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 Residency for IMGs blog: Videos for Internship  



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  #21

xenopus wrote:
Please watch video
http://www.youtube.com/watch?v=H18iESwwGOQ
Focus on the question asked at 2:20 min and from then on.


OK. This is more complicated than I imagined. I think I'm wrong. And I also think the most important question in this video is wrong.

First, there are about 45 million Americans without health insurance. If Obamacare mandates universal insurance (everybody should buy health insurance), then 45 million patients will be taken by the system...they'll have coverage because before they used to 'go naked' (no coverage). So there will be plenty of work for American graduates and IMG doctors!. There will be plenty of work for everyone and his brother!!. And so the ECFMG won't close its doors, and possibly FirstAid, UsmleWorld and Kaplan will do business as ever.

So in the video above at 2:20 min should say '45 million' instead of '40 thousand'.

Therefore the questions we have to ask will depend on information that leaks out of AAMC members. In that regard, Dr. Christopher could tell us more (if he decides to honor his own thread).

So both Americans doctors as well as IMGs will have jobs. So why the heck residency doors are being closed to IMGs?

The hypothesis I have now is that IMGs will possibly be second-class doctors. Similar to current Physician Assistants or Medical Assistants. So imagine that American doctors will be at the top, while IMGs will be dis-empowered and low-waged but with similar knowledge. This stretegy will make possible to finance the coming expensive healthcare system and will also provide ways for Private Health Insurance Companies (PHICs) to decrease their Medical Loss Ratio, i.e., keep profits as today. So if PHICs purchase medical schools, they can control the flow of doctors giving priority to American doctors, while treating IMGs like colored-doctors, and also assuring a very cheap medical care. By owning medical schools, PHICs could offer courses for IMGs to get certified in smaller degrees but never to the level of a full-credentialed American doctor. And on top of that, they can make money from IMGs!. The U.S. has centuries of experience dealing with second class citizens, and they know how to run it as a very smooth operation.

It's truly important for members of the AAMC who attend their meetings to share documents on how they plan to structure medical training during the Obamacare years. Certainly, residency spots are closing, but IMGs will be needed. So we need to find out how IMGs will participate in this big market.

Please feel free to share your insights and documents that you analize or come across.





  #22

xenopus wrote:
Thanks trinidoc for your comment and link. I wasn't aware about all the important things you tell us about JHU partnering with the government of TT, the huge amount of cash spent on this, the huge prevalence of diabetes (DM2) and other chronic diseases. It's interesting that the output of that partnership doesn't look that great. Please feel free to share more information.

At first glance several things come to mind. What kind of healthcare has TT? Single payer? Managed Care? Hybrid? Other. This is important because I want to know who's responsible for that US$0.5 billion. I was just wondering if the TT government was approached by an economic hitman (see from min 1:30 http://www.youtube.com/watch?v=e0JCJ4pIFEw ). Just a hypothesis, hopefully I'm mistaken.

I'm also trying to match and we'd better do it quick. The door is already closing. GL to you. Please keep bringing your perspectives.

EDIT:
Please take a look at the explanation for Managed Care




For a country of only 1.3 million we were actually labelled as "developed" owing to economic status. We have oil and natural gas -- and healthcare, chronic disease medication (generic) as well as tertiary education (as of 2005) is free. However, it is an island! and facilities or staff are not in place for subspecialty training. thus, many of us have to fight up with trying to specialize on our own. especially on my 1st day in med school in 2002 it was announced that my grad yr and all those after 2005 would no longer be given GMC numbers to practice in the Uk owing to new restrictions in place after the UK joined the EU.




  #23

for background UWI = University of the Est Indies, formerly University College London est 1958 in Mona, Jamaica -- now with campuses in Trinidad, Jamaica, Bahamas and Barbados. Even after separating from the UK and becoming independent/republics we were still given GMC (General Medical Council) number to go directly to the UK to practise medicine/specialize. even then, it was competitive to specialize fully, but now the US became our only hope. as i said b4, it is up to governments to make proactive moves to ensure it's medical professionals are well trained given this trend of restriction of movement of medical professionals.


  #24

and yea good luck to us all!


  #25

trinidoc wrote:

For a country of only 1.3 million we were actually labelled as "developed" owing to economic status. We have oil and natural gas -- and healthcare, chronic disease medication (generic) as well as tertiary education (as of 2005) is free. However, it is an island! and facilities or staff are not in place for subspecialty training. thus, many of us have to fight up with trying to specialize on our own. especially on my 1st day in med school in 2002 it was announced that my grad yr and all those after 2005 would no longer be given GMC numbers to practice in the Uk owing to new restrictions in place after the UK joined the EU.


Great trinidoc. Thanks. Trinidad &Tobago has single payer system as you say ( en.wikipedia.org/wiki/Healt...are_in_Trinidad_and_Tobago ). Awesome. Healthcare for free!


  #26

trinidoc wrote:
for background UWI = University of the Est Indies, formerly University College London est 1958 in Mona, Jamaica -- now with campuses in Trinidad, Jamaica, Bahamas and Barbados. Even after separating from the UK and becoming independent/republics we were still given GMC (General Medical Council) number to go directly to the UK to practise medicine/specialize. even then, it was competitive to specialize fully, but now the US became our only hope. as i said b4, it is up to governments to make proactive moves to ensure it's medical professionals are well trained given this trend of restriction of movement of medical professionals.


Possibly some issues like growth or limited space where to grow, are felt quicker in smaller places and thus your population is trying to address problems big countries don't worry much about. Eventually we, all human beings will have to address economic growth. Thanks for your perspectives.


  #27

one last thing xenopus ... many img's talk mainly of scores and bell curves etc. in my experience with US way of life ... the most important thing is to blend in! having this "sheep" theory is all well and good, but the main thing is that you maintain an open mind and be able to have adaptability. this is proportional to your "trainabilty" in the eyes of a PD. have ideas/thoughts etc. but don't become rigid in them, it will show on interview day.

an interview means you have passed the paper test abd the reason why many img's don't match is because they fail the personality test. smiling and gestures are part of good com skills and enhance patient compliance and staff morale. get this idea of discrimination/second class treatment out of your mind -- if you fit in/blend in then there will be nothing to discriminate against.

even the famous McDonald's came to my country where there is a strong Hindu/Muslim/West African/Indian population. they serve fried chicken and chips/fries as a main dish because burgers (beef) don't cut it and there is NO bacon (pork)! they had to blend in ... and even in India, the menu for this restaurant includes typical indian dishes. so in a way the American companies are blending in to our markets ... and we should have the same open minded nature when attempting to market ourselves on iv day.

as morpheus said "free your mind neo!" -- the same applies to you xenopus and it does to me ... if we can do this, the match is guaranteed, one iv or 15 would not matter. good luck to us all!


  #28

trinidoc wrote:
....even the famous McDonald's came to my country where there is a strong Hindu/Muslim/West African/Indian population. they serve fried chicken and chips/fries as a main dish because burgers (beef) don't cut it and there is NO bacon (pork)! they had to blend in ... and even in India, the menu for this restaurant includes typical indian dishes. so in a way the American companies are blending in to our markets ... and we should have the same open minded nature when attempting to market ourselves on iv day.


It's true big companies are trying to blend in. It's their nature. Expanding always. Economical growth!.

You're right, that we should make an effort to blend in...but not to the point of bringing nothing new. As a candidate I do bring new things to the program. Those who have rejected me possibly don't consider those things too important, I'm waiting to see if any of the programs I applied seem to pay attention to the mission I highlighted in my Personal Statement, that is of course based on my trajectory. Good examples trinidoc. Thanks smiling face


  #29

trinidoc wrote:
... get this idea of discrimination/second class treatment out of your mind -- if you fit in/blend in then there will be nothing to discriminate against


trinidoc, the hypothesis I put forward in the prior comments have to do with real things and basic concepts such as Addition and Subtraction. Dr Christopher does bring important facts from the 2008 document(im-for-imgs.com/2011/11/21/...ational-medical-graduates/).

In that document you'll see that residency spots for IMGs are shrinking on one hand. On the other hand, we know that Obamacare plans to cover today's uninsured Americans calculated at 45 million by universal mandate (so called Universal Health Care = everybody has to buy health insurance).

These are the facts:

-In 2006 AAMC recommended a 30% increase in medical school enrollment to deal with the shortage of physicians.
-If we really need more physicians, we should also increase the number of residency places. I don't see it. Dr Christopher considers it unlikely. Now, if it's happening, who has reported it?. I'm open to see evidence from a document or legislation to increase the number of residency places. But as far as I know it's not happening.
-In 2007, the AAMC did a survey about medical school enrollment
-In 2008 survey results were published (www.aamc.org/linkableblob/...2/data/aibvol8no3-data.pdf)
-In 2011, we're reading & analyzing this document. I'm trying to explain it in a different way.
-In 2014 and from then on, changes will be clearer but by this time the goal of the AAMC's recommended 30% increase will be reached.
-AMGs are preferred over IMGs (which is reasonable specially because all of us are standardized doctors).
-Unless anything changes, IMGs will be left out of the loop by 2014-2019 as Dr. Christopher correctly infers. Dr Christopher, score yourself some points! smiling face
-Since new doctors will be needed to care for the 45 million new patients Obamacare plans to bring into the system, where' are those doctors?
-Replacing the potpourri of today's mixed AMGs + IMGs with just AMGs is not an increase in physicians. It's just a purification process. A distillation to be more chemically correct.

If you know simple addition and subtraction, you can guess that IMGs should be flooding postgraduate programs. But that's not happening. If anything, the opposite is true. Please read Dr. Christopher's last sentences:

"Between the 2005 and 2009 matches, the percentage of IMGs who submitted rank lists and matched dropped from 54.7% to 47.8% for US-IMGs and from 55.6% to 41.6% for non-US IMGs. Once these new US students graduate it will get progressively more difficult to attain a residency slot as an IMG. I see it as unlikely that the US government will expand funding of US residency programs to increase the size of residency programs. All this adds up to the slow elimination of the IMGs as residents by 2019."

So if you had to guess how the extra-needed doctors will come while the gates are closing, you'd have to guess they're coming through sewage pipes, door gaps, chimneys, like Santa! Hey!! Not bad for a Christmas connection! ...Anyway, that ties up with the second class citizenship. It's not my idea. It's happening.

Many doctors are flooding Physician Assistant programs, many are nurses or are looking into nursing certification, many are on research not as their ultimate choice but as a temporary fix. This is not my idea. It's happening. I don't have statistics but I'd love for people to come forward and tell their story. But it's up to them to share their testimony or remain silent.

Trinidoc, you have already shared a lot of good things about T&T which I didn't know before you came. Thanks for that. I really appreciate it. Believe me, I learn a lot from every bit of key information and I take it very seriously. Because I know it's good information.

Please take a look at the factual evidence and then you'll discover that there's a big unaccounted gap of doctors. We still don't know what's gonna happen. We can guess though. From my previous experience I know that gap comes at a very dear price to all of us. And I'm not exaggerating. Best. Xen



Edited by xenopus on Dec 07, 2011 - 8:48 AM. : synthax

  #30

xenopus wrote:
...So if you had to guess how the extra-needed doctors will come while the gates are closing, you'd have to guess they're coming through sewage pipes, door gaps, chimneys, like Santa! Hey!! Not bad for a Christmas connection! ...Anyway, that ties up with the second class citizenship. It's not my idea. It's happening...


I don't have the PDF file but getting it, is in tomorrow's TO-DO-LIST.
See for yourself, that at least IMGs have been considered as Physician Assistant cannon fodder.

Accession Number 00001888-199608000-00016.

Author Fowkes, V; Cawley, J F; Herlihy, N; Cuadrado, R R

Institution Primary Care Associate Program, Stanford University School of Medicine, California, USA.

Title Evaluating the potential of international medical graduates as physician assistants in primary care.[Article]

Source Academic Medicine. 71(8):886-92, August 1996.

Abstract The need to increase the nation's primary care workforce, and the presence of large numbers of international medical graduates (IMGs) who encounter barriers to licensure as physicians, have led to consideration of ways that IMGs might practice as physician assistants (PAs). Several states have explored regulatory changes that would allow IMGs to obtain PA certification through equivalency mechanisms or accelerated educational programs. In California, surveys in 1980, 1993, and 1994 collected information about the interest and preparedness among IMGs seeking PA certification. These surveys revealed that few of the IMGs were interested in becoming PAs as a permanent career, and few could show a commitment to primary care of the underserved. Of the 50 IMGs accepted into California's PA programs in recent years, 62% had academic or personal difficulties. Only 34 IMGs became certified, and all accepted jobs in primary care specialties. Two preparatory programs in California have assessed the readiness of unlicensed IMGs to enter PA programs, and they have shown that the participants did not demonstrate knowledge or clinical skills equivalent to those expected of licensed PAs. Therefore, policymakers should not consider that IMGs are or can easily become the equivalent of PAs without additional professional training in accredited PA programs. Preparatory programs appear to lessen the barriers to PA training for a few IMGs. In times of scarce resources for training, however, these programs may not be the best use of public funds to increase the primary care workforce.

(C) 1996 Association of American Medical Colleges (THE SAME ONES WHO RECOMMEMDED INCREASING MEDICAL STUDENT ENROLLMENT)

Author Keywords Certification; Educational Status; *Foreign Medical Graduates; Human; *Physician Assistants (education); *Primary Health Care (manpower); Support, Non-U.S. Gov't; United States.

Language English.

Document Type Journal Article: PDF Only.

Journal Subset Clinical Medicine.

ISSN 1040-2446

NLM Journal Code acm, 8904605




  #31

xenopus wrote:
I don't have the PDF file but getting it, is in tomorrow's TO-DO-LIST.
See for yourself, that at least IMGs have been considered as Physician Assistant cannon fodder.


I couldn't find the article, but found this one published s year earlier. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1381804/ accompanied by a commentary http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1381803/

I don't know exactly how these old articles (1995-1996) would apply today. For example, do the so called 'underserved areas' still exist?. But one thing I do know from Dr. Christopher's blog: IMGs will face unemployment-no-training crisis. I just wonder, Will the Physician Assistant pathway still be the option for many?


Edited by xenopus on Dec 16, 2011 - 6:24 PM. : multiple mistakes

  #32

The following document goes one step further from Dr. Christopher's post on elimination of IMGs. It not only confirms many of his & my assumptions but clearly states about the need to increase residency spots. The question now is who's going to get the biggest chunk of those extra spots, if indeed they become available: AMGs or IMGs?  

www.aamc.org/download/1506...50612/data/md-shortage.pdf

Reference: Association of American Medical Colleges. Physician Shortages to Worsen Without Increases in Residency
Training. (https://www.aamc.org/download/150584/data/physician_shortages _ to _worsen_ without_increases_in_residency_tr.pdf) Published: September 30, 2010.

Pay attention to the following sentence:

"To Ensure an Adequate Physician Workforce, the Medicare Freeze on Residency Training Must End. Because of the concern with likely shortages, the number of medical schools is increasing, and there will be an additional 7,000 graduates every year over the next decade. Still, there can be no substantial increase in the number of residency training positions supported by the federal government."

I'm glad that upon further digging some of the pieces I presented as conjecture, assumption, speculation or educated guesses are coming together as a more complete picture. The most visible thing is how fragmentary information is. I'll possibly try to tighten my hypotheses as new evidence becomes available. It actually takes some time to digest all of this. Thanks to the people who have spent time in making a dialectic conversation, especially those able to see it as genuine issues instead of dismissing it as a simple rant.

 




Edited by xenopus on Dec 16, 2011 - 6:26 PM. : highlighting

  #33

Link

www.aamc.org/newsroom/repo...shortage_under_reform.html

 

There are several statement in this document that are worth commenting. I’ll highlight key paragraphs (in my view) but first I'll paste it.

 

Addressing the Physician Shortage Under Reform

  —By Sarah Mann (apparently published on April 2011)

  Given the likelihood that more people will enter the health care system in coming years following passage of the Affordable Care Act (ACA), it is equally likely that more doctors will be needed to treat them.

  Recognizing the growing gulf between physician supply and patient demand, medical education leaders and the AAMC are working to inform Congress and other lawmakers about the best means of addressing physician shortages. One of these potential means is lifting the existing cap on Medicare-funded residency positions.

  …After the passage of ACA, there is recognition that there will be real physician shortages if we don’t do more to lift the residency cap," said AAMC Chief Advocacy Officer Atul Grover, M.D., Ph.D. …People on both sides of the aisle have realized the need to train more doctors."

  A physician shortage was already expected before ACA was signed into law in March 2010, and now that gap could worsen. According to projections released last fall by the AAMC Center for Workforce Studies, there will be a shortage of about 63,000 doctors by 2015, with greater shortages on the horizon—91,500 and 130,600 for 2020 and 2025, respectively. Earlier projections had placed the shortage at about 39,600 doctors by 2015. Since 2008, AAMC projections have incorporated later utilization data and changing specialization patterns among new physicians, and have shown shortages across those specialties as well as in primary care.

  The Balanced Budget Act of 1997 froze the number of Medicare-supported positions in hospitals at 1996 levels. Since then, the number of Medicare-funded residency slots has remained relatively stable at about 100,000 per year, despite a growing demand for medical services and increasing projections of physician shortages.

Several factors are contributing to the growing demand. On top of the 32 million Americans who will get insurance cards if the ACA is fully implemented, 15 million more will become eligible for Medicare in the coming years. Meanwhile, physician supply is projected to drop because of baby boomer retirement and other factors.

…The new AAMC projections reflect what happens with a relatively sudden increase in physician demand," said Scott Shipman, M.D., M.P.H., senior researcher of workforce studies at AAMC. …From a projection standpoint, there is an exacerbated shortage in all areas."

  To mitigate the coming shortages, in 2006, the AAMC called for a 30 percent increase in medical school enrollment by 2015. To date, enrollment has risen 13 percent. But without a concomitant increase in GME slots, increasing the overall physician supply in the U.S. will be impossible.

  Several specialties in particular could experience shortages of 62,400 doctors by 2020, according to 2008 data from the federal Health Resources and Services Administration (HRSA). General surgery is predicted to be one of the hardest-hit specialties, with a shortage of 21,400 surgeons.

  Ophthalmology and orthopedic surgery are each expected to need more than 6,000 physicians over current levels. Urology, psychiatry, and radiology all are expected to see shortfalls of more than 4,000 physicians, according to the HRSA figures.

  In addition, a recent study from the American Academy of Dermatology found that there are only 3.5 dermatologists for every 100,000 Americans, with patient wait times running as long as three months in some areas.

  The ACA did take steps to address the shortage. For example, the reform law will redistribute some unused residency slots and increase funding for the National Health Service Corps, which sends resident physicians and others to practice in health professional shortage areas (HPSAs). HRSA statistics show that as of September 2009, about 65 million people were living in primary care HPSAs.

  …With the shortage of physicians, it is usually the most vulnerable patients who have access problems," said Tim Dall, a health economist and director of health care consulting at IHS Global Insight. …It’s often the Medicaid population because Medicaid reimbursement rates are so low."

  According to Grover, several legislative options could help alleviate the shortage. Making care more efficient by training residents in quality improvement, patient safety, and team-based treatment is one potential avenue, as is redirecting unused residency slots into new and existing programs while changing existing rules to allow residents to train in non-hospital settings.

  Still, analysts maintain there is no real substitute for raising the residency cap. Grover said the AAMC is hoping to work with members of Congress and others to expand residency slots by 15 percent, or an additional 4,000 slots per year, which would be phased in to mirror a projected 30 percent increase in medical school enrollment.

  Although lawmakers seem more aware of the impending physician shortage, a sluggish economy and the new focus on reduced federal spending will present a challenge to keeping residency cap issues on the congressional radar.

  …In an era with no money, the prospects are pretty grim," Grover said, noting that if cost were not an issue, proposals to lift the residency cap would most likely have …very good" chances.

  Although the prospects are bleak from a financial standpoint, Grover added that it is important to introduce the bill to keep politicians informed.

  …Prospects may be grim on a financial front, but it is important to make sure patients have access, so we want to keep this on the radar."




  #34

will doing a 6 month PED observership help for IM match?


  #35

number of AMGs are increasing right.......but it aint the whole picture ..it is like holding to the elephant heel and when asked what is that you say it is a heel!


  #36

what about the continuos hits medicare are doin to doctors' reimbursement?

 

do you know they cut the cardiologist by 30 % this year?

do you think it is gonna worth it for amercians to spend 11 years = 8undergrad+residency"the least of which is 3 years "

and graduate to find unpaid loans with there interests and find a payement of 120k per annum?

 

believe it or not goin to medical school in U.S is becoming less desirable and more and more americans who know the real financial situation of medicare and medical funding in US are opting to choose other grad schools like law and business


 


  #37

Thank you Mr. Kenneth! So thankful i have some more information! Hope i can find an observeship now that i got the ECFMG certificate, and get ready for next match. May The Almighty bless you!


  #38

can anyone tell me how much time i need to get ecfmg certificate after my application? can anyone apply for it without giving cs & ck, after giving step1?


  #39

wow I genuinely didn't know what I was getting into when I went to the Carib for school, I'm trying to take in all this information I wish all this was clear instead of being sold an image of an easy straight forward path - I will comment once I know enough about the subject matter.





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