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  • Why Importing Foreign Doctors May Not Solve the Shortage.

    Posted by Michael Kennedy on April 17th, 2016 (All posts by )

    MoS2 Template Master

    The coming doctor shortage that I have previously written about might be dealt with as Canada did with theirs some years ago, by importing foreign medical graduates. Britain has adopted a similar plan as thousands of younger doctors plan to leave Britain.

    How is the plan to import foreign doctors working out ?

    Not very well.

    Nearly three-quarters of doctors struck off the medical register in Britain are foreign, according to shocking figures uncovered in a Mail on Sunday investigation.
    Medics who trained overseas have been banned from practising for a series of shocking blunders and misdemeanours.
    Cases include an Indian GP who ran an immigration scam from his surgery, a Ghanaian neurosurgeon who pretended he had removed a patient’s brain tumour, and a Malaysian doctor who used 007-style watches to secretly film intimate examinations with his female patients.

    First of all, foreign medical schools are often limited in real experience and students often graduate with nothing beyond classroom lectures.

    This was the case with Mexican medical schools, like that in Guadalajara where many American students attended. A program was devised to provide them with a year of clinical training before they could be licensed.

    The revelations come just a week after it emerged health bosses want to lure 400 trainee GPs here from India, to help ease short-staffing in the NHS.
    Last night Julie Manning, chief executive of think-tank 2020 Health, said: ‘The NHS has thrived on many international doctors coming to work in the UK – but the public needs reassuring they are all truly fit to practise in the first place.’

    Of course, the foreign doctors have their defenders.

    Dr Ramesh Mehta, president of the British Association of Physicians of Indian Origin, admitted ‘there is a problem’ with the high strike-off rate among foreign doctors. But he claimed racism played a part.

    We have a similar problem with affirmative action medical graduates but the figures are not available about their rates of license revocation. For example, the The Alan Bakke case went to the US Supreme Court, which eventually ruled in his favor. By the time the court ruled, years had gone by and Bakke eventually did gradate from medical school and has practiced quietly ever since.

    However, a black student admitted by the program that denied Bakke a place was subsequently prosecuted for gross negligence and his license removed. Affirmative Action has been vigorously defended.

    An admissions process that allows for ethnicity and other special characteristics to be used heavily in admission decisions yields powerful effects on the diversity of the student population and shows no evidence of diluting the quality of the graduates.

    However, the conclusion does not match the findings in the study.

    Regular admission students had higher scores on Parts I and II of the National Board of Medical Examiners examination, and special consideration students were more likely to repeat the examination to receive a passing grade.

    The article goes on to explain that There was no difference in completion of residency training or evaluation of performance by residency directors.

    A friend of mine was the Chairman of the Department of Surgery at a UC medical school who decided to fire a black female resident for incompetence. He was advised by the UC system and the other department heads that he would lose a lawsuit if she filed one. She did, in fact, file such a lawsuit alleging racial prejudice (of course). The department chair was able to successfully defend his decision but the fact that no one else was willing to try explains the finding that There was no difference in completion of residency training or evaluation of performance by residency directors.

    I have had the experience of being a Surgery Department Chair in a community hospital confronted with the application of a known incompetent surgeon. The same factors apply to those known to be dishonest. A request for a letter of reference from the department in which the applicant trained usually results in a response that states, “The applicant completed the residency from X date to Y date.” No other information is provided and a further request is usually answered by “The matter is in litigation”, or words to that effect. This applies to all such applicants but affirmative action individuals are almost impossible to find negative information on even if the “grapevine” has provided warnings.

    The general concern can be found, but details are thin on the ground.

    A quick scan of the documents reveals that white students applying to medical school with a GPA in the 3.40-3.59 range and with an MCAT score in the 21-23 range (a below-average score on a test with a maximal score of 45) had an 11.5% acceptance rate (total of 1,500 applicants meeting these criteria). Meanwhile, a review of minority students (black, Latino, and Native American) with the same GPA and MCAT range had a 42.6% acceptance rate (total of 745 applicants meeting these criteria). Thus, as a minority student with a GPA and MCAT in the aforementioned ranges, you are more than 30% more likely to gain acceptance to a medical school.

    There are other sources of the facts, but they don’t appear in mainstream publications. Social Justice keeps most of these concerns underground.

    A friend of mine, who is Cuban born and an immigrant as a child, applied to UC, San Francisco medical school. This was in the 1970s. Affirmative Action was well underway. He waited several weeks, then months, to hear if he had been accepted. Finally, he drove to San Francisco and asked someone in the Admissions Office what had happened to his application. He was told that it was in the “Hispanic Applicant Committee”. Having no idea what criteria such a committee might be using to determine who should be admitted, he asked if his application could just be considered as a “white” applicant. This was done and he received a letter approving his admission a few days later.

    The pressure is now on medical education to provide the hundreds of thousands of new doctors this society believes it needs. Productivity of the present graduates is well below that of my generation. Some of that is the disappearance of fee-for-service practice which motivates work ethic. Some of it is a result of the 60% female medical school classes.

    The female doctor population is acknowledged to work less.

    Today, however, increasing numbers of doctors — mostly women — decide to work part time or leave the profession. Since 2005 the part-time physician workforce has expanded by 62 percent, according to recent survey data from the American Medical Group Association, with nearly 4 in 10 female doctors between the ages of 35 and 44 reporting in 2010 that they worked part time.

    This was the reason why medical school admissions committees “discriminated” against female applicants in the 1960s when I was a medical student. They were concerned, even then, about a doctor shortage and assumed women would stop working to have children or practice part-time.

    They were absolutely correct.

    Canada is finding some productivity issues and even some explanation.

    a fee for service model, and its inherent encouragement of increased productivity through increased volume of patients, a significant shift away from this single model is taking hold.

    This, of course, will not deter the Social Justice types as more doctors with less productivity is somehow more efficient than paying doctors more to encourage higher work loads. Socialism is the aim, productivity will have to take care of itself.

    In the meantime, PHYSICIANS WHO DID not attend medical schools in the United States or Canada, referred to as “international medical graduates (IMGs)”, play an integral role in the U.S. health care system. Such physicians now represent approximately 25 percent of practicing doctors nationwide.

    It’s going to increase.

     

    15 Responses to “Why Importing Foreign Doctors May Not Solve the Shortage.”

    1. TangoMan Says:

      This applies to all such applicants but affirmative action individuals are almost impossible to find negative information on even if the “grapevine” has provided warnings.

      In the absence of more specific information, stereotypes have remarkable predictive validity. Don’t see, or hire, black physicians because there is a very high probability that they’re not on top of their game. As Justice Thomas, and others note, this Affirmative Action bias is grossly unfair to the truly competent black person and such people do deserve sympathy but not to the extent that others not react to the real world.

      Some of it is a result of the 60% female medical school classes.

      Society invests the identical resources in training a female physician but, generally, only gets about 1/2 of the lifetime medical hours on the job compared to a male physician. One study looked at the return on investment from the physicians POV and found that a typical female physician would have higher lifetime earnings by investing in training for a physician’s assistant position, getting into the workforce that much sooner, and not carrying as much debt than taking the route of studying to be a physician. For men the route of physician training earned a higher lifetime earnings result because they worked, in general, twice as much as their female counterparts.

      In general, what I find dispiriting is that all of these social revolution decisions pay absolutely no attention to downstream consequences, the entire Left is focused on microrevolutions and when this strategy doesn’t work, as with environmentalism, then they turn to future consequences and unintended consequences, in order to sell their viewpoint, so clearly they can think about consequences but don’t really seem to give much a damn about consequences at all. Female physicians working less, who cares, the bathroom laws now allowing perverts to shower with women, who cares, Bruce Springsteen standing up for the right of perverts to shower with children because he’s only focused on the symbolism of normalizing transsexuals.

      This degradation of society is really going to be a boost for Nostalgia TV – even now people look back on pre-70s society and marvel at how life was more orderly, society more cohesive, culture less pozzed, institutions more functional. They’re even now wondering where it went so wrong, so imagine the future when our medical system is staffed with the best and brightest that Somalia can produce, witch-doctoring has a bright future – more African physicians and more Leftist patients who have alternative lifestyles and so are amenable to being treated by herbs and incantations. Entropy applies to all systems, so when energy isn’t pumped into the system to maintain it at a high state, it will degrade.

    2. Thersites Says:

      The medical establishment is calling for more doctors, they still haven’t remove the bottle neck in the maturation of doctors: residency spots. Residency, the one place where doctors train in the US system, can learn to be doctors, after discovering everything you learn in first 2 years of med school is 10 years behind the times. When looking up the numbers at the MATCH for 2015, there were more applicants than spots available. The number of applicants were 54.000 and number of spots were 50.000, as I recall. Now the cynical part of me believes the call for more applicants without increase the spots is good attempt to get cash from the applicants. A person has to spend about good $150 per applicant and program will get about 5.000 applicants for 16 spots for example. From personal experience, I know a person having to spend $5000 to get a good number of interviews.

      As the IMG numbers, the question I would ask is where are the IMG originating from. We got doctor factories in the Caribbean producing doctors specialize in handling the US health care system. As all the rejects from the US system head down to sandy beaches of Caribbean in order to get a chance become a doctor in the US. The only problem with the Caribbean is quality of training varies. All the med students from the Caribbean do there clerkships and electives in the US. Those clerkships and elective vary from great to sub-par training. The reason for the variety of training, is due to the US and Caribbean med school bidding war over hospital to host there students, this creates a disparity of experience for a lot of students.

      That all I can say about article. As medical student in Caribbean, I want to get a residency spot and not kill someone.

    3. Mike K Says:

      ” Entropy applies to all systems, so when energy isn’t pumped into the system to maintain it at a high state, it will degrade.”

      As usual, Richard Fernandez something worthwhile on this topic.

      Whatever caused Anna Marrie Jones’ death is killing white males too. Gina Kolata of the New York Times noted last November that “something startling is happening to middle-aged white Americans. Unlike every other age group, unlike every other racial and ethnic group, unlike their counterparts in other rich countries, death rates in this group have been rising, not falling.”

      That finding was reported Monday by two Princeton economists, Angus Deaton, who last month won the 2015 Nobel Memorial Prize in Economic Science, and Anne Case. Analyzing health and mortality data from the Centers for Disease Control and Prevention and from other sources, they concluded that rising annual death rates among this group are being driven not by the big killers like heart disease and diabetes but by an epidemic of suicides and afflictions stemming from substance abuse: alcoholic liver disease and overdoses of heroin and prescription opioids. …
      “Wow,” said Samuel Preston, a professor of sociology at the University of Pennsylvania and an expert on mortality trends and the health of populations, who was not involved in the research. “This is a vivid indication that something is awry in these American households.”

      Yup and it is not going away, at least that I can see.

      Affirmative Action bias is grossly unfair to the truly competent black person

      Yes and I see some of them and feel bad for them. There is still the right tail of the IQ graphic.

      My wife had a superb Infectious Disease doc in Palm Desert who was black. He was from Africa and his parents had been diplomates. I think he was even born in the US. She wishes she could go back to him but it is a 2 hour drive each way.

    4. dearieme Says:

      Many years ago I listened to a disagreement between two doctors about intake to their medical school (which, like several other British medical schools, was the best in the country). One, a chap in late middle age, was strongly opposed to letting more women in, because they would obviously work fewer career hours than men. His opponent, a youngish woman, insisted that the proportion of women in the intake must quickly be raised to 50%; anything else was unfair to bright girls who wanted to be doctors. I butted in and said that they were both right, and that the obvious remedy was to let more women in but also to expand the total intake. Whereupon they promptly turned on me!

      A cynic might conclude that the one opinion in which doctors were united was the importance of putting a lid on the rate at which new doctors were trained. Rather pointless, really, since you end up recruiting odds and sods from around the world. And it’s not just the obvious problems with third-worlders – we’ve had nasty scandals involving doctors from the continent: Germany, Italy, …..

    5. Will Says:

      Chicago-based wild man Ezekiel “E-Z” Emanuel’s brother had a job in the White House. E-Z claimed that 75 yrs. was long enough for that demographic to live. (he surely wouldn’t be referring to any other group!) Maybe he really means forty. Bill Ayers, another Chi-town product, said 25 million had to go. Obamacare. Planned Parenthood stay in bidness. Importing tens of thousands from disease-ravaged war zones. Millions unemployed. Not at all puzzling when you consider the players. It’s just a matter of the guy with the camera on him, having the stones to do so, and calling it what it is.

    6. Mike K Says:

      “was strongly opposed to letting more women in, because they would obviously work fewer career hours than men.”

      A friend of mine a former professor of surgery and anatomy in London told me of one of his concerns which was the number of female medical students who were becoming Muslims.

      He could not understand it. Why would these bright young women join such an anachronistic religion that discriminates against them?

      Maybe they see a career opening treating Muslim women who are not allowed to consult a male doctor.

    7. TangoMan Says:

      Importing foreign doctors and importing foreign grade school children are both problems for America, and for the West in general. I read this article from the CSM regarding the “new majority” which is filling our public schools and observed how long established customs in America regarding the local funding of schools is now seen as a problem when dealing with districts filled up with 3rd world students who are failing.

      Standards which worked when America was majority white and did well in educating poor white kids have to be modified to deal with 3rd world populations and so too should we expect this to be the case when more of our physicians are imported from the 3rd world – standards will fall, corruption will increase, and society will be poorer as a result.

      As an aside, try reading that CSM article from the perspective that America isn’t a land of Magic Dirt and that peoples differ (Europe and America became what they are because they were filled with Europeans, Latin America, Africa and the Middle East became what they are because they are peopled with their own people) and see if you notice the blame game directed at white America for failing to deliver equal outcomes to these 3rd world “Americans.” With 3rd worlders now comprising 50% of our public school students the politics taking place regarding school issues is going to transfer to broader society once those kids enter adulthood – unequal outcomes are going to require changing America even more in order to stop all the white racism which is holding back our new majority.

      I’m not really seeing the upside to importing 3rd world physicians. Wouldn’t it be better to fix the problems leading to a decline in Americans filling physician slots rather than keeping the existing, but failing, system in place and stop-gapping the resultant problems by importing substandard physicians?

      Change the people, change the society.

    8. Mike K Says:

      “standards will fall, corruption will increase, and society will be poorer as a result.”

      The standards are already failing. The “Whiteness Conference” the Teachers union is conducting has the solution.

      This next workshop, from the upcoming 2015 Summit, describes a process to brainwash ten-year-old white girls away from their instinctively colorblind attitude that all people are equal, regardless of skin color, and to dismantle their unacceptable “rigid sense of fairness,” and replace it with a hyper-conscious awareness of both the existence of race and the difference between races and, as the final step, to internalize in the girls a self-loathing of their own “whiteness” — which is the last of the program’s “Six Conditions” and the goal of every “conversation about race.” Conference attendees will learn how to implement these indoctrination protocols in their own schools around the country:

      The focus will be particularly on ending the urge to do good work and study. That is “whiteness privilege.” I call it “work” but what do I know of education theory ?

    9. TM Lutas Says:

      We depend on diplomas, licensure, and professional standards bodies to sort out the good from the bad. When such things become less useful or outright corrupt and useless, after a lag we replace them either by new state systems or by free market competition. The fix to the crisis outlined in this post is to reduce the lag.

    10. TangoMan Says:

      The standards are already failing. The “Whiteness Conference” the Teachers union is conducting has the solution.

      The standards are falling in the education sector because theory isn’t aligning with reality and so ever more drastic logical contortions must be employed to explain why the theory of equal racial outcomes is not arising. My point is that this is what awaits the medical field in the future.

      A judge in NY recently ruled that black teachers are adversely affected by uniform standards in the teacher licensing regime in the state. Take a look at these Praxis results for prospective teachers.

      http://i.imgur.com/MiUJyLh.jpg
      http://i.imgur.com/fgDVTRi.jpg
      http://i.imgur.com/DBvLHY0.jpg

      That white privilege conference refers to something they call “racial equity.” What is that? Context suggests racial equity is code for equal outcomes. The medical field requires physicians to have command of sophisticated human biological systems, to have command of various scientific principles drawn from chemistry, physics, biology and math, to have command of a vast body of facts and to have command of an intellect which can analyze real world data in light of what the physicians know about medicine. This takes brain power and brain power doesn’t much care about racial equal outcomes. So, when minorities in the population grow in clout, they call for more of their own people to be in positions of respect, and when the hard reality of high standards confronts the political force of Magic Dirt adherents, the Magic Dirt believers will win because politics is antithetical to high standards, politics is dominated by seeking the lowest common denominator and here wishful thinking doesn’t disqualify a position from being advanced. Standards for ALL physicians are going to fall in order to create “racial equality” and this will drive good students towards other fields. We’re likely already seeing the beginning of that effect with regards to bureaucratic demands put upon physicians, the appeal as a career is diminishing and so smart students find more rewarding careers. Take the existing dysfunctions in the field of medicine and now add, or intensify, the “racial equality” demands and we take another turn for the worse.

    11. TangoMan Says:

      We depend on diplomas, licensure, and professional standards bodies to sort out the good from the bad. When such things become less useful or outright corrupt and useless, after a lag we replace them either by new state systems or by free market competition. The fix to the crisis outlined in this post is to reduce the lag.

      This proposal only appeals to people who value merit and uniform standards and is utterly rejected by those who want equal outcomes no matter the cost to merit or standards. Your viewpoint, once dominant in America, is rapidly diminishing in the face of constituencies who care more about equal outcomes. They’re going to out-vote you.

    12. pst314 Says:

      “we’ve had nasty scandals involving doctors from the continent: Germany, Italy, …”

      I know nothing about Italy, but I would assume that Germany has very good medical schools.
      Could it be that these doctors left Germany precisely because they were not very good and sought to escape their reputations? Or something sort of like that?

    13. Joe Mack Says:

      There is so little hope in medicine. Morale is low. Administrative loads need to be lightened. The computer is demanding more time, JACHO and EPIC make us jump through hoops every few minutes.

      It will get worse. Caring is in short supply, so sad for people dedicated to caring.

      Me, I prefer a radical libertarian position. Caveat Emptor.
      If you want Dr Nick from the Simpsons to cut out you tonsils for $20, good luck.
      Healthcare 2.0
      Take responsibility for your care, pay for what you get.

    14. Mike K Says:

      I was talking to another instructor in the same program at SC Medical School that I taught in for 15 years. I’m not teaching this year an he is still doing so.

      This last week, the new Director, a former pediatrician, took a whole day to have students listen to a drama instructor from the drama school tell them how to interview patients and “relate” to them. He e-mailed his students after the meeting, which he left after 1 hour, and they all told him it was a waste of time.

      This is all part of the “feminization ” of medical school.

      I’m glad I quit teaching.

    15. dearieme Says:

      “Could it be that these doctors left Germany precisely because they were not very good”: I dare say that’s pretty likely. Every country graduates dud doctors, but the proportion of problems caused by foreign doctors is rather alarming.

      I imagine that might be true for nurses too. When I was in hospital a few years ago, one nurse was puzzled that I was to be given 3.75 mg of one medicine. Her trolley had 5 mg pills, 2.5 mg and 1.25 mg. I had to suggest to her how to combine those so that I got 3.75 mg.