Internal medicine vs family medicine doctors?

[parentologist]

At least one state is now planning on licensing FMGs who have not gone through a formal residency in the US, and more are coming. They will have two years of supervised practice, and then can be licensed. https://www.medpagetoday.com/special-reports/exclusives/109168

[WayOutWestMom]

Actually there are several.

These states will grant medical licenses to FMGs after 2 years of supervised training

1. Tennessee
2. Illinois (mandates that FMGs must work in a medically underserved area for at least 2 years)
3. Florida
4. Virginia

Alabama reduced the length of FM residencies from 3 to 2 for FMGs

Colorado reduced the length of FM residencies from 3 years to 1 year for FMGs

Idaho allows a 2 year temporary medical license for FMGs who were “forcibly displaced” AND who’ve applied to an accredited medical residency in Idaho. FMGs are required to work for at least 3 years in a medically underserved community after they complete residency

Washington-- FMGs who have lived in the state for at least 1 year can apply for 2 year temporary medical license that can be renewed once for an additional 2 years.

Seven more states have legislation under consideration to allow FMGs to receive temporary medical licenses or to shorten the required length of residency for FMGs. Arizona, Iowa, Massachusetts, Missouri, Nevada, Vermont and Wisconsin

All FMGs must have graduated from an ECFMG recognized medical school, have taken and passed the USMLEs.

https://www.medpagetoday.com/special-reports/exclusives/109168#:~:text=Some%20IMGs%20Can%20Now%20Bypass%20Residency&text=After%202%20years%2C%20they%20can,visa%20or%20permanent%20resident%20card.

[twoinanddone]

@WayOutWestMom

Geriatricians are trained to work with patients age 65 and older. Typically, however they mostly deal with frailer, older-than-65 patients unless the patient has multiple medical issues that require ongoing management and monitoring.

One of my PCP told me if I had a choice–to pick a younger physician, even a recent residency grad, because they were more current on treatments, patient management and technology (And less likely to be burned out.) He told me he thought the sweet spot was 5 years out of residency.

I needed a new PCP when I was about 61. The doctor recommending (an ER doc who was probably about 40) said she always recommends that her patients over 60 (and to her own parents) go to a gerontologist. It was a good suggestion for me. I wasn’t frail, but I was starting to need more medications and found the recommended doc was good about knowing how they interact, doses, etc. She wasn’t old so it was unlikely I’d lose her to old age.

I have switched to a new practice that only accepts medicare, so I’m actually one of the youngest patients they have. My friend’s MIL who is 101 years old goes to the same practice, but they have service the goes to see her at home.

Again, I find the NP I see to be very knowledgeable about the medications, tests I need, specialists to refer me to, etc. Again, she’s young so I’m not worried about losing her to retirement.

And it is close to my house!

[HImom]

I don’t know many med grads from other countries, only one. I employed her to help us do lung testing clinics around the state. She had no confidence and felt that all my other staff (RNs, RTs, and even volunteers) knew more than she even though she was the one with an MD degree. She seemed accurate about her shortcomings—wouldn’t have wanted her to be my doctor. She panicked when we had a lot of patients and generally was better at data entry than working with people.

I’m sure there are many excellent mds trained elsewhere.

[parentologist]

The South African doctors whom I met in the mid '90s were the best-trained doctors of all, better trained than US doctors. Doctors from 3rd world countries who were doing residencies in the US were mostly awful - some arrived not knowing basics, such as how to do a history and physical. Doctors from former Soviet nations were also badly trained - had all sorts of weird ideas regarding unproven medical conditions that were unheard of in the West, also believed in using herbal teas to treat various conditions.

[BunsenBurner]

Ran into a doc who got his medical training in Romania… he suggested leaving the piece of glass I accidentally stepped on in my foot because “the body takes care of foreign objects.” Nope. Off to the ER we went, and the young ER doc took care of it by locating it using a portable ultrasound machine and taking it out.

[HImom]

The MD who was hired as a on-call staff member by me was trained in Bangladesh. It appears there is considerable variability in the quality of training and MDs.

[jym626]

General practitioner

[rockymtnhigh2]

I can see the confusion of GPs and FP doctors. I was trained as a GP first then specialized for 3 more years (PGY 2-4) in another field. My one year GP internship counted as a PGY 1. I am board certified. I felt that it was invaluable generalized education, delivered 100 babies on my own, worked ER, etc. I believe this training has been replaced with traditional PGY 1-4 in each field.
The GMOs I worked with on the military bases were great.
That said, I chose internal medicine doctors for me and family practice for my kids when they were younger.

[fiftyfifty1]

@parentologist

Doctors from former Soviet nations were also badly trained - had all sorts of weird ideas regarding unproven medical conditions that were unheard of in the West, also believed in using herbal teas to treat various conditions.

Oh interesting. In residency, one of my interns was from the former Soviet Union. She was in her 40s and had been the head of surgery in her old hospital! We were prepared for her to be a disaster with all the chronic condition management and mental health stuff that you do so much of in primary care, but she turned out to be an outstanding family physician. She was very smart, very kind (once you got past her superficially brusque demeanor) and very hard working. She took direction exceedingly well. The only tough task I had with her was convincing her not to wear perfume. I had to be very direct with this!

[blossom]

I’m not sure you can generalize. We all have horror stories (or have family members who have) of poorly trained (or incompetent) physicians who were trained right here in the good old USA, including elite medical schools and residencies. The media loves the stories about the “foreign” doctors who left a surgical sponge inside a patient, but manages to ignore the stories about the US trained surgeons amputating the wrong limb, anesthesiologists walking out of the OR mid-procedure to take a phone call from their paramour, etc.

I’m sure you’ve met your share of “I’d never let them treat my kid” US trained doctors as well.

[ClassicMom98]

@blossom

The media loves the stories about the “foreign” doctors who left a surgical sponge inside a patient

This made me chuckle. Recently, our paper had an article about the rating of our hospital. It started with that they scored above average in “safety.” Of course, they didn’t specify safety in what? Not killing people? Visitors coming in with guns? Infections? Who knows…

But! Then it goes on to says they scored below average in leaving foreign objects inside patients. Umm… Isn’t that a big one? Shouldn’t that number be… oh… say… ZERO!!!