Friday, June 6, 2008

It Begins.....With the Continued AMG IMG Debate

 For some time I have planned to start a blog to not give my advice and opinions like so many bloggers before me. Thanks to Dr. Haisook over at Dr. Haisook's Medicopedia, I finally got my tail in gear and started this blog after Dr. Haisook felt my comment was on the AMG vs. IMG debate was worthy of a blog on his main page. I want to thank the Doctor for his kindness and helping to push me in the right direction with this blog, as well as his civilized discussion. After all, medicine is a team sport.

Before thinking that I am against international medical students entering and practicing in the US, understand that I am not. But what I hope to get across is that my stand on the situation is that citizens of this country should have first dibs on residency programs, with my reasoning listed below. Now, of course there are exceptions to this, there are always exceptions. Do I think that an American student that could barely hack med school and has terrible credentials should get a plastics residency over an outstanding IMG, of course not. But I also think we need a hell of lot less plastic surgeons, or even further, that the words "need" and "plastic surgeon" shouldn't be used in the same sentence.  

I have worked with IMGs and I think they are just as competent as any other physician. Many people complain of accents, but there is a big difference between accents and lack of communication skills, the former is what makes America a melting pot, while the latter has no place in medicine.

Below is my original comment as found here on a previous topic and here as the blog topic with our comments:

I can understand the debate between the IMG and AMG issue, but I think that there is a lot about this subject that is being overlooked. I am not anti-IMG, I know that we need more physicians in this country, but heck, we need more physicians all over the world, so that point is moot. As far as trying to discuss or argue over who deserves a spot more or whose score is more reflective of a better student, that goes both ways. I see on here, responses about how IMGs have it harder because of language differences, drug name differences and differences in the western way of life, but they also have a lot more on their side. I am an American medical student and I have to take the Step 1 after 2 years of class and I get about 5 weeks total to study for this exam on my own. The average IMG has 3 years of classroom experience to learn what we are taught in 2 years, they then have clinical experience and then have as long as necessary to study for the USMLE. There are lots of forums on Kaplan's website with IMG test-takers asking for advice because they only have 2 months left to study for the exam--- I'm sorry but if you can't get it in your head in 2 months there's not much we can do. My roommate and I covered 2 years of education in 4 weeks. I understand the language barrier, but everyone needs to understand that if you want to practice medicine (a profession that puts the lives of loved ones in your hands) you better do all you can to break down that language barrier and learn whatever it is you need to learn in order to communicate to patients and other physicians. You could be the greatest mind in the world, but if you cannot communicate with patients effectively and compassionately, you have no business seeing them. I also see a lot of language problems in comments on websites like this....this is another problem, we all need to be on the same page in medicine to communicate and that page is communicating in English and writing and reading and speaking it FLUENTLY. I do not expect to be treated differently if I wanted to practice medicine in France and had trouble with the language, I would expect them to hold me to the same high standard that they hold themselves, if not then I would not want to be a part of a system that made exceptions for me because I had it a little harder than other individuals.

Another point that is often overlooked is that fact that most residency salaries are paid for by Medicare, that means that US federal tax dollars are paying the salary to train physicians. Based on this, I have no problem giving American students first pick at residency spots because they are the citizens that have paid the taxes that are funding these positions. To come from another country and be upset if you are on the back burner as far as matching for residency because an American citizen who has paid tax money into the system and has been a part of this system their whole life is ahead of you is unconscionable. people should be grateful that American even allows others to enter this country, most other nations would having you jumping through more hoops than you could imagine to practice in their country. I am well aware of our need for doctors and I am also well aware of the sacrifices that American citizens have made for this country. To think that it is unfair that an American is ahead of a IMG is in my mind ridiculous. Our citizens are giving themselves to make this country a better place, if there is a problem with them being first in line, one should first question why IMG are leaving their country of citizenship to begin with, where is the loyalty to one's nation?

Dr. Haisook's response is here, since I am unsure of the copyright rules on posting work of another blog. And my response is below, better explaining my reasoning for why I feel it matters who is paying into the system. 

Dr Haisook,

I truly appreciate your counter-comment. I want to first let you know that I am not writing these things to get into a fight or argument about who has it harder or to even state that I don't want others to enter this nation and make it and the world a better place. I don't have a lot of time to to comment on all your remarks, many of which I agree with, but I do enjoy the back and forth as I feel that this is one way that we can all learn from each other. And I am glad that you believe that communication is SO important in this practice. I will tell you that most of what I say is based on MY experience and with that I will only speak for myself and not on behalf of other AMG's (I say this because I usually don't like what comes out of other people's mouths when they speak on my behalf :). That said, most of what I know of IMG's are from Indian physicians and residents that I have worked with. I do not believe that they should not be here and I am thankful that they are taking care of patients.

I would just like to make a few remarks on what you said. When I made the remark about medicare funds and tax money being used to pay for resident salaries, I was not being clear to you and your readers on my thoughts. I draw a parallel to the way that college tuition works in the US. If someone wants to go to a University/College that is run be a state, say University of Texas, they have a much easier time getting accepted to that school because they have been paying state taxes to run the institution and to be fair to them, the state gives priority to its citizens. Those from out of state have lower priority (and have to pay more). That was my analogy that did not make it on the computer. I am not saying others do not deserve a place or that it is all about the money, just that we have a system that favors those have paid into it and I am okay with that. In regard to the way tuition is run and that our system favors states' rights, it is hardly obsolete.

I would like to comment on your remark about how US schools teach to the USMLE, and your school does not, but before I do so I wonder if you could tell me more about your curriculum. We do 2 years of classroom based basic science and systems based courses followed by 2 years of clinical rotations. A IMG I spent time in clinic with told me she did 3 years of basic science followed by rotations. I don't want to get into an argument on who is right or wrong, but am curious as to how your schools runs medical education, if only for our mutual benefit. I do understand that we are taught in order to be prepared for the exam, but I also believe that we are taught much more beyond just preparing us for Step 1, if not we would not already be in clinic seeing patients to prep for 3rd year.

I would like to ask you why you believe that America is where you can "maximize [your] efforts and REALLY help people." The US is not a country that you will see most of the infections that you read about in textbooks. Immunizations are many times up to date and infections are caught sooner than in less fortunate countries. I am not saying we are perfect, we are far from it. But I don't understand why you can only really help people here. If most physicians have your attitude, that treating your country's people is a waste of time, then what do you hope to achieve here? It seems from your comments that your people need you more than ever, especially if the educated can live there. It takes people like you to make your nation a better place, to change the situation. I don't believe for an instant that "there's NO chance of living [there]."  This is your opportunity to make a difference, if you do not take it, you are letting a chance to do what you can to make the world a better place. I have news for you, American patients are not that great either, you will tell them a medication will help them and they won't take it, they are consistently noncompliant. That doesn't mean that I am going to give up on them....EVER.

I cannot speak to your comment about American's wanting more pay for less work and all wanting to be dermatologists and radiologists, as I am not one of them. I didn't go into medicine for the money, if I wanted money there are MUCH easier ways to get it and get more of it. I want to take care of sick patients and make them and better and to prevent illness. Dermatology? That is a Greek word for fake doctor. There are some specialties that take the brightest pupils in the class and put them into the easiest specialty with the least work, especially when all you need is an atlas. Don't even get me started on plastic surgeons - if they are not helping poor children with cleft palates or soldiers from war and are just doing cosmetic work for cash, they might as well leave this place- they are of no use to me. Please don't tell me you plan on either of these specialties.

That's all I have for now, as alas I must return to my studies. I wish you all the best, and if you come here to practice I will welcome you. But I still believe there is so much to be done in underserved nations. I will be there and hopefully your attitude will change and you will be there to help them, too.

I would like to know more about your curriculum as I said and what the technical issues are that you said hinders IMGs. And I hope that you or your readers do not fell that I think anyone of you is stupid or incompetent....we are all in this together. Healthcare is a team sport.

-Blast (I went by 1/2 way while a commented on Half MD. com).