Mexico Medical Student |

Earlier this year, the president of the AAMC wrote this piece about filling the workforce gap with regards to the coming physician shortage. The piece focused on the various sources of non-allopathic/non-US-trained physicians and what roles they play. I have more than a couple of problems with this piece on how Americans who go to non-American schools are portrayed. For example, in describing foreign physicians going to foreign schools then coming here to practice, Dr. Cohen writes:

The contributions made by physicians born and educated abroad cannot be overestimated. In addition to shoring up the U.S. physician supply generally, foreign-born IMGs have contributed disproportionately to the ranks of primary care physicians and to those practicing in underserved areas, to say nothing of their contributions to medical school faculties and to medical science. Given our country’s tradition of welcoming immigrants seeking a better life and given our dependency on immigrant physicians to meet our workforce needs, we must continue to support the integration of foreign-born IMGs into the U.S. medical profession…Can we, in good conscience, continue to drain so many highly educated professionals from countries that need them even more than we do?

That’s all nice and true, but here’s what he wrote about American IMGs:

We know precious little about [Carribean and other] schools but believe that they are, at best, highly variable and, at worst, wholly inadequate. Nevertheless, many students emerge from their “off-shore” experience in good enough shape to obtain ECFMG (Educational Commission for Foreign Medical Graduates) certification and to compete successfully for a place in an accredited residency. These facts raise several additional questions: (1) What obligation do we have to toughen the ECFMG certification process to bolster confidence that those passing muster have overcome the presumed deficiencies in their undergraduate education? (2) What obligation do we have to go even further and try to improve the quality of the education obtained by U.S.-born IMGs? …

Now this raises my hackles a little. Why are foreign-born, foreign-trained physicians treated with such gushing appreciation–even concern for the ethics of taking them from their needy countries, oh my!–while the American-born graduates of some of those same schools treated as second-class professionals with something to prove? All IMGs practicing in this country took the same ECFMG exam (or did Fifth Pathway, as I will do), so why does being American or foreign make a difference? In almost all cases, Americans IMGs have more schooling, having gotten their bachelors degree before going to medical school in any case.

Dr. Cohen seems to beleive that we American IMGs had “deficiencies” that kept us from going to an American medical school, and in some cases he’d be correct (what the true worth of the measurements used to determine “deficiencies” is another matter), but let me make something very clear: in many foreign countries, Mexico included, there is little or no barrier to entry for medical school. You may not have the cash for a private school like the one I attend, but there are public schools that place little emphasis on pre-selecting students. The system works such that with each year, lots drop out or fail; the system is design to allow the wheat to separate from the chaff along the way as the spaces get fewer and fewer. So yes, a Mexican general physician did have to pass everything along the way, but there is no equivalent to the USMLE or any other nationwide exam to pass to ensure that there is a minimum standard is met unless they are seeking residency specifically. Most doctors here don’t or can’t do a residency due to the space limitations and the huge competition involved. That’s just Mexico. I train in the second largest city of Mexico with more than 7 million people (read: patient diversity), not some tiny island somewhere or a country with no appreciable resources.

I find it appalling that someone in Dr. Cohen’s position would be so biased against the very potential talent sitting under his nose, falling over himself trying to open the door wider for those from other countries, while being more concerned about tightening the requriements for letting us, already and continously taxpaying citizens of this country, come back. Dr. Cohen does address the possibility for increasing U.S. school capacity, but only as an afterthought. I would have expected a more enlightened, or at least fair, approach in all honesty.

Thanks to Niels for the link and the article reference.