Guest Post by Kevin Lynn
I was catching up on reading a stack of newspapes that had piled up while pondering what to write for this week’s blog when the answer leapt out at me from the front page of the Sunday local Lancaster, Pennsylvania newspaper. Front and center was an article entitled DOCTORS WITHIN BORDERS.
Since 2006, 7,000 Cuban doctors and other healthcare professionals have been admitted to the US under a special government program. The article went on to detail how Church World Services (CWS), a volunteer agency (VOLAG) that specializes in refugee relocation services and garnering large federal government grants in the process, helped to relocate these Cuban healthcare workers here and in 11 other cities.
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The article profiled Cuban defector, Dr. Maily Betancourt who is currently working as a caregiver and studying in her spare time to pass US medical licensing exams so she can practice as a doctor once again. For decades Cuba has been renting out its doctors and nurses to foreign countries as way to earn cash and valuable commodities such as oil. In the exchange, Cuba makes billions of dollars a year and its doctors earn what can be considered subsistence pay. Dr. Betancourt exemplifies the thousands of Cuban doctors who have “made their way” to the United States to find a better life.
I was intrigued to read the article because last summer when I was attending Politicon in Pasadena, CA I had the opportunity to interview Dr. Doug Medina, a graduate of Georgetown University’s medical school who despite his never having failed any clinical course work, and having passed all three licensing exams, was not able to matriculate into a residency training program. Now for those not familiar with medical career paths, following graduation if a doctor cannot be matched with a US residency program at a teaching hospital, they cannot be licensed to practice medicine in the US. It is pretty brutal when you consider a student upon completing medical school could be hamstrung with anywhere from $130,000 to $250,000 in student loan debt (and quite possibly more if you factor in 4 to 5 years of pre-med.) Then to add insult to injury, there is the ever accruing interest at 6.7% which could raise a student’s total liability to over $400,000 over the term of the loans.
According to data from the National Resident Matching Program (NRMP), a program that was established in 1952 to assist medical school graduates with finding residency programs in 2016, of 19,692 graduates from US medical schools, 1,900 were not matched with a residency program. Currently, it is believed that there are some 9,000 graduates of US medical schools who were not matched with a residency program and for all intensive purposes will never be able to practice as doctors.
It would be one thing if as in the case of Cuba, education was government funded. Here in the US it is not. And the onus is on the student and their family to come up with ways to finance their education. The question then becomes how is a medical school graduate going to service the debt on their loans if they cannot command the salary of a doctor? If plan B is to become a high school biology teacher or a research assistant, then good luck servicing your debt, buying a house, car, and starting a family. . .
Although in 2016 there were 1,900 graduates of US medical schools that were not matched with a residency program, in the same year, 3,769 foreign trained physicians (FTP) were matched with residency programs here in the United States. At first glance this may sound absurd and sadly, the more one delves into it, it only seems to become more absurd.
Without a doubt there are many areas across this country that are underserved when it comes to physicians. This is why there is a clamor to admit more FTPs. There are solutions. But we must be prepared to bridle the special interests that have helped to create a situation where on one hand, there are patients who cannot get adequate healthcare, and on the other we have medical school graduates that are not allowed to practice because they cannot get into a residency program.
One solution could be to increase the federal healthcare budget and create more resident positions at teaching hospitals. You see, residency training in the United States is funded in part by Medicare. The salary of about $50,000 per year a resident receives is paid out of Medicare. Another solution would be to cut down on the number of resident positions given to FTPs. For instance, if the number of FTPs matched with a residency program had been dropped from 3,769 to 1,896 in 2016, every graduate of US medical schools would have been admitted to a residency program.
Another thing to consider would be to reign in the VOLAGs such as CWS who have actively lobbied lawmakers to admit more refugees. These VOLAGs are given federal grants based on the number of refugees (or doctors from Cuba) they work to resettle in the United States. This is big money. In the case of CWS, 70.8% or $68,448,159 of last year’s income came directly in the form of grants from the Federal Government. Another solution might be to take a chunk of the $68 million given to CWS and allocate to fund more resident programs. At $50,000 a resident position, the money reallocated from CWS to Medicare could create roughly 1,368 new positions.
In addition, the topic of FTPs must also be viewed holistically. The article referred to the arrival of Cuban doctors as an “unprecedented influx of talent.” That may very well be as for very little investment, the US gets to reap the benefit of a person’s education and experience. In the case of Dr. Betancourt, that is schooling from elementary through medical school, residency/ internship, and 15 years of practicing as a physician.
However, our gain is the sending country’s loss. These sending countries need doctors, nurses, technologists, engineers, mathematicians, and scientists also. In fact, their needs may be greater than ours. This brain drain is a double edged sword that is hurting the citizens in this country as well as countries of origin.
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Those 1900 without residency must be all ‘white boys’.
Would you prefer an affirmative action doctor, or a regular doctor?
Old, bad Medical School joke, as told by my brother Dr. Willard:
Q: “What do they call the guy who graduated last in his class from Medical School”?
A: “Doctor!”
I’m not sure all medical school graduates can or should be matched with Residencies. A 12% “wash-out” rate doesn’t seem like a big deal to me. If one of these knuckleheads killed you by accident in the ER, we’d all be worried residency programs were too lenient.
My cousin Dr. Willard was the Chief Resident at a large hospital in our home state’s capital city and could tell you some frightening stories about some of his residents. He successfully implemented changes to their interview screening for the “Match”.
Your cousin without a doubt has a wealth of first hand information that I could not hope to be privy to. But, with the Doctors I met, all had done well in medical school. And frankly, shouldn’t their graduation infer a level of competence? One I met with was even back teaching summer courses part time at the school they graduated from after failing to get a residency. I have had doctors attest to instances where the foreign trained physicians that were selected had failed some of their exams. I have not done adequate research as of this time, but have seen indications of a kind of social darwinism at play in the selection process wherein some programs favor FTPs from particular countries to the detriment of US medical school graduates. It is an area I am planning to devote a lot more attention in 2018. If your cousin has had experience with FTP residents, and would be willing, I would like to interview him down the road . please reach out to me at [email protected]
My step mother is a total imbecile, and a doctor as well. Originally from the state of new mexico, she was trained in mexico because she could not get into an american school. Because she is stupid. She interned as she was schooled, and then used the loophole this article mentions to get her dumb ass into a residency in the US. After residency she moved into holistic longevity, wtf ever that is, as a private practice. She now specializes in life extension, and gets her paycheck from medicare medicaid mostly. She is still a retarded hippie escapee from the 60’s. For the life of me i dont know what she does other than prescribe her own vitamin concoction to old people. Its proprietary vitamins from a stem cell line i am told.
Whatever it takes to bring medical costs down.
That’s what we need to do.
Drop all requirements and let anyone practice medicine. That would bring costs down.
Robert (QSLV)
That would be the consumer driven free market solution, let the patients decide for themselves whether or not their doctor and staff are qualified to treat them instead of government bureaucrats making that decision for them.
Would you recommend the same for commercial pilot’s licenses?
You desperately need to drop your “government is only doing this for our own good and safety” mentality. LIABILITY for the airlines would FORCE them to ONLY hire people whose qualifications were verified or certified. IT DOES NOT TAKE A GOVERNMENT AGENCY TO DO THIS!!!!!!!!!!!!!
Liability can be an insufficient motivator, recall the infamous Pinto Memo. Ford made a financial decision to pay the claims from burned victims rather than pay to recall and fix the defect. Regulation vs Tort is an old debate. Regulation can prevent a tragedy; the tort system can only respond afterwards. Take the Titanic for an example, would it be better to have regulations requiring adequate lifeboats & life jackets, or let the victim’s families seek redress in tort action?
Bob saw his doctor and asked if he had ever laughed at a patient.
“In over 20 years I haven’t because I try to remain professional.”
With that Bob dropped his trousers revealing the tiniest dick the doctor had ever seen. It wasn’t any bigger than a AAA battery.
The doctor burst into uncontrollable laughter. “I’m sorry I really am, I don’t know what came over me, I promise it won’t happen again. Now what seems to be the problem?”
“It’s swollen” said Bob.
Groggy, you’re becoming to me like Dutch…a valued resource for daily laughter.
On that note,
I went for my annual physical and was in the examination room.
I asked the Doc where I should put my pants for the routine prostate exam.
“Over in the corner, next to mine” was NOT what I expected to hear!
Just make sure that both of his hands are not on your shoulders.
As a patient getting free meds for a NIH fellowship training program, I witnessed a few med school graduates who totally lack a bedside manner of any sort and am sure they would have to find work in the back of a research lab somewhere; these cretins did not even finish the 2 yr. program. I am not sure if they had already obtained a residency in a hospital.
My two sisters-in-law were both able to finish med school, residency and boards and become doctors. One has no “bedside manner” worth mentioning: she might tell a patient “Of course you have diabetes, you’re fat, eat too much sugar and carbs and don’t get enough exercise! What did you expect?” which is all true, but not kindly. She eventually went into public health, spent time in D.C. and environs either in the FDC or working for drug companies. It’s probably best she never really tried to stay in private practice. She’s a totalitarian parasite at heart.
The other is similar, but went into anaesthesiology, so she doesn’t have to talk to patients. As a gas-passer she is fairly capable, does her thing and does it well. Her problems have come from her practice partners: sometimes, a practice “bids” for all the anaesthesia for a given hospital, so that no other practice can do that. Not sure how that works, but there it is. It seems likely though that you could write a proverb: “Doctors get rich by screwing their patients, and STAY rich by screwing each other”. Her career is a series of “promised a partnership by X group once five years of service completed, let go by X group after four years eight months service”, “promised partnership in Y group once certain conditions met, conditions met but let go by Y group for trumped-up lack of attendance charges” (not true; the gal is a workaholic), followed by “promised management partnership by Z group, let go after eight years when Z group was “bought out” by another group (led by a Z partner). Sometimes doctors are their own worst enemies.
Usually those who administer “first aid” are immune to charges of malpractice for whatever services they do trying to save someone (generally, on the scene of an accident). How is it that “first aid clinics” require doctors with licenses, or do they?
I always get at least a quick once over from an MD at the urgent care clinic for my HMO. CVS stores now have Minute Clinics that offer free flu vaccines; I suspect CVS jabs patients as soon as they walk in.
I spent two years in Cuba. These are not “doctors”. They are, at best, “feldshers”, comparable to WWII army medics or Navy corpsmen. They know mothing about modern medicine. Do not let one touch you!
It would also help to understand that the limited number of residencies, the limited number of medical schools, professional licesure requirements, etc. are ALL the product of direct COLLUSION between the federal and state governments and the AMA/western medical cartel. Until we get government 100% out of the medical industry, we will NEVER fundamentally solve the myriad of problems THEY have directly caused in the medical industry and will NEVER get back the kind of consumer POWER and CONTROL that we DESERVE.
“professional licesure requirements”,
I’m actually pretty comfortable with the medical license requirement.
Given that you can lose your license in most states for recommending natural alternatives, vitamins, etc. I would think that you might oppose the control over who gets to perform what procedures by those with a vested interest in protecting their cartel. Because that is ALL that professional licensure is about – protecting the entrenched status quo from competition……not protecting the consumer from the criminals. There are plenty of NON-governmental means of protecting the consumer without empowering the cartel or destroying the competitive marketplace.
Crazy, isn’t it?
Lose your license for giving vitamins …. while Big Pharma pushes drugs with one horrendous side effect after another, including Death.
What a country.
I have been refusing vaccines for years.
My HMO is not thrilled but I am enrolled thru Medicare and the head honchos have not threatened termination of my membership.
Even their own staff now wears masks in lieu of getting flu vaccines.
The higher level of sanitation , once the working class had their own bathrooms, is what ended the prevalence of several morbid diseases.
I know several licensed practicing physicians recommending vitamins to patients.
An MD at my HMO used to test my vitamin D levels.
Somehow he ended up on a sabbatical of some sort.
The HMO never gave any other explanation for his “departure”. Vitamin D is the most basic measure of any human’s immunity to diseases, chronic and infectious.
I will always, until I can no longer count pills, make sure my daily vitamins include vitamin D3.
I don’t know the answer. In my wife’s med school class, some of the classmates that had trouble matching had a history of interpersonal conflict with classmates, professors, and administrators. Grades are also an issue. I guess I would rather be treated by a FTP with a B average over a US med school grad with a D average.
Is a “B” earned in a 3rd World country’s university greater than a “D” earned in the US?
Because my experience (from foreigners in the engineering field) says “eh, maybe, maybe not.”
The D might actually mean they are more qualified…
It’s hard to say… that’s why EVERYBODY has to take the same licensing exams before even being considered for residency. That is how they compare AMGs to FMGs.
Around here (NYC area) all pharmacies are becoming like a 7-11 convenience store …. bunch of Dotheads. MANY doctors also. It’s discouraging.
As someone who just got out of a hospital I can tell you the doctors in training we’re Mostly ” people of color or white women ” .Some of these would be doctors could not speak English very well.I would not like them get any near me.It was obvious affirmative action was being used .
Thank God all my surgeons were white with decades of experience .Most of my nurses were white . Another thank God.
I’m aware of several fatal aircraft accidents caused by Affirmative Action Pilots.
This is a somewhat inflammatory article. There is a key fact you do not address and that is the growing doctor deficit across most fields in medicine. The choke point of residency is a problem now being felt by every graduate with an MD and soon DO, regardless of country of origin. It’s a simple truth that blocking anyone from progressing to the next step (AMG or IMG alike) in the face of such need for more physicians is ludacrious. If you are dying of thirst and someone gives you a bottle of water, you don’t reject it because the bottle was made in China. The only obvious solution is to increase residency funding and training positions. It makes no sense for any graduate to be sidelined. Period.
Keep in mind FMGs who do go on to American medical residencies have to take the same licensing exams and still are subject to the grueling interview process. In most cases of selection they are the most competitive applicant… sometimes even more so as NRMP data shows they generally have to score 10-15 points higher on USMLE STEP exams than their AMG counterparts.
Lastly, also consider medical schools in the US alone have been expanding every year since Congress capped residency funding back in the 90s. Established schools are continuing to increase class size and new medical schools are opening every year. All of this without the residency growth to house them. It is an unsustainable system.
Simplifying this down to “FMGs are taking our jobs” is a Trumpish reduction.
” …. have to take the same licensing exams and still are subject to the grueling interview process.”
If the “interview process” was a good indicator of finding the right candidate … then every new hire would be the correct choice. But, that’s far from the case in the real world, isn’t it?
Similarly, passing a test is just about as meaningless. Some, or many, are simply good at taking tests. “Smart” on paper. Dumb as a box of rocks in real life.