Foreign Medical Grads: Doctors As House-Elves

With all of the bruhaha on immigration reform, I had planned to put this post up sooner, but as soon as the idea popped into my head, headlines broke that the National Health Service (NHS) in Britain was absolutely loopy with foreign-born terrorist-doctors who would just as soon blow you into tiny bloody pieces . . . as opposed to put your pieces back together.

From a doctor's standpoint, it was really disconcerting. On the other hand, I was not terribly surprised.

I put the post off because it didn't seem like the time to make the argument that the United States (arrogant snobs that we are) treats foreign-born & trained doctors horribly . . . like second-class citizens . . . and oftentimes worse than indentured servants. And if, to start with, there's any resentment (religious/political/whatever) brewing in the noggins of these highly-educated-people-forced-to-kowtow-for-that-coveted-VISA-or-green-card . . . a number of years of being treated like pond scum doesn't help.

I've blogged before on a dear friend that I trained with . . . from India, now a gifted neonatologist . . . who was forced to return home because of VISA issues. She could make wonderful contributions here.

But when it comes to medicine, our government has its head completely up its ass.

All of this came back to mind a few weeks back when I met a lovely young woman from the Philippines who was serving as my "nurse" in one of the clinic settings where I now work. Trouble is, this young woman is NOT a nurse, but a doctor . . . who completed medical school and a Pediatric residency in the Philippines.

I had her sit down and tell me about all of the hoops she would have to jump through in order to practice as a doctor here. Apart from comprehensive testing, it included completing another complete residency.

She seemed surprised that I cared.

And then she spoke of the "service-in-an-under-served-area-(i.e. the jobs most Americans won't take)-for-your-green-card" deals. In these situations, the doctors are generally little more than pawns on some clinic administrator's chessboard . . . indentured servants that no one really worries about too much because there is a never-ending and eager supply . . . in what amounts to a two-to-three year cycle of doctors who come to places in the middle of nowhere, but rarely stay.

Of course, I'm one of those Americans who did not hail from a long line of well-named doctors, and who did take a variation of that same "public service" deal (to pay off the monster loans) . . . and who got royally screwed in the process.

Afterwards, it became clear that I might as well have been an FMG working the bar at the local country-club for all of the "justice" I got from the mill-owners who run my hometown.

Maybe that's why I feel the pain of these foreign MD's more than most.

What this young doctor told me about the hurdles that lay before her was just absurd. But she was upbeat and optimistic. America is the land of opportunity, after all.

She asked me where I was from and how I came to be at the clinic. I laughed it off by telling her it was a long story, best told over several beers, and let it drop. I think she could tell by the look in my eyes, that the laugh was not genuine. But this is a newbie I do not want to discourage.

From Dr. McMahon's link: IMGs make up 23% of the US physician workforce, and 24% of residents (in training). The heaviest concentrations of IMGs are in New Jersey (50% of the workforce), New York (48%), Florida (42%) and Illinois (38%). Almost half of all IMGs (48%) train in primary care specialties vs. 33% of U.S. graduates. The largest national groups are from India 20%, Pakistan 12%, Philippines 9% Former soviet republics 3%. Of the 196,576 total IMG population, 85% are involved in patient care, the rest in research.

Now, my conversation with this young lady really brought back the memories. My residency program was stocked about half & half with Americans and Filipinos . . . with a few Indians/other nationalities scattered here and there. There was a joke going around at the time that Brenner's had a hot-line to the Philippines.

The red phone was in a drawer in the Chairman's desk.

These foreign medical grads ("FMGs or IMGs") were gifted and incredibly smart . . . most of them already had considerable medical training in their home countries . . . and were bi or trilingual. When it came to book-learning, most of them could dance circles around the Americans in the program. And all of them became good friends. I've kept in touch with several of these folks, and I've actually crossed paths (in those "rural"/"under-served" areas) with one or two. A few went back home out of a sense of duty. Most stayed, are done jumping through the years of hoops, and are making great contributions to their adopted communities.

It is a shame it took them so long.

I guess my point is, at the very time that dire physicians shortages supposedly loom on the horizon, this country treats good, hard-working, high-educated people like dirt . . . like the house-elves in Harry Potter.

These good people have all played by the rules to get here and where they are. I wonder how some of them felt about the "immigration reform" bill that would have granted amnesty and easy paths to citizenship to those who did not play by the rules?

As for the "doctors-as-terrorists" bit, in my travels over the last ten years, I have met only two foreign physicians whose mannerisms and/or political & religious rhetoric were deeply disturbing. One was so demeaning towards women and generally incompetent that he more or less did himself in. The other learned to tone it down . . . at least around me.

But I have little doubt that some "un-friendlies" are out there. And I'm equally certain that, in the system under which they labor, they're getting un-friendlier by the second.

If you think about it, it's another good lesson from Harry Potter: Be nice to the house-elves, or they will bite you in the butt.

While I'm musing on the subject, here's another thought. A very good argument can be made that the "doctor-shortages" looming in the United States are completely of our own making. We simply don't train enough physicians to meet the demand . . . as evidenced by the fact that about a quarter of our doctors nationwide are from somewhere else.

And increasingly, this nation is treating physicians in a manner that makes me wonder why anyone would go into medicine.

Of course, I could write a book on that. It's deep in me somewhere. I may have to stop blogging to do it.