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.
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).