Here is a short video discussing the shortage of residency programs available to medical students after graduation.
One of the comments there:
"bogus source. insiders know all too well, the aamc ama acgme and the nrmp organizers are duplicitous in the ever deteriorating prospects for US med grads. they are totally aware where the migrant sweat shops are, what quality of trainees are finding positions and who is graduating. they are partnering in the RRCs and the sham guvmint financing of visa guest workers. Just why are medicare funds used to finance residency positions for imported docs.
get rid of the midlevels who have no place in any inpatient critical care setting. Let the hospitals learn the hard way, the USgrads are still the best deal going to advance patientcare"
26 comments:
Medicine, now with more IRS! What could possibly go wrong?
The author sounds disgruntled. I had no idea that US MD's were under such direct threat from imported talent -- a similar situation exists for US STEM students.
It's a difficult situation to assess except for one aspect: the bottom line of most all companies (and I suppose now) hospitals and clinics is paramount and not the quality of care or the analogous science.
Just why are medicare funds used to finance residency positions for imported docs.
get rid of the midlevels who have no place in any inpatient critical care setting.
I know little about medical education but a great deal about US science education. In chemistry, to specialize for a moment, the post-graduate enrollment is over 50% foreign (probably 90% of that number is Chinese). Most of these people used to stay here, but with the rapid growth of well-funded science in China, more and more are returning there. In a very real sense, we are subsidizing and seeding their science infrastructure. It's a gracious thing for US to do (the Germans and the Brits did the same for US in decades past). But make no bones about it: chemical science is leaving the US and is relocating across the Pacific. Many say "good riddance."
Speaking generally about immigrants and their growing roles in the American workforce: science and medicine are easy marks because language and communication skills are minimized (or I should say not prized highly enough). Science has no national boundaries or jurisdictions and practically anyone with talent can practice in this country. It makes a certain business sense to import the lowest cost talent, ceteris paribus. This is decidedly not so in careers such as law and politics. The best patent claims are still drafted by Americans, and the best SCOTUS cases are still argued by Americans.
That video is a request by the American Association of Medical Colleges for your support for legislation which would give more money from Medicare to them to help pay the cost of residencies.
That may or may not be a good thing to do, but the fact that I had to dig a little to find out that the video was about its makers wanting more money from the government (and the business about the "cap" is part of their misdirection) makes me want to resist their effort.
Is anybody in a bureaucratic organization simply honest and up-front anymore?
Is anybody in a bureaucratic organization simply honest and up-front anymore?
Is that sort of behavior even rewarded anymore? I'm serious.
When socialism controls your industry, you have to beg for scraps.
Stupid dipshits, the medicos.
Pogo: Night of the Living Dead Poets Society said...
When socialism controls your industry, you have to beg for scraps.
If US medical science goes the way of the chemical industry, I would invest now in medical tourism.
Pogo, is it true we'll be importing a lot of immigrant doctors? If so, will they be of good quality?
'Night all.
What the hell is "good quality"? And who'll be in charge of that determination? Quality Contorl
MamaM said...
What the hell is "good quality"?
According to Pirsig:
He makes a case that originally the Greeks did not distinguish between "Quality" and "Truth" – they were one and the same – and that the divorce was, in fact, artificial (though needed at the time) and is now a source of much frustration and unhappiness in the world, particularly overall dissatisfaction with modern life. link
Another favorite American novelist had something to say about how quantity and quality interrelate:
Water grows colder and colder and suddenly it's ice. The day grows darker and darker and suddenly it's night. Man ages and ages and suddenly he's dead. Differences in degree [quantity] lead to differences in kind [quality].
~ John Barth "The Floating Opera"
@MamaM: American health care never lacked quality; the stated problem was quantity: there wasn't enough of it. Once there is "enough of it" the quality problem will naturally reappear.
A modern sophist will convince you that ten minutes past sunset is still part of "today" rather than make the qualitative distinction which truth demands: it's nightfall. Blurring distinctions is what sophists do well.
Muslim women doctors refuse to wash their arms due to "modesty" or some horseshit.
You should not let them touch you if you desire to remain well. They are disease vectors.
That's one example.
The Duke system is now chocked full of losers and dimwits - one black doctor who saw me spent the entire visit looking at herself in the mirror on the back of the exam room door.
I didn't report that as you never know who is going to read it and what they are going to do with any criticism of their cronies, er, peers. Besides being vain has all get out she was dumber than a box of rocks. Seriously, you used to have to have an intellect to even get accepted in med school. Not these days, if you meet other criteria.
The whole system is corrupt as hell and getting worse.
I had no idea that US MD's were under such direct threat from imported talent
This has been going on for decades. FMGs (foreign medical graduates) will work for less money than graduates of American medical schools, and will go to places that Americans shun. A FMG who graduated form a reasonably good med school can get an American internship or residency, assuming a passable fluency in English.
The costs of hiring medical residents are paid by Medicare, essentially giving major hospitals free MDs to serve an under-insured or non-insured patient population. Hiring FMGs and paying them less improves the hospital's income statement, and provides MDs who speak the native languages of a diverse population.
Ever hear an American med student say "I want to become a doc so I can serve the population of Jersey City"? Or South Bronx? Or Nome? FMGs willingly work in those areas because, hey, they're better than New Delhi, or Bangalore, or Manila. And it's America, after all, and every Indian family wants their best and brightest to move to America.
Where an MD was born doesn't matter to me. When I have a major medical issue, I want the smartest human I can find to treat it. My primary care doc is a Serb. My heart doc is Lebanese. Big. Brains. Not only did they have to learn a second or third language well enough to master medical textbooks, journals, and lectures, they needed to out-work and out-learn American born students and residents to get here, stay here, and start their own practices.
It's easy to say :I have the doc form Pago Pago and the guy was incompetent. Probably happens. But it isn't limited to FMGs. As my nephew the MD explains "You know what they call the guy who graduates at the bottom of his med school class? Doctor."
As long as affirmative action and hiring quotas exist we will continue to get doctors with sub-100 IQs. That's a fact. You will not get the best and the brightest because the selection process is based on skin color, party affiliation and religion, not intelligence.
Maybe you don't mind, but I do.
Haz, precisely. When my dad was operated on a few weeks before he died, the surgeon we met with, a young Indian woman, made my heart sing. I knew he was getting the best.
Sixty, you raise the other end of the issue. It is scary. You're not always going to get Denzel Washington (ER).
On the other hand, you will get extremely intelligent doctors from Nigeria, etc.
Sixty, other than when scrubbing for surgery it is not protocol to wash above the wrists.
@Sixty - It is not possible to become a physician with an IQ less than about 140. The material is just too difficult for someone with an IQ below that level.
I have a grand-nephew entering year three of medical school. He's about half-way through it, before internship, residency and fellowship.
His med school requires all students to take an abilities test - essentially an IQ test oriented to math, chemistry, and anatomy - at the end of year two. Based on the outcome of that test, the med school will direct the student to medical specialties the student has the native ability to master.
Some are told they are qualified to be primary care docs, for example, while others have the high IQ necessary for a career in oncology, or neurosurgery, for example.
the point is: medicine is so effing difficult that it requires a high IQ to get into med school, and an even higher IQ for certain specialties.
Medical care in the US has been highly regulated for many years. It did not start with Obamacare. There are regional authorities, set up by federal law, which control where hospitals can be built and what they can do. No competition is allowed. For example, a hospital in Greenville SC, that I know about, was fined for having too many beds. If a hospital wants to add new equipment, such an MRI machine, an approved certificate of need is required. The number of internships and residencies are likewise controlled through subsidies and fines. BTW, none of this has anything to do with the AMA. Most doctors today are not members. The only thing they really control is a magazine.
Obamacare is just an added layer of BS on top of previous regulations. It is driving many doctors into retirement or joining hospital owned practices out of self defense. That leaves room and a need for foreign doctors. BTW, one problem with foreign doctors from high-power-distance cultures is that they tend to treat people they perceive to be low-status, such as nurses and assistants, like dirt. Almost anywhere in south Asia is considered high-power-distance. Malaysia is the worst.
This is the major reason I have steered my kids away from medicine as a career. I would hate to see them invest $200,000 or more in a medical education and not be able to get a residency position. What the heck do you do with an MD degree if you can't get into residency?
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