leaves me wondering about your post of "[America] being too corrupt!" - You are from England for god's sake! You don't have room for THAT judgement.

Hypochonrdiac is not a troll. He's not English either. I think he is Canadian.

which leaves me wondering about your post of "[America] being too corrupt!" - You are from England for god's sake! You don't have room for THAT judgement.

I see... so, Americans are allowed to judge the entire world with such hilarious comments (well, they would be if these words weren't written with 100% seriousness) as 'every person in the world wants to live in the US!' 'medical education in any other country is second rate!'... et cetera, but a non-American is not allowed room for a simple statement that America is corrupt. I see. Maybe Hypochondriac should have said "[America] being too hypocritical!"

The medical school argument is a waste of time as most of the people arguing have their ideas based on belief not logic or reason. It is pointless trying to convince a fundamentalist christian that evolution is a plausible theory, just as it is pointless to convince a minority of Americans on this board that electricity and clean water exist outside their golden country.

 

[deleted36260]

Originally posted by Purifyer

I see... so, Americans are allowed to judge the entire world with such hilarious comments (

I didn't cast the first stone, for I know of my own country. I didn't offer up my opinion of England first.And if he is Canadian, my mistake Still, I can list 100 things corrupt about his country - I choose not to.

My point is, and still was, that it was an unneeded, uncalled for comment.

For the rest of your post, don't put words in my mouth, nor class me with your preconceived notion of Americans

 

[The White Coat Investor]

Hmmm...I delivered the baby yesterday of two Mexican physicians. I found it interesting that they came here to have their baby by this "American Physician." I took it as a compliment and gave em a great looking kid and no tears. The FMGs I have actually worked with were good, but I think PDs do a good job screening out the ones that wouldn't be.

The biggest problems I have with FMGs is not their training, but their English skills. When I can't understand them when I call them on the phone I find it very frustrating and I think it compromises patient care. If I were a PD, I'd worry more about communication skills than academic qualifications...hell, you can teach medicine to a resident, but no resident has time to learn English (or Spanish or Italian etc)

 

[rgerwin]

I know this is a mpost from awhile ago, but I just started on this forum. It's concerning DO practice overseas. All American DO schools are on the WHO list of aceepted medical schools. If someone were to do an allopathic residency and become licensed by the American Medical Association, I was under the impression they could practice abroad in some countries, such as the uk, as a primary care physician.

Am I wrong? COuld you show me the literature where?

Thanks!

 

[smf]

because they teach you The Coronels Secret Recipe.

 

[theodore]

Just a couple of words: a person that thinks" I'm the best, f..k the rest" can NOT be a good doctor. He may have the best credentials,knowledge,brains in the world, but these qualities are just half of the "good doc" equation. I think it's clear who I'm talking about.

 

[theodore]

But even when it comes to knowledge, IMGs take the very same exams that AMGs take. Besides, if the US is full of medical geniuses, why does it employ IMGs by the thousands? I'm not talking about all AMGs here, just about a particular one. I don't know about his IQ or credentials, but I know one thing for sure: his arrogace is unsurpassed.

 

[tofurious]

Why do we hire anyone from out of this country in any job market? Because there is a higher demand (artificial or real) than the supply. Nobody wants to go to rural states (all the people who enter med school saying they want to practice rural family medicine end up doing derm or radiology in NYC) or small hospitals, so there is a need for IMGs. If the lawsuit against the NRMP prevails, IMGs will either become history because better compensation will encourage more people to go to these small programs and the poorly run hospitals will close down (except the really excellent superstars who have accomplished careers in their home countries already) or become the norm since it will be cheaper to hire them by offering the $+visa package.

And theodore: I count quite a few USMGs in this thread. I think our combined arrogance can probably fly a hot air balloon across the Atlantic...

 

[lgreen]

International graduates have not had as much premed education as US med students and may (but not always) need more help with research and critical reading. Also, communication skills and understanding of a complex insurance, legal, and ethical system hold back IMGs in the beginning. These keep IMGs from being accepted into many competitive programs initially and contribute to increased difficulty finding fellowships. These things are all overcome eventually and IMGs are doing well overall. A program director learning the rules....

 

[Miklos]

Originally posted by tofurious
Why do we hire anyone from out of this country in any job market? Because there is a higher demand (artificial or real) than the supply. Nobody wants to go to rural states (all the people who enter med school saying they want to practice rural family medicine end up doing derm or radiology in NYC) or small hospitals, so there is a need for IMGs. If the lawsuit against the NRMP prevails, IMGs will either become history because better compensation will encourage more people to go to these small programs and the poorly run hospitals will close down (except the really excellent superstars who have accomplished careers in their home countries already) or become the norm since it will be cheaper to hire them by offering the $+visa package.

And theodore: I count quite a few USMGs in this thread. I think our combined arrogance can probably fly a hot air balloon across the Atlantic...

Ah, the economics of the NRMP case.

Truly an interesting argument.

Consider this:

If a top program receives 500 applications for 16 positions, even if the residents win, do you think that they will have any incentive to change compensation?

I do not believe so. They will continue as they did before, as they will have plenty of applicants who will accept a lower compensation package in lieu of receiving an excellent postgraduate education from a top ranking institution.

Okay, let's look at supply and demand in general. IMHO, residents are underpayed for the work that do, but I don't see anyone else doing that work. After all, someone with an M.D. behind their name must sign orders. I don't see attending physicians or anyone else doing what residents do now.

Regardless, most of the rural hospitals that you mention have a patient base that someone needs to serve. Using residents is one of the cheapeast possible ways. Why? Direct and indirect compensation by the Federal government for residents services along with low resident salaries may mean that hospitals are generating a positive cash flow from residents (that is pretty much what the suit alledges).

So, IMHO, if the suit succeeds (depending on the outcome, of course) the change will be that instead of making cash from residents services, the hospitals will have to pay them more. It might even have the effect of requiring greater productivity from attending physicians. I don't see lots of programs closing, as someone (perhaps the IMG) needs to do that work.

As far as the number of physicians are concerned, that is a whole 'nother can of worms.

 

[smf]

Originally posted by Desperado
Hmmm...I delivered the baby yesterday of two Mexican physicians. I found it interesting that they came here to have their baby by this "American Physician." I took it as a compliment and gave em a great looking kid and no tears. The FMGs I have actually worked with were good, but I think PDs do a good job screening out the ones that wouldn't be.

The biggest problems I have with FMGs is not their training, but their English skills. When I can't understand them when I call them on the phone I find it very frustrating and I think it compromises patient care. If I were a PD, I'd worry more about communication skills than academic qualifications...hell, you can teach medicine to a resident, but no resident has time to learn English (or Spanish or Italian etc)

I too have had a similar disheartening experience related to a consultants English skills. Certain things are hard to forget despite the lapse in time. One evening while covering an ED in new york we received a motorcyclist who had part of his brain hanging outside of the cranial cavity and not doing well at all.

OK, did the stabilization measures, got the glasgow,got the ct then paged the on call US born, fully usa trained neurosurgeon, who then told me he was at a movie and it was in the middle, and that I was a Fu----ng Ass--le MF,SOB, and that the patient needs a "doctor" and he is NOT a doctor, but a "brain surgeon"

And believe it or not, I have had very similar problems with another fully usa trained non doctor as above.


Hence, proficiency in the English language is important as I will agree with you.

 

[Masonator]

Originally posted by irisheyes
Texasblue, I believe your analysis was right on the money. Likewise in Ireland if you are lucky enought to gain admission to med school, people will not comment on or rank your school. It is impressive enough that you are in a medical program. Now if certain medical programs were turning out inferior doc's or something similar then of course there would be an issue. This simply is not the case. In which regard I cannot understand ( nor do I care to) people obsessed with program rankings. It all seems a bit " look at me, look what I did". Maybe I am wrong but that type of gratuitous attention seeking reeks of insecurity and/or immaturity. If you have an MD or a DO after your name and have passed the relevant licencing exams then in my humble opinion you have done well enough. What else do you need to prove and why? I mean we are doctors for god's sakes, not candidates in a high school popularity contest. just my $0.02 for what its worth.

America is a culture of ruthless capitalism and competition. These two things feed off of each other. Everything is seen as a competition. Here are some examples:
getting a job, getting a promotion, getting a nice car, buying a nice house, finding a good spouse, going to the best schools, having the smartest children, having the nicest body. Look at America's reality TV programming, it is all based on ruthless balls to the wall competition. European reality TV is based more on new novel risque topics like sex and intellectualism.

Why should medicine be any different. By the way I am an American so I know what I am talking about. Personally I think Europes long history of class warfare and their decision to accept socialism has helped them overcome the competitiveness seen in American culture. You could also argue that the competitive ambitious people in Europe immigrated to America to make their fortunes.

 

[smf]

Originally posted by Masonator
America is a culture of ruthless capitalism and competition. These two things feed off of each other. Everything is seen as a competition. Here are some examples:
getting a job, getting a promotion, getting a nice car, buying a nice house, finding a good spouse, going to the best schools, having the smartest children, having the nicest body. Look at America's reality TV programming, it is all based on ruthless balls to the wall competition. European reality TV is based more on new novel risque topics like sex and intellectualism.

Why should medicine be any different. By the way I am an American so I know what I am talking about. Personally I think Europes long history of class warfare and their decision to accept socialism has helped them overcome the competitiveness seen in American culture. You could also argue that the competitive ambitious people in Europe immigrated to America to make their fortunes.

Eloquent words masonator.

I also grew up in the states and what has irked me since childhood is the opening introduction of an NBA game in which one of the teams won last years playoffs. That team is introduced as" The world Champions" Funny how the playoffs only include NBA teams in the USA.

 

[deleted21609]

I am a medical student in Europe but did electives in NY. Not every student there was better than at my home school, but most of them were.

The European (British) television I've seen has been largely based on potty humor, men dressed as women, or both.

 

[Masonator]

Originally posted by student.ie
I am a medical student in Europe but did electives in NY. Not every student there was better than at my home school, but most of them were.

The European (British) television I've seen has been largely based on potty humor, men dressed as women, or both.

Do you seriously think that the US school system produces better trained residents then the British system? Which NY hospital were you at? If it was Cornell, Columbia or Mt. Sinai you might have a slighty skewed view of US medical students as these are some of the best programs in the country.

 

[deleted21609]

I was at one of the schools you mentioned and I met an excellent British Attending there. The students were better than at my own school though.

 

[neilc]

Originally posted by Masonator
Do you seriously think that the US school system produces better trained residents then the British system? Which NY hospital were you at? If it was Cornell, Columbia or Mt. Sinai you might have a slighty skewed view of US medical students as these are some of the best programs in the country.

i really think the US sysem emphasises clinical skills more, and earlier. so, clinically, i would say that the majority of US students are better than the majority of European students.

but, i think that these clinical skills can also be picked up pretty quick, and that the theoretical knowledge from the Euro schools is as strong as anywhere you will find.

 

[Masonator]

In my own experience, I've been very impressed with people who train in Ireland. I have seen some weak FMGs come out of India.
I've heard that Indian FMGs aren't the best and brightest from the Indian system, as these will usually stay in India. I have an n of around 5, so I am not generalizing or trying to start a flame war.

 

[DrSambo]

Lots and lots and lots and lots of Canadians travel down south for med schools every year.

I didn't think that lots and lots and lots and lots of Canadians even existed. I mean the whole damn place has less people than the state of California.