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Thread: US Residencies should go to US Citizens first!

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    georgelucas45's Avatar
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    US Residencies should go to US Citizens first!

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    If you can pass all your steps, you should be qualified to be a physician. If that is not the case, then the passing score and/or content of those exams should be changed, such that passing them would indeed signify that you are qualified to practice medicine.

    When a FMG gets a residency position over a qualified US IMG, something is wrong with the system. US residencies are funded by US taxpayers and as such, should go to US citizens first. ‘Nuff said.

    My ex-girlfriend went to an Indian medical school in Kerala (after going undergrad in the US). She said that as long as you know the right people or your pockets were deep enough, almost anybody can get into an Indian medical school. She even told me that for a few hundred thousand rupees you can get someone to take your USMLEs and they guarantee to get you a 99. Those who cannot afford to pay must study on their own. It often takes them many years to complete their USMLEs. I’m fairly confident that I and most of my classmates could get dual 99s if we studied for months to years for the exam. The good news is that some (though not enough) program directors now realize this. They've started to take note of when FMGs actually sat for their exams. Some programs offer objective exams to screen out the applicants that paid to have the USMLEs taken. Some go as far as assessing writing skills for note legibility and pre-interview phone calls for speaking proficiency. This is a good step in the right direction and will prevent FMGs from wasting money traveling to interviews only to be auto-rejected because of poor communication skills.

    Despite all this, you’ll still hear arguments made by some bold FMGs that they are ‘superior’ to many Caribbean grads simply because they scored higher on their steps. A favorite conversation starter these FMGs love to use on the interview trail is, “What are your credentials?” It seems that many FMGs equate step scores with the quality of the physician. It is indeed impressive to see people with 99/99, but what about other qualities besides test-taking skills? What about: strength of character, strength of heart, bedside manner, ability to build rapport with patients? Surely no FMGs would say that their USMLE results supersede all these characteristics, would they?

    Many FMGs also say that they should get a residency because they will train at programs where nobody else wants to go. This statement may indeed apply to AMGs, but I know a good amount of US IMGs doing residency in the same hospitals as FMGs. As far as I’m concerned, qualified US IMGs should always be placed before a FMG at these programs.

    For some peculiar reason, a lot of foreign schools have only 0-2 weeks of psychiatry. That’s not the most comprehensive curriculum now is it? Granted, you don't always deal w/ psychosocial issues on a daily basis in most fields, but shouldn't you at least know the major signs and symptoms of psychiatric diseases? That's kind of hard to do with 0 weeks of psychiatry in your curriculum. What I find truly ironic is that, despite this, so many FMGs are applying to psychiatry (as a backup I might add). Although it is historically the easiest specialties to get into, isn’t psychiatry the specialty where command of the English language is most imperative? I’m just saying… these FMGs may end up doing their patients a huge disservice if they miss a subtle nuance, don't understand slang or sarcasm, etc.

    Some FMGs can get pretty uppity making claims like,” We are the best in our country and you couldn’t even get into an American School.” If they are indeed so great, why don’t they just stay in their country and help the people there? Also, a little humility can also go a long way in winning people over. There is however, some truth to their statement. While almost all of us in the Caribbean couldn’t get into a US MD school, a good number of us could have gotten into a DO school but decided against going for whatever reason. Does that mean US IMGs are stupid? Far from it; it’s simple supply and demand. There are just not enough spots for all the qualified applicants. Fortunately, for medical school, there are other options like the Caribbean that allow us to pursue our dreams. Unfortunately however, for residency, there are NO other options. To practice in the US, you must train in the US. These limited spots for non-AMGs should go to all the qualified US IMGs - so dedicated to the profession of medicine that they would go to a completely different country for medical school while enduring countless hardships and economic burden.

    These residency spots should NOT go to those FMGs who are here to exploit the USA. Let me educate you guys. In India, medical school is dirt cheap but doctors must pay to do residency. When FMGs do residency here, they just got a very cheap medical education and got paid to do residency training (it's a good hustle). It's not like they all want to stay in the US either; many FMGs just come here for residency and then go back to their home country. This troubles me because when a residency program gives an FMG a spot over a US IMG, there’s a chance that that grad’s passion to practice medicine will get extinguished by not matching. The US will then have lost an excellent physician who would have done tremendous good for their US community as well as bring in hundreds of thousands of dollars in tax revenue - all because of these FMGs. For shame!

    The actions of these FMGs affect more than just the non-matching US IMGs. I know some residency programs that were put on probation because not enough of their graduates sat for the boards. These FMGs are selfish and have no remorse for tarnishing their programs name (even after that program went out of their way to accept an FMG and do visa paperwork). These FMGs also have no guilt over stealing money from the US taxpayers who paid for their residency training. Is it too much to ask that they stick around for a few years? The whole idea of being trained in the US is so that you'll be able to practice and give back to your US community for many years to come. (I realize some FMGs have to go back to their countries b/c of visa requirements. I'm not talking about them here; I'm taking about those who never intended to stay in the US to begin with.)

    My name is George Lucas. I was born an American, I will live as an American and I will die an American. Because I chose to pursue medicine to help my fellow countrymen, I currently have a negative net worth. I gave O'bama the only thing a poor person can - my vote. He talks about strengthening the math and sciences of our country; I am sure he would include physicians somewhere in that spectrum. So unless he wants to contribute to the brain drain going on in medicine, laws must be passed so that no FMG will match while there are still qualified US IMGs to choose from. O'bama, help a brother out.

    Some of you may think that I am a fear monger, a racist, an elitist, ethnocentric, etc. I hope a greater number of you see me for what I truly am, a Patriot. God Bless America.

    Acronyms:
    AMG: Graduate of a US Medical school (MD or DO)
    US IMG: US Citizen at a foreign school whose primary goal is for graduates to attain residency in the US (ie. Caribbean schools)
    FMG: Non-US Citizen at a foreign school whose main purpose is to produce practicing physicians for that country (not the US).

    tldr - The residency process needs major changes - mainly that taxpaying US IMGs should have absolute priority over FMGs for residency positions.

  2. #2
    leadsled is offline Senior Member
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    I hope you write your senators and congressman!

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    Scott1981's Avatar
    Scott1981 is offline Super Moderator 10511 points
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    might as well place a warning on this thread since it may degenerate quick. any posts on this thread that are in violation of the terms of service will result in immediate infractions. no courtesy pm's. now feel free to have a civil discussion.
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    Quote Originally Posted by georgelucas45 View Post
    If you can pass all your steps, you should be qualified to be a physician. If that is not the case, then the passing score and/or content of those exams should be changed, such that passing them would indeed signify that you are qualified to practice medicine.

    When a FMG gets a residency position over a qualified US IMG, something is wrong with the system. US residencies are funded by US taxpayers and as such, should go to US citizens first. ‘Nuff said.

    My ex-girlfriend went to an Indian medical school in Kerala (after going undergrad in the US). She said that as long as you know the right people or your pockets were deep enough, almost anybody can get into an Indian medical school. She even told me that for a few hundred thousand rupees you can get someone to take your USMLEs and they guarantee to get you a 99. Those who cannot afford to pay must study on their own. It often takes them many years to complete their USMLEs. I’m fairly confident that I and most of my classmates could get dual 99s if we studied for months to years for the exam. The good news is that some (though not enough) program directors now realize this. They've started to take note of when FMGs actually sat for their exams. Some programs offer objective exams to screen out the applicants that paid to have the USMLEs taken. Some go as far as assessing writing skills for note legibility and pre-interview phone calls for speaking proficiency. This is a good step in the right direction and will prevent FMGs from wasting money traveling to interviews only to be auto-rejected because of poor communication skills.

    Despite all this, you’ll still hear arguments made by some bold FMGs that they are ‘superior’ to many Caribbean grads simply because they scored higher on their steps. A favorite conversation starter these FMGs love to use on the interview trail is, “What are your credentials?” It seems that many FMGs equate step scores with the quality of the physician. It is indeed impressive to see people with 99/99, but what about other qualities besides test-taking skills? What about: strength of character, strength of heart, bedside manner, ability to build rapport with patients? Surely no FMGs would say that their USMLE results supersede all these characteristics, would they?

    Many FMGs also say that they should get a residency because they will train at programs where nobody else wants to go. This statement may indeed apply to AMGs, but I know a good amount of US IMGs doing residency in the same hospitals as FMGs. As far as I’m concerned, qualified US IMGs should always be placed before a FMG at these programs.

    For some peculiar reason, a lot of foreign schools have only 0-2 weeks of psychiatry. That’s not the most comprehensive curriculum now is it? Granted, you don't always deal w/ psychosocial issues on a daily basis in most fields, but shouldn't you at least know the major signs and symptoms of psychiatric diseases? That's kind of hard to do with 0 weeks of psychiatry in your curriculum. What I find truly ironic is that, despite this, so many FMGs are applying to psychiatry (as a backup I might add). Although it is historically the easiest specialties to get into, isn’t psychiatry the specialty where command of the English language is most imperative? I’m just saying… these FMGs may end up doing their patients a huge disservice if they miss a subtle nuance, don't understand slang or sarcasm, etc.

    Some FMGs can get pretty uppity making claims like,” We are the best in our country and you couldn’t even get into an American School.” If they are indeed so great, why don’t they just stay in their country and help the people there? Also, a little humility can also go a long way in winning people over. There is however, some truth to their statement. While almost all of us in the Caribbean couldn’t get into a US MD school, a good number of us could have gotten into a DO school but decided against going for whatever reason. Does that mean US IMGs are stupid? Far from it; it’s simple supply and demand. There are just not enough spots for all the qualified applicants. Fortunately, for medical school, there are other options like the Caribbean that allow us to pursue our dreams. Unfortunately however, for residency, there are NO other options. To practice in the US, you must train in the US. These limited spots for non-AMGs should go to all the qualified US IMGs - so dedicated to the profession of medicine that they would go to a completely different country for medical school while enduring countless hardships and economic burden.

    These residency spots should NOT go to those FMGs who are here to exploit the USA. Let me educate you guys. In India, medical school is dirt cheap but doctors must pay to do residency. When FMGs do residency here, they just got a very cheap medical education and got paid to do residency training (it's a good hustle). It's not like they all want to stay in the US either; many FMGs just come here for residency and then go back to their home country. This troubles me because when a residency program gives an FMG a spot over a US IMG, there’s a chance that that grad’s passion to practice medicine will get extinguished by not matching. The US will then have lost an excellent physician who would have done tremendous good for their US community as well as bring in hundreds of thousands of dollars in tax revenue - all because of these FMGs. For shame!

    The actions of these FMGs affect more than just the non-matching US IMGs. I know some residency programs that were put on probation because not enough of their graduates sat for the boards. These FMGs are selfish and have no remorse for tarnishing their programs name (even after that program went out of their way to accept an FMG and do visa paperwork). These FMGs also have no guilt over stealing money from the US taxpayers who paid for their residency training. Is it too much to ask that they stick around for a few years? The whole idea of being trained in the US is so that you'll be able to practice and give back to your US community for many years to come. (I realize some FMGs have to go back to their countries b/c of visa requirements. I'm not talking about them here; I'm taking about those who never intended to stay in the US to begin with.)

    My name is George Lucas. I was born an American, I will live as an American and I will die an American. Because I chose to pursue medicine to help my fellow countrymen, I currently have a negative net worth. I gave O'bama the only thing a poor person can - my vote. He talks about strengthening the math and sciences of our country; I am sure he would include physicians somewhere in that spectrum. So unless he wants to contribute to the brain drain going on in medicine, laws must be passed so that no FMG will match while there are still qualified US IMGs to choose from. O'bama, help a brother out.

    Some of you may think that I am a fear monger, a racist, an elitist, ethnocentric, etc. I hope a greater number of you see me for what I truly am, a Patriot. God Bless America.

    Acronyms:
    AMG: Graduate of a US Medical school (MD or DO)
    US IMG: US Citizen at a foreign school whose primary goal is for graduates to attain residency in the US (ie. Caribbean schools)
    FMG: Non-US Citizen at a foreign school whose main purpose is to produce practicing physicians for that country (not the US).

    tldr - The residency process needs major changes - mainly that taxpaying US IMGs should have absolute priority over FMGs for residency positions.
    so, all those Canadian doctors that America has been poaching all these years should go back home, right? You can't have it both ways, going into other countries and "recruiting" (i.e. stealing) their doctors that you didn't pay to have trained and complaining that other countries are sending some of their physicians here to train.

    I was born in Canada and spent many years growing up in the US and contributing to the US system, so are you going to lump me and all the other Canadians who leave our country forever to go to the US to practice the way we want in with all these other nasty FMGs you're talking about? Or is it just the ones whose culture isn't close enough to that of Americans or those who have a strange accent? If you got rid of all the FMG's in this country, the American healthcare system would collapse....so what if there are a few who go back to their home country, the majority actually do stay here and contribute. Do you think that they don't pay taxes in America during their residency? That they aren't contributing to the economy of America? As far as I know they all pay rent, taxes, do all their shopping here while they are completing their residency, they do contribute, significantly. I'm one of those FMGs who did my clinical training in the US and who has fallen in love with an American and I want to stay here, so am I ok to get a residency here? Or am I still equal to these Indian FMGs that you seem to have so much hatred toward?

    Trust me, America hasn't yet experienced a "brain drain" in medicine, that was Canada back in the 80s, 90s and early 2000s when American recruiters came up and offered them all kinds of money and incentives to go down to the US to practice. THAT's a brain drain....give me some numbers about what percentage of trained residents leave this country after their residency.

    And for someone born in a country that was founded on immigration, yeah, this comes across as fear-mongering.....Canada implemented a system a few years back requiring FMGs that do their residency training in Canada to do a Return of Service agreement that keeps them in the country for the equivalent numbers of years of their residency training. However, they didn't implement anything for Canadian graduates that was similar...and what do most of them do? Right after their residency training they head on down to the US to practice. So, you are getting doctors that America didn't pay to have trained.

    And really? Years to study for the USMLEs to get 99/99? I've got 99/99/pass/99 all on first attempt and the maximum time I studied was for Step I, took 2 months to go through everything, the rest of my exams I took about one month to study for. These exams are relatively simple, and for someone whose native language is English, it should be even easier for you to do this over some guy from India.....

    And don't even start in on the President, have you been keeping track of all the cuts that are going on? Sure, lets make it even less worth our time to go into primary care when Medicare won't be paying us anything to see these patients. Lets increase our workload without increasing the number of residency spots. Lets not do anything with tort reform and keep the insurance companies in charge of medicine. The way this is going, when I have my own private clinic, I'm not accepting any kind of insurance and just getting people to pay cash up front like back in the old days.

    While I do agree with you that the residency training system needs overhauling, perhaps you can be a little more realistic in the sense that a lot of these FMGs keep the system and hospitals going by providing man-power that many AMGs and even US-IMGs find "beneath" them. There are plenty of FMGs that I would rather have treat me than US-IMGs I went to school with and even some AMGs I know. There are also other FMGs I wouldn't let touch me with a 10 foot pole, but I could say the same for some AMGs and US-IMGs as well....
    Brolle, brusmani and WindsorGirl91 like this.
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    kananaskis_girl's Avatar
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    Hope that was civil enough Scott
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    I thought it was pretty civil... and you even kept that Canuck accent in check.

    (I kid, k_girl, I kid... I spent my formative years in Alberta.)

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    rokshana is offline Member Guru 11644 points
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    wah, wah, wah...cry me a river...threads like this regularly pop up after match day...and if an off shore student doesn't get a spot, its no one elses fault but their own...maybe if their application was stronger than they would have been a more competitive applicant..'nuf said...

    you really what such a policy to be set? then guess what? IMGs will be the ones shut out as well...because then a true hierarchy WILL be set...meaning US seniors at US med schools will ALL get spots first, then US citizens attending foreign school will get the leftovers...given that the number of US seniors are increasing and there are only ~10% overage of residency spots, very very few IMGs will get anything...and those WILL only be in family, IM, peds and prelim surgery.

    and BTW a majority of the students in the caribbean have yet to pay a PENNY in US taxes...better that you say taxpayers' children....
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    rokshana is offline Member Guru 11644 points
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    Quote Originally Posted by kananaskis_girl View Post
    And don't even start in on the President, have you been keeping track of all the cuts that are going on? Sure, lets make it even less worth our time to go into primary care when Medicare won't be paying us anything to see these patients. Lets increase our workload without increasing the number of residency spots. Lets not do anything with tort reform and keep the insurance companies in charge of medicine. The way this is going, when I have my own private clinic, I'm not accepting any kind of insurance and just getting people to pay cash up front like back in the old days.
    no kidding...boutique medicine is looking better and better!
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    Last edited by devildoc8404; 03-19-2011 at 04:37 PM. Reason: inadvertent double post

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    Scott1981's Avatar
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    Quote Originally Posted by rokshana View Post
    no kidding...boutique medicine is looking better and better!
    until O unleashes a decree making it illegal to deny insurances.
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