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I love my PMD, but I can’t pronounce his name!

August 13, 2013

With immigration reform under hot debate in washington, it’s important to remember that all of us except the Native Americans are foreigners.  It’s what has made our culture so diverse, for example in the area of food:  it has allowed students in NYC to get amazing and cheap chow fun, provided authentic tacos to the strip malls of LA, and has actually made possible access to real balsamic vinegar and decent olive oil.  People from foreign countries ideally bring the best of their cultures to the US and enrich us all with the diversity of life.  This advantage lessens considerably when those visitors want to enter fields in which understanding of endemic American culture is critical.  So it can be with Foreign Medical Graduates (FMGs).

The New York Times did a piece on FMGs today:  Being an FMG has become sort of derogatory.  You tend to see them staffing surgicenters and walk-in clinics and doing primary care in Nebraska.  Sort of like the stereotype of the Mexican immigrant who does work Americans don’t want to do.  Now, I have many friends who are “FMGs” and they are all fantastic doctors.  They probably were before they were subjected to all three steps of the mostly useless United States Medical Licensing Examination and a second full residency.  In fact I know they were.  Foreign doctors are caring, professional, knowledgeable, and often smarter than your average american grad.  The reason they work in Nebraska is that, as the NYT article points out, it’s very hard to get credentialed here and many of these talented doctors end up in lower-end residencies in less competitive specialty areas.  They are doing great work in some difficult under-served areas of our country and their own.

There are two problems with foreign doctors practicing in the US.  Number one:  Communication.  Last week I did a piece for KevinMD on trust between physicians and patients.  A quick review of research strongly suggests that communication, or a compatible communication style, is one of the most important ingredients in trust between me and you.  Some doctors come from overseas with great English skills; others not so much.  Some come from their countries very “westernized”, some not so much.  Being a great clinician and knowing a lot are part of being a good doctor, but so are the ability to communicate effectively in the language of the patient, and to appreciate the culture and mores the patient brings to her attitudes about health and illness.  This principle goes the other way too.  How many times do western doctors go to third-world countries with the best of intentions and the best of technology, but are unable to make progress because of a profound cultural gap?

The other problem is the “brain-drain” one.  Some foreign doctors trained in the US are desperately needed in their home countries.  While it is a perfect solution to the above paragraph to train a doctor in the US then have him go back to use his language skills and cultural knowledge to bring top-quality medicine to their own country, this doesn’t always happen.  Once people see what we have here it is sometimes hard to leave.

None of this is true in all cases, and I’m sure I’ll get some nasty-grams about racism or bigotry.  I love my FMG friends.  I just don’t think they are a solution to primary care in North Dakota.  One NYT reader commented that maybe there is some way to accredit some overseas programs so that those physicians have an easier transition to the US.  I think that’s a good idea.  Re-thinking the USMLE is another.  The real question is twofold:  why do we  consider all other training programs inadequate?  And why do we think we need to solve the primary care problem with FMGs?  Let’s welcome every doctor who really cares about medicine and people, wherever they are from, and support their education and pay them in such a way that young doctors will WANT to do primary care in North Dakota.   Because it will be cool, and useful, and interesting, and great medicine, and compensated.


From → Healthcare

  1. connie permalink

    We in San Diego have many many FMG’s. And we are a very multicultural City. Most of the people in my Senior’s Sunday School Class have foreign born doctors. They all love them. However most of them can’t pronounce their names and some can’t remember their names. But if they were not getting good care and adequate communication from their doctors they wouldn’t “love” them. Even in my own experience with FMG specialist I have not had communication problems. If there are problems on the east coast it is not communication it is ethnocentrism on the part of the medical establishment and/or the patient population. My ignorance of, and impression of North Dakota and the Mid-west Makes me think that they would be more intolerant of FMG’s than the major urban centers of our country. Part of it is the old anti-immigrant attitude “Those people (usually an expletive included) are coming in and taking over our jobs!” It is certainly an interesting and complex problem. Dad

  2. Interesting article! For foreign doctors trained in the US, sometimes student loans and mortgages and car notes tie them down here to jobs that can help them pay back these expenses and provide for their families. Sometimes they’re stuck here too even though they would prefer to go back to their home countries where healthcare is more practical and less controlled by who’s paying.

    • Thanks for reading! Very good point. American students saddled with debt can barely hope to pay it off. How can foreign students be expected to?

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