We need national FMG/IMG licensure

[neilc]

oh yeah, i saw the application. it took my school over a year to do it. however, i would support an process like that if it was the be all and end all of licensing. i don't think that answering those questions is unreasonable, at least if it is a one time deal.

i do agree that in the instance of a 6-year englinsh languange parrallel it is darn stupid. we also take the exact same courses as the locals, with the exact same facilities and professors...but, i think we have the 4 year polish programs to thank for the extra scrutiny there, and the mail order russian schools.

i think the fact that it is easier for a carib shoe box school to fill it out means little. i am sure that they will have other difficulties, such as a long, drawn out approval process, multiple site visits, etc...and a school that doens't have much to put on the application may have trouble getting approved!

is short, i agree that it is a huge pain in the butt. i was miserable for the year that my school had the application, worried that they were just going to say "screw it, this is a joke" and never finish the stupid thing. however, i do think the process does seperate the "real" schools from the phonies, and i would support the widespread use of such a standard.

[tRmedic21]

Wow.... I don't think that you guys meant that quite the way it sounded.... did you?

[neilc]

just re-using his terminology. i took it to mean the smaller schools in the carib working out of limited facilities (ie. some of the questionable schools). it seems clear that these schools would have no trouble with the application, because they could just answer "none" on many of the facility and type questions.

our schools are huge, with thousands of students and faculty, lots of different hospitals, clinics, departments, lots of research, etc...when you see this application and the details that it is looking for, you will understand why the small schools (and all the carib schools, for that matter) will have it a lot easier than the big medical universities.

[Miklos]

You read my mind.

[Miklos]

Originally Posted by neilc

oh yeah, i saw the application. it took my school over a year to do it. however, i would support an process like that if it was the be all and end all of licensing. i don't think that answering those questions is unreasonable, at least if it is a one time deal.

i do agree that in the instance of a 6-year englinsh languange parrallel it is darn stupid. we also take the exact same courses as the locals, with the exact same facilities and professors...but, i think we have the 4 year polish programs to thank for the extra scrutiny there, and the mail order russian schools.

i think the fact that it is easier for a carib shoe box school to fill it out means little. i am sure that they will have other difficulties, such as a long, drawn out approval process, multiple site visits, etc...and a school that doens't have much to put on the application may have trouble getting approved!

is short, i agree that it is a huge pain in the butt. i was miserable for the year that my school had the application, worried that they were just going to say "screw it, this is a joke" and never finish the stupid thing. however, i do think the process does seperate the "real" schools from the phonies, and i would support the widespread use of such a standard.

Neil, I think there is a lot we agree on. However, I must take exception on a couple of items.

The approval is re-evaluated after 7 years. This essentially means that everyone who intends to practice in California someday should immediately apply for licensure as soon as the school is approved so that they can avoid a catch 22.

There are a number of reasons I am frustrated with the California med board.

Before I left for Hungary to attend med school, I contacted them and asked them about recognition and licensing issues. I was told that there were no issues. Then sometime during my basic sciences years the regulations changed without notice. The way my med school found out was that a graduate tried to get licensed and could not. This set them down the approval path. People like me were then caught in a catch 22...already having invested money and time in a med school that was okay when we entered it and no way out as we could not transfer (as they basic science requirement would still be disapproved). The med board's response essentially was "tough luck", as they have statutory authority to decide who practices medicine and who does not.

What makes this even more galling is that Hungarian program graduates have NO LICENSING ISSUES IN CALIFORNIA, despite the fact that the English language programs completely mirror them. Worse, past graduates of either program at any of the schools have not had licensing issues either.

The med board's response to this is in my view ridiculous. I think that there would be a clear case for a lawsuit for those caught in the catch 22 if all schools here do not receive approval following application. Problem is financing it.

Also, if you look closely at the Review of International Medical Schools, Proposed Regulations under http://www.medbd.ca.gov/Current_Proposed_Regs.htm it seems that the med board has come to understand that its current med school review process (as it has essentially not been codified) leaves them vulnerable to legal challenges and that is why they wish to adopt these new regulations.

More interesting is how they (will?) distinguish between the schools they wish to review and those they do not. If I read it correctly, the proposed regulation differentiate between schools located in OECD member countries (see http://www.oecd.org/document/58/0,23..._1_1_1,00.html for the list of 30 member countries) teaching primarily for their own citizens and all other medical schools. Under this regulation, if I read it correctly it may well be possible that schools in the Czech Republic, Slovakia, Hungary, Poland and Mexico might be able to bypass the approval process for their English language programs if they can prove that they teach primarily their own citizens. This should not be a problem for the six year programs...

A further issue I have is that the disapproved list on web site (well hidden I should add) makes no mention of the requirements imposed on the schools or their status. This makes it easy for any number of shady med schools to claim that they are approved when they have not applied.
This fundamental lack of transparency on the medical board's part is highly disturbing.

I would be interested in your and other opinions.

[FLK]

I think every state should just use the California criteria and then establish a national database.

if you want to work in any particular state, you pay the usual fees to that state

great idea

[DoctorJ]

I still don't understand why people are making a big deal with the Spartan article. It's not the school's fault. The guy passed his Steps and he graduated from his residency program didn't he? So it's more of his program's fault.

He went to an offshore school for tickets to sit for the boards and he has just done that....

A good buddy of mine is a 4yr med student at a med school in IL. He hasn't delivered any babies, he doesn't know how to draw blood or do IV. He can't interpret a EKG.

I have done 10 interviews for FP so far (applied to 20 programs and got 17 interviews) and I'm from a no name offshore school. Some residents at good Univ programs can't even read EKGs that well and they're AMGs. I feel like our med knowledge is about the same and sometimes I know more handson than them b/c I've done some rotations in Mexico.

One upper classman from my school interviewed at Mayo, Cleveland Clinic and eventually matched with IM at U of KY, 3rd choice, (241/249 Step1/2) and he told the truth about our school where most American students just sit in their apt and read and study b/c no formal training for basic sci, sometimes w/o AC. The PDs were very very impressed. He thought highly of him as he self-taught himself basic sciences.

I scheduled some of the less attractive interviews at the beginning of my campaign for experience purposes and I was honest with the PDs (experimenting to see how receptive they are). Again, they were surprised and then told me how much they respected my motivation and my willingness to work hard. In fact, I'm the first applicant of the school that I'm from that they have ever interviewed. So no, track records are not important, at least not in FP or IM.

They've sent me personal hand-written holiday greeting notes saying I'd be a good fit at their programs.

So the bottomline, it's the residency program that makes a doctor who he is and not the medical school.........

[teratos]

I agree, DrJ. We are often more motivated then our US counterparts. We appreciate what we have. We have often worked harder than they have. It is the residency that makes the doc. Of course you have to have a pretty solid background before starting. G

[Nebakanezer]

Originally Posted by tRmedic21

"Why can't we, as FMGs/IMGs, lobby the national legislature to make a national licensing law?"

I believe this was attempted a few years ago with the "Uniform Medical Licensing Act" To the best of my recollection, it died in committee...

[FLK]

there is a special category of Off shore students and that is US citizen, English speaking physicians.

I have seen people really very highly recruited at large community programs, for Primary care residencies.

The PD can match 10 Americans from the Caribbean, and get a highly Motivated AMERICAN, or he can match 10 docs from Bangladesh and Syria that barely passed the TOEFL

No brainer !