The pay levels for procedure-based specialists versus diagnostic-based primary care physicians create incentive for medical graduates to go into the procedure-based specialties, even though one could argue that we need the best medical graduates in primary care, where the broadest range of medical knowledge and thinking is needed to diagnose patients who may come in with anything.
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And from your posted article…a noted quote
One admissions officer provides this tip: Don’t worry about the degree.
How is this not clear? What does this have to do with differences in training & licensing?
If anyone would like first hand info about the training and licensing of DOs, please send me a private message.
If someone is more comfortable having all of their doctors being MDs, that’s their decision, and I’m fine with that.
When I’m choosing a doctor, I look for someone with excellent recommendations, good reviews, good first hand info from friends. Some of my docs are DOs and some are MDs. And I like them all.
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And for anyone who has mercifully been spared serious illness- a warning- you won’t like all your docs. I saw a noted oncologist who had zero personality and the worst bedside manner I’d ever seen. I had a procedure with a surgeon who was mean and dismissive. And one of my kids- then a minor- had surgery and I could not believe how obnoxious the anesthesiologist was.
I’d rather competent, capable, admired by both the nursing staff and colleagues, then Mr. or Ms. Sunshine who has racked up a boatload of complaints for negligence. I’m not inviting them for dinner. I’m putting my life in their hands and trusting that their experience and judgement will overcome their personality deficits!
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Who said that DO’s are not physicians? Not me! My point was that we already have plenty of DO’s practicing in the US, they are well-integrated, and we need more physicians, INCLUDING DO’s!
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Thank you for clarifying what you wrote. That is not how it read. I agree…we need more doctors, but that also means getting a lot more residency sites and rotation sites , and that isn’t always easy.
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Very interesting. While we of course do need research facilities, the truly pressing need is for trained physicians (and by that I mean MDs and DOs). In fact, there is currently way too much emphasis on pre-meds and med students getting research published, as a criteria for selection for competitive residencies, that has resulted in a research arms race of massive amounts of low-quality research, just so that the applicant can claim that they’ve published X number of papers before applying. Part 1 of the Boards going P/F, supposedly to reduce stress, has only led to more emphasis on quantity of published papers by applicants - it’s even worse than the stress of preparing for the Boards.
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And I think this is also exacerbated by the more frequent/pronounced use of PA’s and NP’s. It’s as if the logic goes “it’s OK that most of our patients are never seen by an actual doctor. Primary care and gatekeeping is the responsibility of the PA. But when it’s SERIOUS they see Dr. so and so- who has co-authored a groundbreaking study on the link between smoking and fetal development.”
Which as a post-menopausal patient of this GYN practice is nice for me to read on the bragsheets. But also not that relevant. And while the PA I see is perfectly capable of diagnosing a UTI once the urine sample is tested (heck, I can read too) you do wonder about the chain of command and communication…
That’s because RDs need some way to sift applicants since Step 1 is now P/F and many med students apply for residency before their Step 2 scores are available.
It’s rather lazy default, but it is what it is.
Luckily, only the cream of the crop are able to land US residency spots, and those that do are just as qualified as their US grad peers.
Unfortunately, this is absolutely not true. Many IMGs come from countries rife with corruption and bribery, which extends to admission to medical school. The board exams that they have to pass in order to apply have been reported to have been compromised (early access sold). I could go on and on about this, and give many examples of IMGs from certain countries arriving without basic foundational med school knowledge and training, but the reality is that most IMGs from the 3rd world (and even some first world countries) are not trained to the same level and in the same evidence-based medicine as are US med students. Then, they go to low quality residencies that have the lowest training standards, where there are no US med students, and these residencies do not remediate their deficiencies. There are cases where residencies are run by IMGs from a particular 3rd world country, and every single resident accepted is from that 3rd world country - very possibly because the residency program director is the last step on a ladder of access to medical training by bribery!
No, it is most definitely not the cream of the crop, it’s not a good system at all. Plus, those 3rd world doctors are trained at public expense in countries that are very poor, and desperately need those doctors. It is just wrong that we, a wealthy country, should be taking those doctors from the nations where they are most needed.
The only such case I am aware of was cheating at the Nepal test center in 2023 and caught in 2024. Are you aware of any other instances?
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Plus, those 3rd world doctors are trained at public expense in countries that are very poor, and desperately need those doctors
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I’m not sure about the Caribbean, Mexico, and the Philippines, but I know India and Pakistan have a very large supply of medical graduates. It’s the postgraduate training and employment opportunities that are scarce. Pakistan in particular has 14.3 medical graduates per year per 100k population compared to 8.6 in the US and 7-8 in India.
Those IMGs might not get the same training as U.S. educated doctors, but they do need to pass the same licensing exam requirements as domestically trained doctors. And, as you know…those aren’t exactly cakewalk tests. Those are administered at very controlled test centers in this country.
The top 4 sources of immigrant doctors moving to the US are: India, Canada, Pakistan, Hong Kong.
Are you saying all of these countries have corrupt and substandard medical education systems?
What about the medical education offered in the UK and Australia— which doesn’t include the advanced biochemistry taught in US med schools? Is the medical education in those countries substandard because of the omission?
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Also, for future reference, third world is a term used to identify a country’s political allegiance during the Cold War. First World= US aligned. Second World = Soviet Union aligned. Third World= unaligned.
This terminology is no longer used and political alliance isn’t relevant to any discussion of educational standards.
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Oh, because they didn’t get caught, you think that in countries where bribery and corruption are so rampant that people printed up fake money to represent bribes, as a protest, it never happened? Really?
Pakistan has about 1/3 the number of doctors per capita that the US does: about 1:1000 vs about 3.5:1000 in the US. India has about the same number of doctors per capita as Pakistan - and similar economic challenges. Pakistan is an incredibly poor country, with a vast underclass, and a small oligarchical ruling class. You think that they don’t need every single doctor that they’re training? You think India doesn’t? Of course they do. Yet, they’re here in the US, not there in Pakistan or India, because we’re willing to have them come here with their degrees (without saying anything about the quality of their degrees, or how they were obtained), do residency here on our taxpayer dime, and virtually all of them stay here to practice medicine, don’t go back home where they were educated at public expense.
As for “they passed the boards”, if the boards were administered in the bribery-ridden 3rd world, they’re questionable. And BTW, if it were just boards, honestly, a lot of US med students could pass them well before they completed med school. I “passed” a dry run of my specialty boards when they gave them to us 2 weeks into internship year. That didn’t mean that I didn’t still have to do my years of internship and residency! Passing the exam validates just one component of medical education.
We need more medical school seats in the US, to train our own doctors. It is better medicine for out population, and it is a moral imperative, to not be poaching desperately needed doctors from the 3rd world.
Yes, without evidence (which would be quite easy for the NBME to catch), there’s no reason to assume cheating is widespread. The fact that low level public enployees sometimes request bribes has no bearing on the character of Prometric employees. It’s well known that public employees accept bribes (hence the existence of the zero rupee note) because they can’t keep their corruption a secret, yet somehow you think Prometric (an American company) has managed to both be corrupt and also keep it a secret for who knows how many years? Really?
I recommend you research the security measure Prometric uses to make corruption/bribery if individual proctors a non-starter.
You’re confusing medical graduates with trained doctors. They have plenty of medical graduates, but are limited by postgrad training opportunities necessary to become practicing physicians (the opposite situation as the US). Thus, when an Indian or Pakistani graduate goes to the US for training, they aren’t reducing the number of trained physicians their home country has access to.
Certainly not. Fortunately, I do not believe FMGs are skipping US intern year and residency and jumping straight into practicing full time just because they passed the boards.
You miss my point. Do you really believe that 3rd world countries don’t need every single doctor that they pay to train? They just, as a matter of policy, have decided to expend their very limited public resources on training physicians for the US? And do you really believe that it is not possible for 3rd world nations and doctors to provide residency training to their own med school grads? How did they ever have medical systems, before their doctors could go to the US for residency (and never move back)?
My point about the boards (and I’m referring, in the case of IMG’s, to the boards that one needs to pass in order to begin residency) is that one can pass them and still have had deficient training, or no training. Having passed the boards does not mean that one had decent training in medical school. But it does mean, for IMGs, that they get to start residency with potential huge gaps in their education. In the course of my training, I met many IMGs who really were not well-trained, who had been taught strange concepts that were not based in standard medical practice, who had major deficiencies in their education. I also met South African doctors who were better trained than I was. But the ones from the 3rd world? Nope.
I don’t believe we are “poaching” doctors from developing countries. These folks are making their own decisions to come to the U.S.
In addition, if the new cost for a sponsored visa goes into play, there are very few places that will be able to pay this cost.
As noted above, we are adding medical school seats by opening new MD and DO schools here.
I’m still waiting to hear how we can also expand rotation spots…but more importantly residency spots (this is the bigger issue). @WayOutWestMom
By “train” are you referring to medical college or the residencies that come after?
I’m sure if it was as simple as just making more residency spots, they would have done so. It sounds a bit like saying “if the US has so many homeless people, why doesn’t it just build more houses?”
If you and I could come up with a solution like “provide more residency spots”, I’m sure they can too, and so it’s probably not as simple as it seems.
I honestly have no idea what you’re trying to get at with this question. In the past, I would guess their medical systems existed but weren’t as developed as they are now, since countries tend to develop their medical systems with time.
I have heard of US residency adcoms starting to look for US clinical experiences in their FMG applicants. Presumably they believe the opinion of a US preceptor to hold weight in determining an applicant’s level of medical training, which allows for them to filter for residents who do have good clinical skills.
Not a single IMG from the “3rd world” without major deficiencies? Really?
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