We need national FMG/IMG licensure

[tRmedic21]

After reading the article posted about Spartan and a couple of other schools which have been banned in some states, where the representative of the Texas Boards of Medical Examiners complained that they really didn't WANT the job of making licensing standards, I have to ask myself the question...."Why can't we, as FMGs/IMGs, lobby the national legislature to make a national licensing law?"

I mean come on, Texas is one of the most notorious states in terms of restricting licensure to foreign-trained doctors, and if even they are asking for a national standard, why don't we have one? Wouldn't that make the whole licensing issue that much easier for everyone involved? I mean, yes, granted, we would have to deal with the federal government instead of the various state governments, but one is better than 2, or 3, or 10 isn't it? Surely there is something we can do?

We already have national certification for physicians (USMLE and/or COMLEX), eligibility for foreign physicians to take these tests (ECFMG), why not just do it that way? Follow that route, take it one step further? Once internship or residency requirements have been fulfilled, then issue a "National Medical Licensure Permit" which allows one to simply register in whichever state one wishes to practice in, and be done with it. Hell, this could even help streamline the practice of keeping poor physicians out of public practice! We all know, as a physician, you can simply move to another state if you've been barred in one for various misdeeds. With National Licensure status, we could have someone barred for 5 years, or 10, or life, and make it stick!

I'd love to hear other opinions on this, pro and con, tell my why it would be a great thing (besides the obvious for us FMGs/IMGs, 50-state licensure), and why it would be a bad thing! I am particularly interested in opinions from those currently in medical practice, who have greater insight into the kinds of controls we do and don't need over this important subject. I am prepared to write my congressman, for what little good it will do, but I'd like to get my ducks in a row first, as well as maybe drumming up some support from fellow FMGs and even US grads, as it would provide some national standard we could all be proud of! There are many places on the net where we all gather to yak, and it seems a great place to me to get this thing started, getting people to spread the word and yank on some Congressional ears.

Whaddya think???

[Beaker]

it's not in our favor to do this coz fmgs want to be treated as equally as possible. not that long ago, fmgs were required to take a separate test (the FLEX) which was determined to be much more difficult than the USMLE. now we take the same exam. up to this year only fmgs r required to take the csa, but starting next yr, the u.s. students r required to take it too. the english proficiency exam is the only additional test required. so why would we need an extra obstacle? i think that the national exams can test our abilities and compare us to u.s. med students and grads. that is the national equalizer that ur talking about. the difference is that a select few states that have an overload of docs already and want to be more selective by adding extra obstacles to prevent fmgs from taking up spots in their state (cal).

the national rules exist in the ecfmg certification, but the states have the right to require further things. luckily only a few states have taken advantage of this and most schools do not have problems in most states. but for some reason those r the states that everyone always focuses on. but unless u go to a u.s. med school, u will unfortunately be at a disadvatage in these states regardless of which school u attend.

my $.02

peace

[raj]

how

[Picard]

What I would suggest is this -- if LCME does not want the job, then creat another agency parellel to LCME and APPLY THE SAME STANDARDS LCME USE TO ACCREDIT US/CANADIAN MEDICAL SCHOOLS... and accredit foreign medical schools the same way... This is the ONLY way for IMG's to be seen as "equals" in the US medical community.

It's great that we now take the same exams regardless of where we go to school, US or otherwise... but what IMG's hear alot from the US counterparts is "passing USMLE does not necessary mean that the education one received is equivalent to US students..." Heck, there are people who can do very well on USMLE without ever set foot in medical school. What the US medical community complaints most about is the lack of standardized accreditation process among foreign medical schools, whereas all US schools must go through LCME accreditation... So I say if LCME doesn't want the job, creat another agency (see if ECFMG wants to expand its roles), and apply the SAME LCME standards to all foreign schools, and issue U.S. accreditations to foreign schools who meet the standards, and only issue licenses to grads from these schools -- I think this will go a long way to achieve equality.

P

[teratos]

There are always those debates about states rights. When the founding fathers framed the constitution, they tried to keep power out of the hands of the federal governement. The feds should only build interstates, provide a national defense, and regulate international trade. That is just my opinion. You will have states that complain about the federal standards. Some will say they are too tough, and some will say they are too lax, depending on the need of the state for docs. You will then have MORE trouble than you do now. I agree that the ideal would be a US medical license, but there are lots of politics involved. G

[bts4202]

What if the LCME could open its doors to foriegn schools on a voluntary basis only. If a school wants to be LCME accreditted, then it would pay for all teh inspections, etc to get the approval. If a school did not go through that accreditation then they are subject to the highly intensive scrutiny of the state boards.

There would be a huge amount of interest from froiegn schools to get that accreditation and states could be sure that the school in question is really "up to par".

[teratos]

Good point BTS. That is probably the best solution. It would give offshore schools some credibility. They could come up with the "Good Housekeeping Seal of Approval" for med schools. I don't think they would actually give full LCME accreditation, but they could say the school "meets the standards". Someone, quick, call the LCME. G

[DoctorJ]

Sounds like a good idea but there must be a reason why we don't have a national ID card or a national driver's license.

Accredidation for foreign/international medical schools? Why would a med school in China or Australia or India want to be visited and evaluated? They weren't establishd to crank out MDs to practice in the US in the first place. Maybe offshore schools would.

[neilc]

why not just use the california list in all the states? i think that is going to happen more and more...they have a good system, reasonable standards and it doesn't cost a state anything...they just have to adopt legislation that says the school not be prohibited in any other state or some such thing.

the california eligibility is the standard that i think all students should look at. even if you don't expect to live in california. it is pretty safe to say that if your school can get approved there, you shouldn't have a problem anywhere. if a state decides to toughen up it's rules, it will likely look to the california list. if you are on that list, you are smiling. if not, there goes another state!!!

[Miklos]

Originally Posted by neilc

why not just use the california list in all the states? i think that is going to happen more and more...they have a good system, reasonable standards and it doesn't cost a state anything...they just have to adopt legislation that says the school not be prohibited in any other state or some such thing.

Neil, have you seen the 95 page California Questionnaire?

I have and it is ridiculous. In fact, it is much easier for a shoe box Carib./off-shore school to fill it out than it is for a real medical school (for example, Charles or any of the Hungarian ones). A small sample of the directions on the questionnaire;

Clinical teaching facilities (for each one): describe ambulatory (outpatient) facilities for each service. (Location, square meters, number of examination rooms, equipment.) Complete for each service offfering ambulatory care the number of outpatient visits per year, number of days open per week, number of hours open per day, number of physicians on duty.

Attach a separate document listing the names of all faculty members (including chiefs or persons in charge) in basic sciences by department. Indicate for each person: rank, status, (fulltime, parttime or visiting), years on faculty, physical location, percentage of time spent teaching for the institution, percentage of time spent teaching at each site, number of weeks in year teaching at each site. Submit a resume of each faculty member listed.

Attach a separate document listing the names of all members of the clinical science faculty by department (including chiefs or persons in charge). Indicate for each person: rank, status (fulltime, parttime, or visiting), years on faculty, physical location, hours taught per week, weeks per year, how each is reimbursed for teaching the institution's students.

This is only a small part of the questionnaire. If the medical school is like Charles or the Hungarian ones, simply filling it out is an issue. Consider the demands this makes on a major medical center. How many outpatient services does such a place provide (I stopped counting when I hit 20 at one Hungarian med school). The square footage?! The equipment in the unknown number of ambulatory examination rooms?? A resume for each member of the basic science faculty. I am sure this runs in the hundreds at a real medical school. Same for the list of clinical faculty members... I am surprised that any school has been able to get approval.

Wait a minute; How many schools that have gone throught the approval process (as opposed to getting the automatic approval) have approval as of today? My list is: Semmelweis, Szeged, Ross, AUC and SGU. Any I have left out, in particular Mexican ones?

I personally think this is ridiculous overregulation by the State of California.

Especially, considering that the English programs in Hungary (by Hungarian law) must mirror the Hungarian programs, which are fully recognized (as the US Department of Education considers them equivalent to US accreditation standards). If that is not discrimination against USIMGs, I don't know what is.

The only good news is that two of four universities here have the accreditation and the other two are in the process of applying.

I would be very curious to hear Pat Park's response.

N.B. Cost to the state. There is a significant expenditure in having a division that deals with just that. Also, the State of California pays for the big bucks analyst to figure out whether or not the school requires a site visit.

Originally Posted by neilc

the california eligibility is the standard that i think all students should look at. even if you don't expect to live in california. it is pretty safe to say that if your school can get approved there, you shouldn't have a problem anywhere. if a state decides to toughen up it's rules, it will likely look to the california list. if you are on that list, you are smiling. if not, there goes another state!!!

Here, (as the situation stands for potential students) I must agree with you.

However, that does not eliminate the problem that IMGs face with regard to "piecemeal" regulations by states. Once another state starts adopting another standard, what is to keep IMGs from facing 50 different standards in the future?

Miklos