IMGs: Get used to it

Some patients are still wary of foreign medical doctors. With the current physician shortage, this physician says get over it:

“Make sure he speaks English,” she said, adding, “and knows what he’s doing.”

She was an acquaintance who asked me to find her a doctor — one “without a funny name. You know what I mean?”

I did indeed. Worried she’d get a second-rate physician, she wanted a home-grown, presumably American- born and American-trained doctor — not a “foreigner” (formally known as an “International Medical Graduate”). What she didn’t know is that this request is not only harder to fill now than ever before, but also largely unnecessary.

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  • Anonymous

    My IMG medical school was 6 years as opposed to 4 here in the U.S. Thank you very much…

    And we did study medicine as opposed to spending months/years on “problem-based learning” and multiple choice questions… See Panda’s blog for reference:

  • Alison Cummins

    As a patient, in general, no, I’m not worried. All doctors are certified; some individuals are a better match for me than others, and that individualism crosses cultures. But as an educated white lesbian with a middle-class upbringing, I specifically sought out similarly-privileged doctors when seeking psychiatric care for the depression that had been eating away at my life for fifteen to twenty years.

    When I tried to imagine approaching someone who had worked hard to overcome the many obstacles to becoming an IMG to complain that I, with all my advantages and no reason not to do better, was depressed – I couldn’t do it. I felt ashamed.

    When I looked at the list of psychiatrists seeing outpatients at my local hospital, and they were all foreign-born men, I couldn’t help but speculate that many of them came from cultures where women were not expected to have careers of their own. Which led me to wonder if the doctor might judge my culture for expecting me, a poor weak woman, to have a career, thus leaving me exposed to failure and depression. Or whether he would judge me for making such a stupid and easily avoidable mistake as to choose to be a lesbian.

    I didn’t assume that I couldn’t be accepted with an open mind by a foreign-born man – but I did feel too vulnerable to take the risk.

    That was then. Now that my depression is under control (I’m under the care of a foreign-born woman) I would feel more more confident about seeing a foreign-born man when my current doctor retires. Not everyone will be a match for me no matter what their backgrounds, but now I feel less vulnerable and open to taking more risks. (Or what I, rightly or wrongly, perceive to be risks.)

    For other aspects of my care – seeing a new doctor is always a risk, but it’s less personal than psychiatry and I don’t feel vulnerable to judgement if the match isn’t good.

    I’m clearly not the only person with these hesitations, hence the only psychiatrists trying to build their practices at the hospital being foreign-born men. One day I might be able to help one of these rejected guys out.

  • Anonymous

    The World Health Organization has a compendium on medical systems of member countries. Not the political stuff you see discussed, but the nuts-and-bolts of who they call physicians, what academic degree they carry (MD, DO, MBBS, something not in the Roman alphabet), what legal testing and certification requirements are needed, and what a foreign-trained physician needs to do to be considered a physician in that country.

    The USA has one of the more transparent and straightforward systems. For all the complaints IMG’s have about trying to get into the USA, try going the other way.

  • Anonymous

    I dont have a problem with IMGs per se, as long as they speak english.

    I was rotating at a small community hospital the other day that was chalk full of IMGs.

    We were doing rounds with the program director who was on service for the month.

    We come to an elderly patient’s room, and the intern starts doing bedside presentation to the program director/attending. This is an IMG girl who can barely speak english. Her accent is so thick that everybody on the team has a hard time understanding her.

    The patient chimes in and says she cant understand what the intern is saying. Then the fucking asshole program director who accepted this IMG into the program has teh audacity to say this:

    Attending: “Its OK if you cant understand her, she is still working on her english.”

    Patient: “I’m sorry doctor, but I do consider this a problem. If she’s going to be my doctor here, then I need to be able to understand what she’s saying to me”

    Attending: “I can understand what she’s saying so everything will be fine.”

    The program direcotr interviewed this IMG. He KNEW how bad her English was and accepted her regardless. Its because he wants that federal Medicare money. Hospitals make a TON of money off residents. Thats why every hospital in teh country is clamoring for more residency slots. They would be happy taking as many foreigners as they could possibly get just so they can pick up that nice paycheck from the fed govt.

  • Anonymous

    For the first poster, who thinks that his medical school was longer (6 years vs 4 here) is lying to you with the witholding of certain facts.
    Most medical studies in other countries begin out of high school, and much of the first few years of ‘medical school’ is spent getting college basics that the average freshman and sophomore might here. They never earn a bachelors degree separtate from medical studies and thus are far more homogenous than the classes at US med schools.
    My class of 100 had 5 students arrive with doctorates, 8 with masters, and the bachelors degrees were all over the place (engineering, history, english, physics, mathematics, in addition to 25% each of biology and chemistry).
    That is the strength of 8 years of medical education (undergrad plus med school) versus the 6 that our european colleagues are satisfied with.
    We can see the same problem with the two ’6 year’ medical schools here in the US. Their graduates all have the same homogenous and abreviated undergrad experiences. In the words of Robert Heinlein, excessive specialization is for insects.

  • Anonymous

    What are the USA 6-year medical programs?

    I thought it was Brown and Northwestern. Did any others try that model?

    And yes, as I recall, many schools outside the USA have 6-year programs for medicine, but they are six years from high school. Not that I am trying to run down any foreign programs.

  • Anonymous

    My transitional internship at a community hospital some years ago had a number of spanish speakers. My first unit month had the attending, residents and interns all (but me) with spanish as their first language. It was an occasional event that rounds would break out in spanish. They were polite whenever they recognized this and would backtrack for their monolingual intern.

  • Anonymous

    To heck with PC. I will tell what my experiences have been over 25 years practicing medicine. Some of the best docs I know are foreign trained. But not in general. Most of the worst docs that I know are foreign trained. Some of the most dishonest docs I know are American born. Most of the dishonest docs that I know are foreign born.

    Having said that, I judge physicians by the individual, not the country of origin. But if I don’t know the individual, what do I have to go on? I am sure that there is a Philipino doctor somewhere who is reliably professional. I haven’t met him.

    Sociopaths come from all cultures. But the docs from some places just don’t seem to really buy into the whole professional ethics thing or to see medicine as a profession of gentlemen rather than just a trade or a business. I guess that make since with no liberal education beyond high school.

  • Anonymous

    Our med school had a 6 year track for especially bright high school students. Some were very mature and did well but as a whole they were simply too immature to make the most of med school and ended up with med school performance below what their intellect would lead one to expect. I can see that in the foreign trained doctors–techinical proficiency but weak in the medical humanities and judgement sometimes. Fuzzy about the core principles of ethics in many cases. On the other hand, I have known a few real scholars with a strong background in the humanities–esp from Columbia (do they have a different system there?)

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