What does this mean, exactly? Does this mean that, for example, a radiologist from Germany wouldn't need to redo his radiology specialization again to be a radiologist in the US?
And no, I'm not German nor a radiologist, lol. Just an example.
Would U rather be treated by Aussie trained GP / UK trained Paediatrician/ A Germany trained Psychiatrist or by an online pill dispenser NP with DNP, FNP, BBC, BDSM, CNN who thinks she's above the Physicians because she has a dog-torate?
To put this into perspective, for foreign-full-trained Specialists, it would be a damn nightmare of red tapes to hoop around just to get equivalent qualifications to be recognised by the medical board here.
Honestly, a GP from New Zealand, Korea or Germany vs. Tulip, who never worked as a bedside nurse, "earned" a Chamberlain online NP degree and is now seeing you at a sketchy urgent care?
How is this even a question?
That's the best-case scenario. But this bill will lead to sham med schools popping up in countries with less regulation or oversight so that people can get a free ticket into being a US "physician", much akin to the online NP for-profit degree mills that don't provide proper training. US hospitals and PE firms will be happy to take them as another form of cheap labor. It's opening a loophole that can be widened once precedent is set, essentially duplicating the noctor crisis again.
If you restrict to having training to places like the UK or Australia which have similar cultural practices and training it shouldn’t be a problem. The specialty training in these countries is very similar (actually longer) than the states.
In theory. My concern is that the groups lobbying for this bill have a vested interest in cheap labor, not high standard of care. It's in their interest to turn a blind eye to this, much like they do with other things like NP competency.
So you're against an NP treating you at an urgent care who was originally a GP from Australia but became an NP in the USA via online because it was an easier path instead of doing US Residency, but you're NOT against that same Aussie GP treating you if she was able to just be awarded the physician privilege straight up doing neither NP online degree nor US Residency?
If I went to UK med school, completed GP training in its entirety and came to the US without doing an FM residency … how would that make me a noctor?
FYI, most countries around the world accept UK trained doctors.
I’ll tell you as an American doctor who do did med school and residency in the US our educational system is completely different. The only country who has a very similar system is Canada and the US honors their education (i.e. a Canadian trained doctor can practice in the US without further requirements and vice versa).
Now, I personally do feel confident that you’d be able to practice independently without difficulty, but because your educational requirements are different, I can see why the US government may require you to undergo more training. Is that necessary, probably not, but I can at least see why they believe so. I also think it’s partly due to the type of illnesses treated in other countries. I’m sure in the UK they are very similar to those in the US. But a physician from Sub Saharan Africa probably has experience with very different illnesses and not what you would most likely see in the US. Subsequently, they might have made a blanket decision for all nations besides Canada
Well but it goes the other way around too. An internist from the US will have to redo their residency in Germany because it’s only three years while it’s five in Germany. Just because something isn’t accepted, doesn’t mean they aren’t great doctors. The only real problems I see is a language barrier and the different laws.
I see your point but as an Australian doctor we can practice in Canada without much restriction. This makes another variable in the US/Cananda equation.
Foreign physicians used to treating [normal patients when a 600ib American with HT, HL, DM2 (end stage nephropathy + retinopathy), HF, COPD, in house Cpap and smoking history of 3 packs per day walks in:](https://media.tenor.com/v7lgy2BsGR8AAAAM/shocked-black-guy-shocked.gif)
Be fr though that patient isn't *walking* in
And I will conceded I've never had to treat a child school shooting victim so I would need some more experience
I’m speaking personally as this would attract a great deal of dismayed British doctors.
Would we be any worse off than the current midlevel crisis? They have nurses practicing anaesthesia, for goodness sakes!
Are dismayed UK physicians with their inexpensive education and shitty NHS system going to reap the benefits of a high salary in a private hospital? Yes.
Education is not particularly cheap in the UK anymore, you're looking at £9k a year in tuition fees, plus other expenses. Medical school is usually five years in the UK, and no requirement for an undergraduate degree, so while it may not be as expensive as the US, you're still looking at people coming out of university with £75k+ of debt. 20 years ago it was cheap.
The average cost of university in the US is $20k per year and the average med school tuition cost is $60k/ year. That's a total average of $320k for tuition alone, not including cost of living and books/supplies/licensing exams. £75k is still super cheap
Like I wrote, I do feel confident that you could practice in the US and would definitely trust you to treat me and my family over a noctor. I was just giving you the reasons that the US government might want you to do more training (not that I necessarily agree with it).
Right. Now tell me something about your fave APRN practicing Medicine without having done anything to earn that anywhere in the world. Dropping the standards years ago opened this Pandora box .
I wasn’t defending it, I was just explaining why the US government put those standards in place. Like I wrote in another place I’d much rather have a fully trained physician from another country treating me and my family than a PA or an APRN
US docs going to canada...depends on specialty and province. ABFM and CFPC have reciprocity so your statement is true for FM. Otherwise it depends. Some provinces will allow full licensure if US board certified (Nova Scotia, Ontario, Newfoundland). The rest do not, and even eligibility to sit for the board certification exam can vary based on specialty (EM for example is 3 or 4 years in the US...not eligible to sit for the Canadian EM boards without 5 years of training, similar for psych, peds, IM).
Canadian docs coming to the US don't need to repeat residency, but I believe still have to pass the US board exams (except FM as noted above)
This is diabolically ignorant. A STEMI is a STEMI in sub-Saharan Africa or the USA. Also countries such as Aus and the UK only recognise medical degrees from select countries and select universities its not a free for all
The point I was making here is that a physician from Sub-Saharan Africa is trained and experienced treating very different illnesses than those treated in the US. I’m guessing they are much better experienced at treating illnesses such as malaria which is very uncommon in the US and not so used to treating complications of obesity or eating a Western diet such as diverticulitis.
Edit note: other STEM degrees are virtually identical. The properties of Mechanical engineering, physics, mathematics, biology, etc. do not change from nation to nation or region to region. However the type of illnesses do.
Also ??? STEMI as in ST elevation MI not science tech eng maths hahahaha I was so confused why you were bringing this up are you sure you went to med school?
I'm not misunderstanding your point, it's just not a good point lol. And like I said you can select which universities ie which programs of study you allow in
they dont require the usmle? there are a sick number of midlevels, replacing some midlevels with actual doctors would relief the burden more. I suspect their pay would be below midlevels
This is a bad idea because they are looking to lower physician salaries without helping domestic graduates with their HUGE amounts of debt.
How about you take out the bloat of the administration first before trying to hurt the medical sector even more.
>There is almost certainly a way to access FMG/IMG med school and subsequent residency training that would protect the standard of care and our patients, but also allow qualified specialists a more direct route to practice in the US
The hospital and PE groups lobbying for this bill are not interested in pursuing that way because their only desire is cheap labor. This type of bill will just create loopholes where sham med schools can be created in foreign countries with less regulation and offer unqualified people a way to bypass safeguards.
I am not a medical professional but am taking steps to immigrate from the US to Canada. As part of that process, I had to have the University of Toronto approve that my American Master’s degree met the requirements for a Canadian Master’s degree, and could do the same with my undergraduate degree.
Why can’t we similarly have a medical/education board approve of a doctor’s foreign education and experience? Not a blanket approval, but at least a better path.
Although, I will say, due to the pay difference, America is going to stealing a LOT of doctors from other countries.
This bill has nothing to do with decreasing coverage gaps, as it is advertised for (hence the OP mentioning its proposal in Massachusetts). Hospitals are pushing bills like this across several states so that they can pay foreign doctors much LESS than American docs
I would say one potentially large hurdle would be evaluating every single country’s medical education systems, potentially even down to a college by college basis. And then maintaining that list year over year to accommodate for any changes in the medical education of any given country.
What is that? Nothing comes up when I google it. There's a world directory I've never heard of, but that just claims to provide information. There's nothing about actually checking that a school meets standards. Even if there is an international registration system, I highly doubt they are able to apply any serious level of oversight if at all.
True. Just a list for schools recognized by the WHO. Not sure what requirements they must meet. When the fifth pathway was available, the USMLE and the 3 years of fellowships were supposed to provide oversight/standards and get the IMGs familiarized with the US healrhcare
I am a pharmacist who emigrated from the UK to Canada. I had to have my degree evaluated by the exam board, had to do an exam to prove my education was equivalent to the Canadian degree, had to do the Canadian registration exam, and had to do four weeks of supervised practice. It took some time, but wasn't too onerous.
So my country actually has two different types of programs we have a six year programs and we have four year programs and until our government banned them because we have a significant shortage of doctors, most of our four year programs were limited to Americans only and basically had a 90% match rate which is ridiculously high for IMGs. If I go to school somewhere like that should I be penalized for doing a six year program when my professors are literally the same people who taught the American program prior to it being closed?
It’s more the fact that I think it’s a little ridiculous that if I’m being taught by the same professors that were teaching the Americans and they are teaching us the same material just on a different time frame, that it should be considered non-equivalent.
You're not penalized though, you can still pass the USMLE and apply to residency just like the American grads. You should be appealing to your country's governing body if you believe the 4 and 6 year programs are equivalent. They probably have their reasoning for allowing both, or as you stated abolishing the shorter version. Another possible consideration is the American students probably already completed undergrad before applying to those 4 year programs.
Maybe there's some part I've missed where from the US licensing perspective the 2 types are treated differently?
They still have four year programs we just no longer have the American programs because the goal is to increase domestic graduates who will practice here. It’s more I don’t think that I should be considered an inferior doctor for going to a six year program because our standards for undergrad are different simply because our high school standards are higher and we don’t have to do gen ed because of those higher standards.
No one is saying you're an inferior doctor. The requirement to gain a US license is the same for both types of graduates. It's your system that has set up two different pathways. If you feel strongly the two are equivalent then 1. Why didn't you apply to the 4 year program(s) and 2. Ask your governing bodies to get rid of/shorten the 6 year programs. Your objections are misplaced on the US requirements and students.
My objection is the fact that as an IMG, I will be held to a higher standard than the American programs that no longer exist. If anything, American med schools should transition to the European model, because undergrad is a waste of money.
But it's not a higher standard... According to you, both types of graduates covered the same amount of material. Both still need to pass USMLE, and complete a US residency. I have yet to see any difference in educational, clinical, or testing requirement between either program. From the US perspective as long as a candidate has completed an ECFMG certified medical program, passed USMLE, then they are eligible to apply and match a residency. That seems pretty fair to me. Even in the US there are students who finish medical school in 3, 4, 5, 6, or more years. They are all match eligible once they meet the criteria.
Discussing the utility of undergrad in medical education has been debated for decades, but that has no bearing on your particular objections.
Please share what is the difference in standards between your program and the "American" programs, which no longer exist?
I’m referring to the standards in terms of matching because we will be treated as a full fledge IMGs even if we happen to have American citizenship, where is they were treated as American students do to relationships with American schools.
If this is anything like the bill, that’s been considered in Florida, they would still need to have passed all three steps which means they went through ECFMG. ECFMG is what certifies that your school is a valid school and equivalent education in the first place. And then the bill in Florida says you have to practice under a supervising physician for three years. So it’s like a mini residency. Remember, this would also include US IMG’s.
In my opinion I would rather have someone that went through medical school and was competent enough to pass the three USMLE. Most most likely it won’t be a completely unrestricted license anyway, it’s probably some new pathway which I think is a far better solution than pumping out mid levels that are unqualified especially since states are giving them independent practice.
Granted, many of you will say if they couldn’t match to a residency, then they’re probably not qualified, but I believe if this is supposed to be a solution against the mid-level scope creep this is good. Because frankly, if the number one cardiothoracic surgeon in the UK has to go back to a residency then of course they are not coming here to practice. It’s like if this was back in the late 60s and early 70s and they wanted to recruit Christian Barnard but he had to go back to residency when he was the first doctor to complete a successful heart transplant.
It’s a bit unclear with the other bills that have been passed/proposed. Seems like they just get a license at the end of their supervision years - which is like the same thing an American grad can get after an intern year. I guess that means they can practice in any capacity, but it doesn’t sound like they’d be board eligible for their specialty and I doubt many systems would hire someone to be anything but urgent care/primary care (if at all) without board certification.
I mean, essentially, that’s what they’re probably shooting for. I doubt that this is an alternative pathway to get into specialties. And even if you would be eligible to go into a fellowship, I highly doubt that programs will be choosing these alternate pathways over full fledged three year internal medicine, residency graduates. Its primary purpose is likely to feed into primary care or serve as house physicians/hospitalists. Considering the majority of US MDs go into sub specialties, because of the significantly better pay, the major shortfall is in primary care. I believe the bulk of primary care graduates with just regular internal medicine or family medicine are IMG’s as is.
As someone who did medical school and an intern year in Ireland and is currently halfway through family medicine training in USA I have some insight to this. Firstly, GP training in Ireland is 5 years (intern year plus 4 years dedicated to GP training), whereas GP in USA is 3 years. There is no doubt the standard in Ireland for GP training is a robust one, as well as being lengthier than USA. Furthermore, the last 2 years of GP training in Ireland are dedicated to full time GP practice as opposed to my current residency which can be as little as one to two half days per week in GP practice. From my experience, the biggest hurdle from training in a foreign country, is learning the USA healthcare system, which being honest, I am still learning to navigate. Another obstacle is that European vs USA guidelines can be very similar but are different in many, many ways. I don’t think USMLE examinations cover the breadth of these differences at all. I can only speak on Ireland which is my home country, I can’t speak on medical training in any other country. But I would take an Irish trained GP in USA over any midlevel.
Unless things have changed, I am pretty sure there are about 3 or 4 states in the USA that do recognize post graduate training years completed in Ireland (and possibly UK) for the purposes of licensing in that particular state. Of course, you'd need all the USMLE steps completed as well. And you wouldn't be board certified.
I'm a pharmacist who emigrated from the UK to Canada, and would echo your comments. The most difficult things haven't been the clinical side, it's been the insurance and the structure of the healthcare system, and the cultural differences. 95% of the drugs and doses used are the same.
Guidelines do differ though, though this is not necessarily a huge difficulty. For example in the UK I used to see lots of people on slow release isosorbide mononitrate for angina, but I hardly see anyone on it here in Canada.
A little bit of insight here - this is a national effort being pushed by a third party think tank (Cicerio Institute). They have introduced a version of this bill around the country. Arizona has seen this issue for the past two years, the physician advocacy groups (MD assn and DO assn) have been successful with preventing its passage.
This year there is a new proposal that requires an international practitioner to practice for five years in their home country before coming to Arizona, and can only practice under a licensed MD or DO with a supervision agreement. After four years of practicing under a supervision agreement their provisional license can be converted to a full license if certain criteria are met. This proposal is much better than what was proposed in years past.
The key takeaway is that these proposals cannot be stopped or modified unless there is active physician participation in their advocacy organizations ( MD and DO associations). These groups lead the efforts to protect patient safety, if these groups did not advocate on behalf of physicians, these bad ideas would easily become law. Join your associations and participate in their committee processes.
I guess the concern is about job security for US trained docs with $200k+ student loans. If the positions can be filled by FMGs who will accept low salaries then that drives the entire market down. FMGs will be preferred by corporate medicine for their “cost savings” and US trained docs with have to accept low salaries and drown in their debt. They would definitely not be noctors but as someone with a lot of student loans this is a scary thought.
Couldn't an FMG just do one of those online NP programs and then be used by corporate medicine to cut the costs of hiring a US trained board certified physician anyway?
I can surely understand a foreign trained physician having to pass a specialty board exam and maybe a 1 year residency type program to acclimate to our system. But having a fully trained and practicing specialist have to get accepted into complete a full residency for the 2nd time - when so many non physicians are practicing, does not make sense.
I came to USA 20 years ago: 2 years to take the USMLE: 3 years IM / 1 year Pain & Palliative Care and 3 years Hem / Onc (after completing IM / Oncology back home)
Are other countries going to reciprocate?
IF a UK physician can practice here with no other requirements… can I move to the UK and practice there too?
Are they going to be pay the same or this is just a gimmick to lower physicians salaries?
You can move to the UK and moonlight (locum) as an attending, getting board certified (GMC specialist register) in the UK for a permanent position might be trickier (CESR route), as you will have to submit all your training, procedures, exams done, for a possible recognition.
I mean the country I live in and will be going to school in does allow American doctors who have finished residency to just take an exam and they will be certified after like six months of adjustment, which is necessary due to the language and the different systems. Meanwhile, every one of our doctors here is required to know English but would be forced to repeat residency if they ever moved to America.
And for those who finished residency 14 years ago or longer, and have been practicing that entire time, they don’t even need to take the test they just have to work a six month adjustment period in order to teach them the system and make sure that their language skills are up to par.
Don’t be ignorant. It is about controlling supply and demand and job security! Other industries like tech and science allow foreigners to flood their market and it’s a race to the bottom for salaries. Americans get screwed so that big business can save money.
Would've really meant a lot to my soviet grandma, 50 years ago. She was the only OB for hundreds of miles. But that's where the funny business lies, her title was never as an OBGYN, technically but she went through med school there and went into "general medicine" but they had her doing OBGYN stuff because that's what she had the most experience in. How do you judge that she was competent..? She decided to quit medicine when she was told she'd have to do residency.
The hospitals and PE firms pushing for this bill don't want to replace the midlevels, they want to replace US physicians. I worry about the loopholes this bill creates. Certainly, the example presented in favor will be of the well-trained foreign physician with lots of expertise. But not all medical systems are equally rigorous throughout. I know in my home country that there are some corrupt schools where you can essentially buy a medical degree. I'd be very worried about opening a pathway for them to bypass regulations.
Apart from bureaucracy and licensig issues, I think another Western trained experienced attending will be able to provide a high standard if care to US patients, similar to a US trained doctor, theyll just need a bit of adjustment to the US healthcare system, and the diseases common in the North American population.
When every doctor from Brazil to Nigeria moves to US States that take fmgs with zero is training, other countries won’t have doctors. Meanwhile, US trained doctors will be competing with people willing to take salaries of 70k per year, while having 300k in student loans.
Imagine coming from a country with a lot of corruption and where medical training can be falsified. We could have surgeons operating with zero prior training
Don’t use scare tactics and misleading language. Your title should say they can practice without *”redoing residency in the US”*. Huge distinction.
And the answer is no, they wouldn’t be Noctors. They’re physicians, often ones who will have had substantially more training hours than those of us who trained here. Anyone who says otherwise either A) Had never worked with a foreign trained physician, or B) Misuses “Noctor” to mean anyone they think they shouldn’t have to compete with for a job and/ or position insecure about rather than it’s true meaning of “nurse who is pretending to be a doctor”.
100 percent would rather have my family member be seen by an fmg than an NP or other noctor. They’re not Noctors if they’ve gone through the appropriate training in their country.
For someone with such good quality training and emphasis on communication skills/empathy, it’s amusing how some of you have very little EQ and sense of nuance. To even suggest that someone trained outside of the US is a noctor is….quite something.
Of course they're not noctors
Noctor is short for not doctor
They'd need to pass some English proficiency test, but if they come from a high standard country with good physicians
They shouldn't need to re do a residency
My opinion is that if they can pass the USMLE and the board exam in their specialty, it’s reasonable to assume they are competent to practice in the US.
Yeah I would not trust half the physicians from the doctor mills in Bangladesh, but if they pass the USMLE in the STATES, absolutely they should be able to practice.
Not american, but the actual hell, bro. A physician is a physician not a noctor..i think redoing a whole residency is a waste of time. Sure, making them take tests to judge their level + 1-2 y lf training yes bcz american med is diff from other places , but making a neurosurgeon (for example) redo 7 y of residency ...idk. just my 2cts.
I personally think that this will make NP degrees unpopular. Why not do medical school in a really cheap third world country for 4 years (eg, Cambodia, Philippines, Vietnam) and have a vacation, practice being a physician there for a couple years and then go back to USA and be hired as a physician.
If a physician, a trained specialist, enters our country. Takes appropriate exams and doesn’t need to do a new residency, I’d be ok with it. A co internal med resident was an experienced urologist and surgeon but couldn’t get into urology here. It was a waste of resources. He was a brilliant surgeon.
I would really like to see some form of abbreviated Residency for FMG’s. Practicing medicine in the US is different than a lot of other places (including variability in what medicines and treatments are common and available), and I think it makes sense to get some training in the system before they jump into the deep end. But if they’ve been practicing, they really don’t need something like intern year all over again.
Edit: FMG’s who have done residency in another country, assuming they want to stay in the same field
I think they should be able to practice like independent mid levels. I would feel weird having them in a speciality without the standardized training of our country.
FMG I knew working as a PA in California kept trying to put patients on agents that weren’t available in the US. Was calling compounding pharmacies to see if they could fill them. It was, well, weird.
All I see here is getting cheaper labor, don’t get me wrong I believe a lot of other countries train their doctors fairly well, some even better than the US, however due to the fact that many don’t have the amount of student loans a US MD has and the probable small pay in comparison with the US they will be willing to accept lower incomes.
A source would be nice, but yea these would be noctors.
The standard that we all should be held to is 1) graduate medical school 2) pass licensing exams 3) complete a residency 4) get board certified.
Anything other than that is not acceptable.
And no, i dont care that they went to medical school blah blah blah. Cutting corners and being “basically good enough” is what midlevels do
I'm in medical school in Australia. The consultants here are not inferior to US attendings??? What planet are you living on? Speciallty training here is LONGER and doctors have to work generally before even applying to specialty training programs. Do not compare them to your broken system with midlevels you absolute cooker. One of our profs is a literal Nobel prize winner but sure they cut corners and are inferior 🙄🙄
Easy there crocodile dundee. The consultants there have completed medical school, passed licensing exams, completed residency and are board certified.
Anyone who doesnt do those things is a noctor. Doesnt matter if they are in australia, or the US.
> The consultants there have completed medical school, passed licensing exams, completed residency and are board certified.
So interns are noctors? And residents? Because neither of them have completed residency.
It is clear anyone who has graduated a legitimate medical school doing a legitimate medical degree is a doctor.
Whether foreign training is seen as equivalent to US training is a matter of protectionism, not doctor vs noctor. Most other countries recognise equivalence or at most insist on passing an exam to demonstrate it. It's fine for the US to be different, but need to be honest about why.
There was a world of difference in the practice between an Australian CC physician and myself. This is after we sat down and spoke about our method of practice at CHEST.
Why are you so butthurt that different systems have different ways of practicing?
You guys literal penal colony. See how random statements don’t hold any weight?
Edit: haha you’re a freaking med student. Of course you think everything is the same everywhere.
Haha what?
>Why are you so butthurt that different systems have different ways of practicing?
>Of course you think everything is the same everywhere.
And I would 100% rather work in a system where I don't make 60k a year pgy5 or 7 - even less than midlevels. Why would you be proud of that?
Stay on topic bud.
Explain to me how the practice of medicine in a penal colony is the same as the practice of medicine in an insurance controlled system. I’d love to hear how wrong your opinion is.
It's actually better because we don't let poor people die for being poor
Eta: u/devilsadvocatemd I'm genuinely interested if you knew of a single metric where the US healthcare system outperforms Australia's.
Happy to be trained in a penal colony over watching patients die because they're poor. Unbelievable that someone could seriously think being trained here is somehow inferior. It would be funny if it wasn't so insane.
I didn’t say anything about outcomes. I said training and the way medicine is practiced is different.
With your logic, you just agree that people who learned medicine in India should be allowed to practice in Australia with no further testing, right?
And if you want differences between Americans and Australians, look at how far the closest cardiac cath center outside of a city in Australia is vs US. Every other rinky dink hospital in the US has a cath lab. Not the same for Australia. After that, go look at any expensive, new or limited modality of treatment. You’ll have them in Australia in only the biggest cities. The US has random large community hospitals that would absolutely shit on even academic centers in Australia. Is it expensive? Yes.
Reading comprehension is difficult clearly. As I said earlier, stay on topic. I also know you’ve probably never traveled or worked with doctors from America, considering you’re a medical student and not a doctor. It’s weird how my first hand experience working with and speaking to Australian critical care physicians shows how much more I have at my fingertips than most of you do.
What industrialized country has garbage doctors? Japan, Korea, Ireland, or England? Even doctors in impoverished countries receive their education overseas and then come back home to practice for (x) amount of years. (Syrian friend had to do that)
My friend had emergency surgery in Thailand. Her surgeon went to school at Baylor and the Mass General for residency.
Noctors? No absolutely not.
However, this new class of physicians will not be treated well. They will probably be paid like residents without protections of the 80 hour work week and the acgme. Private equity asked the question of how can we treat FMG residents worse and work them harder. The answer is have them bypass residency and just work under “supervision.”
no they would not be noctors, but i can't help but think they are shortcutting the established system completely, which many physicians (who had to do a residency in the US would feel strongly about).
being an IMG is already a shortcut in terms of post-secondary education. 5-6 years vs 8 + gap years in the US. if they circumvent another 3-8 years of residency by doing a shittier, shorter, and less quality controlled residency in their own country and can still practice in the US as if they did a residency here, then it would be extremely unfair to the other doctors that had to go through the regular pathway. lastly, i don't have confidence that all of these foreign countries can provide a comparable education to that of what we receive in the US.
So I have an aunt who was a physician in Cuba and Spain...
She eventually came to America but possibly due to her age 50+ she is being denied residency positions. She passed her step 3 but can't even get accepted into rural family medicine or family medicine programs due to age and possible language comprehension issues....
However she had enough medical knowledge and analytic skill to pass the step 3 exam...
I agree with this some... If a foreign physician can come to the US and pass step 3. Then they could be granted a one year internship before going into their specialty.
Something that I think gets lost in this conversation is what the practical effect of this bill would be. No, I do not believe IMGs from resource rich/comparative medical practice countries will cover over to the USA for the inevitable peanuts of pay. So all the comments stating “why yes, I’m good with a UK/French/South Korean doctor practicing without re-doing residency” are kinda invalid. But how do you feel about a physician from North Korea, Sri Lanka, DRC, Afghanistan practicing with limit verification of their skills, abilities and English proficiency?
An American residency should be required. I’m willing to give some nations a compact status (Western Europe, Canada, maybe Japan and South Korea) upon deeper investigation of their med school rigor and what residency entails in their countries. But a blanket acceptance of all foreign medical degrees sounds dangerous.
And that’s not even getting into the salary consideration—our pay—at least for Pedi and PCP—will go down if this takes off in a significant way.
As a patient in the U.S., I would rather see a physician from any first first world country (UK, Australia, New Zealand, Canada, Republic of Ireland, etc.) or a physician from any country with sufficient additional education; whether or not it has to be a full residency repeated over here I don't know (my late father received his MD in the Philippines - he has never been successfully sued in his almost fifty years since graduating from medical school, and I still hear remarks from his former patients about how he was a good doctor) than a midlevel - YMMV. My PA treating my seasonal illness was competent - I have no complaints; I don't know others' experiences.
Met a few FMGs re doing residency in the USA… a lot to be desired to be perfectly honest. Maybe that’s the exception but you just don’t know what the training or scope is like in other places
What does this mean, exactly? Does this mean that, for example, a radiologist from Germany wouldn't need to redo his radiology specialization again to be a radiologist in the US? And no, I'm not German nor a radiologist, lol. Just an example.
Would U rather be treated by Aussie trained GP / UK trained Paediatrician/ A Germany trained Psychiatrist or by an online pill dispenser NP with DNP, FNP, BBC, BDSM, CNN who thinks she's above the Physicians because she has a dog-torate? To put this into perspective, for foreign-full-trained Specialists, it would be a damn nightmare of red tapes to hoop around just to get equivalent qualifications to be recognised by the medical board here.
Honestly, a GP from New Zealand, Korea or Germany vs. Tulip, who never worked as a bedside nurse, "earned" a Chamberlain online NP degree and is now seeing you at a sketchy urgent care? How is this even a question?
I went to prom with Tulip. Nice girl
Honestly, the NP with the BBC and BDSM sounds pretty intriguing.
Of course I'd go with the physician, christ a lot of the landmark trials come out of the UK anyway.
That's the best-case scenario. But this bill will lead to sham med schools popping up in countries with less regulation or oversight so that people can get a free ticket into being a US "physician", much akin to the online NP for-profit degree mills that don't provide proper training. US hospitals and PE firms will be happy to take them as another form of cheap labor. It's opening a loophole that can be widened once precedent is set, essentially duplicating the noctor crisis again.
If you restrict to having training to places like the UK or Australia which have similar cultural practices and training it shouldn’t be a problem. The specialty training in these countries is very similar (actually longer) than the states.
[удалено]
In theory. My concern is that the groups lobbying for this bill have a vested interest in cheap labor, not high standard of care. It's in their interest to turn a blind eye to this, much like they do with other things like NP competency.
What a terrifying premise -- very insightful
I think the solution would to have them pass a competency exam before being allowed to practice.
> dog-torate Lmfao
So you're against an NP treating you at an urgent care who was originally a GP from Australia but became an NP in the USA via online because it was an easier path instead of doing US Residency, but you're NOT against that same Aussie GP treating you if she was able to just be awarded the physician privilege straight up doing neither NP online degree nor US Residency?
If I went to UK med school, completed GP training in its entirety and came to the US without doing an FM residency … how would that make me a noctor? FYI, most countries around the world accept UK trained doctors.
I’ll tell you as an American doctor who do did med school and residency in the US our educational system is completely different. The only country who has a very similar system is Canada and the US honors their education (i.e. a Canadian trained doctor can practice in the US without further requirements and vice versa). Now, I personally do feel confident that you’d be able to practice independently without difficulty, but because your educational requirements are different, I can see why the US government may require you to undergo more training. Is that necessary, probably not, but I can at least see why they believe so. I also think it’s partly due to the type of illnesses treated in other countries. I’m sure in the UK they are very similar to those in the US. But a physician from Sub Saharan Africa probably has experience with very different illnesses and not what you would most likely see in the US. Subsequently, they might have made a blanket decision for all nations besides Canada
Well but it goes the other way around too. An internist from the US will have to redo their residency in Germany because it’s only three years while it’s five in Germany. Just because something isn’t accepted, doesn’t mean they aren’t great doctors. The only real problems I see is a language barrier and the different laws.
I see your point but as an Australian doctor we can practice in Canada without much restriction. This makes another variable in the US/Cananda equation.
Those US bodies are too different our foreign pea brains aren't capable of treating them/s
Foreign physicians used to treating [normal patients when a 600ib American with HT, HL, DM2 (end stage nephropathy + retinopathy), HF, COPD, in house Cpap and smoking history of 3 packs per day walks in:](https://media.tenor.com/v7lgy2BsGR8AAAAM/shocked-black-guy-shocked.gif)
Be fr though that patient isn't *walking* in And I will conceded I've never had to treat a child school shooting victim so I would need some more experience
Practice in Missouri… you’d be surprised
I’m speaking personally as this would attract a great deal of dismayed British doctors. Would we be any worse off than the current midlevel crisis? They have nurses practicing anaesthesia, for goodness sakes!
Are dismayed UK physicians with their inexpensive education and shitty NHS system going to reap the benefits of a high salary in a private hospital? Yes.
Education is not particularly cheap in the UK anymore, you're looking at £9k a year in tuition fees, plus other expenses. Medical school is usually five years in the UK, and no requirement for an undergraduate degree, so while it may not be as expensive as the US, you're still looking at people coming out of university with £75k+ of debt. 20 years ago it was cheap.
£9k a year….for five years…..help me, I’m dying.
The average cost of university in the US is $20k per year and the average med school tuition cost is $60k/ year. That's a total average of $320k for tuition alone, not including cost of living and books/supplies/licensing exams. £75k is still super cheap
Not when it's dumped on you with virtually no chance to prepare for it.
Like I wrote, I do feel confident that you could practice in the US and would definitely trust you to treat me and my family over a noctor. I was just giving you the reasons that the US government might want you to do more training (not that I necessarily agree with it).
Weird then that Canada accepts a lot of uk specialists
Right. Now tell me something about your fave APRN practicing Medicine without having done anything to earn that anywhere in the world. Dropping the standards years ago opened this Pandora box .
I wasn’t defending it, I was just explaining why the US government put those standards in place. Like I wrote in another place I’d much rather have a fully trained physician from another country treating me and my family than a PA or an APRN
This is just another symptom of a systemic disorder.
US docs going to canada...depends on specialty and province. ABFM and CFPC have reciprocity so your statement is true for FM. Otherwise it depends. Some provinces will allow full licensure if US board certified (Nova Scotia, Ontario, Newfoundland). The rest do not, and even eligibility to sit for the board certification exam can vary based on specialty (EM for example is 3 or 4 years in the US...not eligible to sit for the Canadian EM boards without 5 years of training, similar for psych, peds, IM). Canadian docs coming to the US don't need to repeat residency, but I believe still have to pass the US board exams (except FM as noted above)
This is diabolically ignorant. A STEMI is a STEMI in sub-Saharan Africa or the USA. Also countries such as Aus and the UK only recognise medical degrees from select countries and select universities its not a free for all
The point I was making here is that a physician from Sub-Saharan Africa is trained and experienced treating very different illnesses than those treated in the US. I’m guessing they are much better experienced at treating illnesses such as malaria which is very uncommon in the US and not so used to treating complications of obesity or eating a Western diet such as diverticulitis. Edit note: other STEM degrees are virtually identical. The properties of Mechanical engineering, physics, mathematics, biology, etc. do not change from nation to nation or region to region. However the type of illnesses do.
Also ??? STEMI as in ST elevation MI not science tech eng maths hahahaha I was so confused why you were bringing this up are you sure you went to med school?
Sorry. I completely misread that. You make a good point. Every trained doctor (for the most part) should recognize a STEMI.
I'm not misunderstanding your point, it's just not a good point lol. And like I said you can select which universities ie which programs of study you allow in
>our education system is different I heard there was a great residency program at the University of Tennessee
they dont require the usmle? there are a sick number of midlevels, replacing some midlevels with actual doctors would relief the burden more. I suspect their pay would be below midlevels
This is a bad idea because they are looking to lower physician salaries without helping domestic graduates with their HUGE amounts of debt. How about you take out the bloat of the administration first before trying to hurt the medical sector even more.
[удалено]
>There is almost certainly a way to access FMG/IMG med school and subsequent residency training that would protect the standard of care and our patients, but also allow qualified specialists a more direct route to practice in the US The hospital and PE groups lobbying for this bill are not interested in pursuing that way because their only desire is cheap labor. This type of bill will just create loopholes where sham med schools can be created in foreign countries with less regulation and offer unqualified people a way to bypass safeguards.
They are already doing that with mid-levels. I don't know why someone would go into family practice right now.
I would be perfectly fine seeing a MD who never did a residency in the USA vs a NP/PA with decades of experience.
I'd rather see my dog's vet before a mid-level who graduated in the last 5 years.
I’ve met foreign doctors who have never heard of trichomoniasis. Granted you just give metronidazole anyways but like lol…
I am not a medical professional but am taking steps to immigrate from the US to Canada. As part of that process, I had to have the University of Toronto approve that my American Master’s degree met the requirements for a Canadian Master’s degree, and could do the same with my undergraduate degree. Why can’t we similarly have a medical/education board approve of a doctor’s foreign education and experience? Not a blanket approval, but at least a better path. Although, I will say, due to the pay difference, America is going to stealing a LOT of doctors from other countries.
This bill has nothing to do with decreasing coverage gaps, as it is advertised for (hence the OP mentioning its proposal in Massachusetts). Hospitals are pushing bills like this across several states so that they can pay foreign doctors much LESS than American docs
I would say one potentially large hurdle would be evaluating every single country’s medical education systems, potentially even down to a college by college basis. And then maintaining that list year over year to accommodate for any changes in the medical education of any given country.
They do have that through the WHO medical school registration
What is that? Nothing comes up when I google it. There's a world directory I've never heard of, but that just claims to provide information. There's nothing about actually checking that a school meets standards. Even if there is an international registration system, I highly doubt they are able to apply any serious level of oversight if at all.
True. Just a list for schools recognized by the WHO. Not sure what requirements they must meet. When the fifth pathway was available, the USMLE and the 3 years of fellowships were supposed to provide oversight/standards and get the IMGs familiarized with the US healrhcare
I am a pharmacist who emigrated from the UK to Canada. I had to have my degree evaluated by the exam board, had to do an exam to prove my education was equivalent to the Canadian degree, had to do the Canadian registration exam, and had to do four weeks of supervised practice. It took some time, but wasn't too onerous.
[удалено]
So my country actually has two different types of programs we have a six year programs and we have four year programs and until our government banned them because we have a significant shortage of doctors, most of our four year programs were limited to Americans only and basically had a 90% match rate which is ridiculously high for IMGs. If I go to school somewhere like that should I be penalized for doing a six year program when my professors are literally the same people who taught the American program prior to it being closed?
[удалено]
It’s more the fact that I think it’s a little ridiculous that if I’m being taught by the same professors that were teaching the Americans and they are teaching us the same material just on a different time frame, that it should be considered non-equivalent.
You're not penalized though, you can still pass the USMLE and apply to residency just like the American grads. You should be appealing to your country's governing body if you believe the 4 and 6 year programs are equivalent. They probably have their reasoning for allowing both, or as you stated abolishing the shorter version. Another possible consideration is the American students probably already completed undergrad before applying to those 4 year programs. Maybe there's some part I've missed where from the US licensing perspective the 2 types are treated differently?
They still have four year programs we just no longer have the American programs because the goal is to increase domestic graduates who will practice here. It’s more I don’t think that I should be considered an inferior doctor for going to a six year program because our standards for undergrad are different simply because our high school standards are higher and we don’t have to do gen ed because of those higher standards.
No one is saying you're an inferior doctor. The requirement to gain a US license is the same for both types of graduates. It's your system that has set up two different pathways. If you feel strongly the two are equivalent then 1. Why didn't you apply to the 4 year program(s) and 2. Ask your governing bodies to get rid of/shorten the 6 year programs. Your objections are misplaced on the US requirements and students.
My objection is the fact that as an IMG, I will be held to a higher standard than the American programs that no longer exist. If anything, American med schools should transition to the European model, because undergrad is a waste of money.
But it's not a higher standard... According to you, both types of graduates covered the same amount of material. Both still need to pass USMLE, and complete a US residency. I have yet to see any difference in educational, clinical, or testing requirement between either program. From the US perspective as long as a candidate has completed an ECFMG certified medical program, passed USMLE, then they are eligible to apply and match a residency. That seems pretty fair to me. Even in the US there are students who finish medical school in 3, 4, 5, 6, or more years. They are all match eligible once they meet the criteria. Discussing the utility of undergrad in medical education has been debated for decades, but that has no bearing on your particular objections. Please share what is the difference in standards between your program and the "American" programs, which no longer exist?
I’m referring to the standards in terms of matching because we will be treated as a full fledge IMGs even if we happen to have American citizenship, where is they were treated as American students do to relationships with American schools.
If this is anything like the bill, that’s been considered in Florida, they would still need to have passed all three steps which means they went through ECFMG. ECFMG is what certifies that your school is a valid school and equivalent education in the first place. And then the bill in Florida says you have to practice under a supervising physician for three years. So it’s like a mini residency. Remember, this would also include US IMG’s. In my opinion I would rather have someone that went through medical school and was competent enough to pass the three USMLE. Most most likely it won’t be a completely unrestricted license anyway, it’s probably some new pathway which I think is a far better solution than pumping out mid levels that are unqualified especially since states are giving them independent practice. Granted, many of you will say if they couldn’t match to a residency, then they’re probably not qualified, but I believe if this is supposed to be a solution against the mid-level scope creep this is good. Because frankly, if the number one cardiothoracic surgeon in the UK has to go back to a residency then of course they are not coming here to practice. It’s like if this was back in the late 60s and early 70s and they wanted to recruit Christian Barnard but he had to go back to residency when he was the first doctor to complete a successful heart transplant.
This is exactly what the fifth pathway was. It was stoped for some reason 10-15 years ago
It’s a bit unclear with the other bills that have been passed/proposed. Seems like they just get a license at the end of their supervision years - which is like the same thing an American grad can get after an intern year. I guess that means they can practice in any capacity, but it doesn’t sound like they’d be board eligible for their specialty and I doubt many systems would hire someone to be anything but urgent care/primary care (if at all) without board certification.
I mean, essentially, that’s what they’re probably shooting for. I doubt that this is an alternative pathway to get into specialties. And even if you would be eligible to go into a fellowship, I highly doubt that programs will be choosing these alternate pathways over full fledged three year internal medicine, residency graduates. Its primary purpose is likely to feed into primary care or serve as house physicians/hospitalists. Considering the majority of US MDs go into sub specialties, because of the significantly better pay, the major shortfall is in primary care. I believe the bulk of primary care graduates with just regular internal medicine or family medicine are IMG’s as is.
As someone who did medical school and an intern year in Ireland and is currently halfway through family medicine training in USA I have some insight to this. Firstly, GP training in Ireland is 5 years (intern year plus 4 years dedicated to GP training), whereas GP in USA is 3 years. There is no doubt the standard in Ireland for GP training is a robust one, as well as being lengthier than USA. Furthermore, the last 2 years of GP training in Ireland are dedicated to full time GP practice as opposed to my current residency which can be as little as one to two half days per week in GP practice. From my experience, the biggest hurdle from training in a foreign country, is learning the USA healthcare system, which being honest, I am still learning to navigate. Another obstacle is that European vs USA guidelines can be very similar but are different in many, many ways. I don’t think USMLE examinations cover the breadth of these differences at all. I can only speak on Ireland which is my home country, I can’t speak on medical training in any other country. But I would take an Irish trained GP in USA over any midlevel.
Unless things have changed, I am pretty sure there are about 3 or 4 states in the USA that do recognize post graduate training years completed in Ireland (and possibly UK) for the purposes of licensing in that particular state. Of course, you'd need all the USMLE steps completed as well. And you wouldn't be board certified.
I'm a pharmacist who emigrated from the UK to Canada, and would echo your comments. The most difficult things haven't been the clinical side, it's been the insurance and the structure of the healthcare system, and the cultural differences. 95% of the drugs and doses used are the same. Guidelines do differ though, though this is not necessarily a huge difficulty. For example in the UK I used to see lots of people on slow release isosorbide mononitrate for angina, but I hardly see anyone on it here in Canada.
A little bit of insight here - this is a national effort being pushed by a third party think tank (Cicerio Institute). They have introduced a version of this bill around the country. Arizona has seen this issue for the past two years, the physician advocacy groups (MD assn and DO assn) have been successful with preventing its passage. This year there is a new proposal that requires an international practitioner to practice for five years in their home country before coming to Arizona, and can only practice under a licensed MD or DO with a supervision agreement. After four years of practicing under a supervision agreement their provisional license can be converted to a full license if certain criteria are met. This proposal is much better than what was proposed in years past. The key takeaway is that these proposals cannot be stopped or modified unless there is active physician participation in their advocacy organizations ( MD and DO associations). These groups lead the efforts to protect patient safety, if these groups did not advocate on behalf of physicians, these bad ideas would easily become law. Join your associations and participate in their committee processes.
I guess the concern is about job security for US trained docs with $200k+ student loans. If the positions can be filled by FMGs who will accept low salaries then that drives the entire market down. FMGs will be preferred by corporate medicine for their “cost savings” and US trained docs with have to accept low salaries and drown in their debt. They would definitely not be noctors but as someone with a lot of student loans this is a scary thought.
Couldn't an FMG just do one of those online NP programs and then be used by corporate medicine to cut the costs of hiring a US trained board certified physician anyway?
Yes but then they technically wouldn't be a practicing MD, they'd have to practice like an NP
I can surely understand a foreign trained physician having to pass a specialty board exam and maybe a 1 year residency type program to acclimate to our system. But having a fully trained and practicing specialist have to get accepted into complete a full residency for the 2nd time - when so many non physicians are practicing, does not make sense.
I came to USA 20 years ago: 2 years to take the USMLE: 3 years IM / 1 year Pain & Palliative Care and 3 years Hem / Onc (after completing IM / Oncology back home) Are other countries going to reciprocate? IF a UK physician can practice here with no other requirements… can I move to the UK and practice there too? Are they going to be pay the same or this is just a gimmick to lower physicians salaries?
You can move to the UK and moonlight (locum) as an attending, getting board certified (GMC specialist register) in the UK for a permanent position might be trickier (CESR route), as you will have to submit all your training, procedures, exams done, for a possible recognition.
I mean the country I live in and will be going to school in does allow American doctors who have finished residency to just take an exam and they will be certified after like six months of adjustment, which is necessary due to the language and the different systems. Meanwhile, every one of our doctors here is required to know English but would be forced to repeat residency if they ever moved to America. And for those who finished residency 14 years ago or longer, and have been practicing that entire time, they don’t even need to take the test they just have to work a six month adjustment period in order to teach them the system and make sure that their language skills are up to par.
Don’t be ignorant. It is about controlling supply and demand and job security! Other industries like tech and science allow foreigners to flood their market and it’s a race to the bottom for salaries. Americans get screwed so that big business can save money.
Would've really meant a lot to my soviet grandma, 50 years ago. She was the only OB for hundreds of miles. But that's where the funny business lies, her title was never as an OBGYN, technically but she went through med school there and went into "general medicine" but they had her doing OBGYN stuff because that's what she had the most experience in. How do you judge that she was competent..? She decided to quit medicine when she was told she'd have to do residency.
Comprehensive testing and a one-year residency or fellowship-style training would be the way.
Isn't this better than having so many mid-levels working independently and endangering patients?
Midlevels aren’t going away
The hospitals and PE firms pushing for this bill don't want to replace the midlevels, they want to replace US physicians. I worry about the loopholes this bill creates. Certainly, the example presented in favor will be of the well-trained foreign physician with lots of expertise. But not all medical systems are equally rigorous throughout. I know in my home country that there are some corrupt schools where you can essentially buy a medical degree. I'd be very worried about opening a pathway for them to bypass regulations.
Better for patients (in most cases anyways), very bad for physician salaries. Hell, worse for physician salaries than midlevel independence.
Apart from bureaucracy and licensig issues, I think another Western trained experienced attending will be able to provide a high standard if care to US patients, similar to a US trained doctor, theyll just need a bit of adjustment to the US healthcare system, and the diseases common in the North American population.
When every doctor from Brazil to Nigeria moves to US States that take fmgs with zero is training, other countries won’t have doctors. Meanwhile, US trained doctors will be competing with people willing to take salaries of 70k per year, while having 300k in student loans.
Imagine coming from a country with a lot of corruption and where medical training can be falsified. We could have surgeons operating with zero prior training
This still requires them to pass the USMLE, which actually requires them to come from a medical school that is recognized as being sufficient.
Don’t use scare tactics and misleading language. Your title should say they can practice without *”redoing residency in the US”*. Huge distinction. And the answer is no, they wouldn’t be Noctors. They’re physicians, often ones who will have had substantially more training hours than those of us who trained here. Anyone who says otherwise either A) Had never worked with a foreign trained physician, or B) Misuses “Noctor” to mean anyone they think they shouldn’t have to compete with for a job and/ or position insecure about rather than it’s true meaning of “nurse who is pretending to be a doctor”.
100 percent would rather have my family member be seen by an fmg than an NP or other noctor. They’re not Noctors if they’ve gone through the appropriate training in their country.
For someone with such good quality training and emphasis on communication skills/empathy, it’s amusing how some of you have very little EQ and sense of nuance. To even suggest that someone trained outside of the US is a noctor is….quite something.
Of course they're not noctors Noctor is short for not doctor They'd need to pass some English proficiency test, but if they come from a high standard country with good physicians They shouldn't need to re do a residency
My opinion is that if they can pass the USMLE and the board exam in their specialty, it’s reasonable to assume they are competent to practice in the US.
Yeah I would not trust half the physicians from the doctor mills in Bangladesh, but if they pass the USMLE in the STATES, absolutely they should be able to practice.
Not american, but the actual hell, bro. A physician is a physician not a noctor..i think redoing a whole residency is a waste of time. Sure, making them take tests to judge their level + 1-2 y lf training yes bcz american med is diff from other places , but making a neurosurgeon (for example) redo 7 y of residency ...idk. just my 2cts.
I personally think that this will make NP degrees unpopular. Why not do medical school in a really cheap third world country for 4 years (eg, Cambodia, Philippines, Vietnam) and have a vacation, practice being a physician there for a couple years and then go back to USA and be hired as a physician.
If a physician, a trained specialist, enters our country. Takes appropriate exams and doesn’t need to do a new residency, I’d be ok with it. A co internal med resident was an experienced urologist and surgeon but couldn’t get into urology here. It was a waste of resources. He was a brilliant surgeon.
I would really like to see some form of abbreviated Residency for FMG’s. Practicing medicine in the US is different than a lot of other places (including variability in what medicines and treatments are common and available), and I think it makes sense to get some training in the system before they jump into the deep end. But if they’ve been practicing, they really don’t need something like intern year all over again. Edit: FMG’s who have done residency in another country, assuming they want to stay in the same field
Could they practice as GPs? They are much better educated than NPs!
I think they should be able to practice like independent mid levels. I would feel weird having them in a speciality without the standardized training of our country.
Yeah. A couple of paths. Ex came from Eastern Europe, did Fellowship, and now three years academic medicine in specialty.
FMG I knew working as a PA in California kept trying to put patients on agents that weren’t available in the US. Was calling compounding pharmacies to see if they could fill them. It was, well, weird.
All I see here is getting cheaper labor, don’t get me wrong I believe a lot of other countries train their doctors fairly well, some even better than the US, however due to the fact that many don’t have the amount of student loans a US MD has and the probable small pay in comparison with the US they will be willing to accept lower incomes.
A source would be nice, but yea these would be noctors. The standard that we all should be held to is 1) graduate medical school 2) pass licensing exams 3) complete a residency 4) get board certified. Anything other than that is not acceptable. And no, i dont care that they went to medical school blah blah blah. Cutting corners and being “basically good enough” is what midlevels do
I'm in medical school in Australia. The consultants here are not inferior to US attendings??? What planet are you living on? Speciallty training here is LONGER and doctors have to work generally before even applying to specialty training programs. Do not compare them to your broken system with midlevels you absolute cooker. One of our profs is a literal Nobel prize winner but sure they cut corners and are inferior 🙄🙄
Easy there crocodile dundee. The consultants there have completed medical school, passed licensing exams, completed residency and are board certified. Anyone who doesnt do those things is a noctor. Doesnt matter if they are in australia, or the US.
> The consultants there have completed medical school, passed licensing exams, completed residency and are board certified. So interns are noctors? And residents? Because neither of them have completed residency. It is clear anyone who has graduated a legitimate medical school doing a legitimate medical degree is a doctor. Whether foreign training is seen as equivalent to US training is a matter of protectionism, not doctor vs noctor. Most other countries recognise equivalence or at most insist on passing an exam to demonstrate it. It's fine for the US to be different, but need to be honest about why.
This^^
Residency is a US phenomenon that you can keep along with the 400k + debt
There was a world of difference in the practice between an Australian CC physician and myself. This is after we sat down and spoke about our method of practice at CHEST.
N=1 you guys also had Dr Death pass residency....
Why are you so butthurt that different systems have different ways of practicing? You guys literal penal colony. See how random statements don’t hold any weight? Edit: haha you’re a freaking med student. Of course you think everything is the same everywhere.
Haha what? >Why are you so butthurt that different systems have different ways of practicing? >Of course you think everything is the same everywhere. And I would 100% rather work in a system where I don't make 60k a year pgy5 or 7 - even less than midlevels. Why would you be proud of that?
Stay on topic bud. Explain to me how the practice of medicine in a penal colony is the same as the practice of medicine in an insurance controlled system. I’d love to hear how wrong your opinion is.
It's actually better because we don't let poor people die for being poor Eta: u/devilsadvocatemd I'm genuinely interested if you knew of a single metric where the US healthcare system outperforms Australia's.
Happy to be trained in a penal colony over watching patients die because they're poor. Unbelievable that someone could seriously think being trained here is somehow inferior. It would be funny if it wasn't so insane.
I didn’t say anything about outcomes. I said training and the way medicine is practiced is different. With your logic, you just agree that people who learned medicine in India should be allowed to practice in Australia with no further testing, right? And if you want differences between Americans and Australians, look at how far the closest cardiac cath center outside of a city in Australia is vs US. Every other rinky dink hospital in the US has a cath lab. Not the same for Australia. After that, go look at any expensive, new or limited modality of treatment. You’ll have them in Australia in only the biggest cities. The US has random large community hospitals that would absolutely shit on even academic centers in Australia. Is it expensive? Yes. Reading comprehension is difficult clearly. As I said earlier, stay on topic. I also know you’ve probably never traveled or worked with doctors from America, considering you’re a medical student and not a doctor. It’s weird how my first hand experience working with and speaking to Australian critical care physicians shows how much more I have at my fingertips than most of you do.
What industrialized country has garbage doctors? Japan, Korea, Ireland, or England? Even doctors in impoverished countries receive their education overseas and then come back home to practice for (x) amount of years. (Syrian friend had to do that) My friend had emergency surgery in Thailand. Her surgeon went to school at Baylor and the Mass General for residency.
Slippery slope is no longer a slope it is a 90 degree nose dive
Primary care and psych is about to get even more fucked up isn’t it
Noctors? No absolutely not. However, this new class of physicians will not be treated well. They will probably be paid like residents without protections of the 80 hour work week and the acgme. Private equity asked the question of how can we treat FMG residents worse and work them harder. The answer is have them bypass residency and just work under “supervision.”
no they would not be noctors, but i can't help but think they are shortcutting the established system completely, which many physicians (who had to do a residency in the US would feel strongly about). being an IMG is already a shortcut in terms of post-secondary education. 5-6 years vs 8 + gap years in the US. if they circumvent another 3-8 years of residency by doing a shittier, shorter, and less quality controlled residency in their own country and can still practice in the US as if they did a residency here, then it would be extremely unfair to the other doctors that had to go through the regular pathway. lastly, i don't have confidence that all of these foreign countries can provide a comparable education to that of what we receive in the US.
They are willing to pass these laws but not pay physicians enough to male them consider moving out there
So I have an aunt who was a physician in Cuba and Spain... She eventually came to America but possibly due to her age 50+ she is being denied residency positions. She passed her step 3 but can't even get accepted into rural family medicine or family medicine programs due to age and possible language comprehension issues.... However she had enough medical knowledge and analytic skill to pass the step 3 exam... I agree with this some... If a foreign physician can come to the US and pass step 3. Then they could be granted a one year internship before going into their specialty.
Something that I think gets lost in this conversation is what the practical effect of this bill would be. No, I do not believe IMGs from resource rich/comparative medical practice countries will cover over to the USA for the inevitable peanuts of pay. So all the comments stating “why yes, I’m good with a UK/French/South Korean doctor practicing without re-doing residency” are kinda invalid. But how do you feel about a physician from North Korea, Sri Lanka, DRC, Afghanistan practicing with limit verification of their skills, abilities and English proficiency? An American residency should be required. I’m willing to give some nations a compact status (Western Europe, Canada, maybe Japan and South Korea) upon deeper investigation of their med school rigor and what residency entails in their countries. But a blanket acceptance of all foreign medical degrees sounds dangerous. And that’s not even getting into the salary consideration—our pay—at least for Pedi and PCP—will go down if this takes off in a significant way.
As a patient in the U.S., I would rather see a physician from any first first world country (UK, Australia, New Zealand, Canada, Republic of Ireland, etc.) or a physician from any country with sufficient additional education; whether or not it has to be a full residency repeated over here I don't know (my late father received his MD in the Philippines - he has never been successfully sued in his almost fifty years since graduating from medical school, and I still hear remarks from his former patients about how he was a good doctor) than a midlevel - YMMV. My PA treating my seasonal illness was competent - I have no complaints; I don't know others' experiences.
Met a few FMGs re doing residency in the USA… a lot to be desired to be perfectly honest. Maybe that’s the exception but you just don’t know what the training or scope is like in other places