American College of Physicians: Internal Medicine — Doctors for Adults ®

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From the May 1998 ACP Observer, copyright 1998 by the American College of Physicians.

Don't blame IMGs

The article on one residency program's reforms seems to suggest that the ratio of international medical graduates (IMGs) to U.S. graduates was the major obstacle to the program achieving its goals. ("In trying to build the better internist, the key for one program is change," February ACP Observer, p. 1.)

I suggest that the program director, who is also chairman of the department of medicine, did nothing to help the IMGs in his program. All the new, "innovative changes" that he implemented occurred only after he filled his slots with U.S. graduates. If Nayan Kothari, FACP, had really been interested in the IMGs in his program, he would have implemented these changes several years ago. Frequently, IMGs who hold some ability to monitor the mix of their residents feel "forced" to tailor the makeup of their programs to suit the current political climate, which currently resembles a witch-hunt for IMGs.

If Dr. Kothari is an IMG, he must surely remember what it was like to get to where he is today. Instead of blaming IMGs for inadequacies in his program, he should start paying attention to them. If we could be more sensitive to the needs of IMGs, both in their academic training and in their "grooming" for private practice and academic circles, we would all come out ahead.

In his column in the same issue ("In the debate over work force, IMGs remain a difficult issue," p. 16), Harold J. Fallon, MACP, Past Chair of the College's Board of Regents, sums up the debate nicely: "Most IMGs in U.S. residencies are extremely well educated, pass the same examinations as U.S. medical graduates ... and clearly are not to blame for any anticipated oversupply of physicians ... IMGs must be accorded the same respect, opportunities and high regard as U.S. medical graduates."

Suresh J. Antony, ACP Member
El Paso, Texas

It is well accepted that IMGs traditionally fare as well as or better than U.S. medical graduates on their board exams. (See "International Medical Graduates and the In-Training Examination" in the May 15, 1997, issue of Annals of Internal Medicine.) Therefore, it is difficult to attribute the improved board pass rate at Dr. Kothari's program to the recruitment of U.S. graduates.

Implementing an interactive morning report and other educational activities appears to be a more logical reason that the program's pass rate on the boards has improved. Hiring only U.S. graduates to gain prestige amounts to blatant discrimination.

Pankaj Rajvanshi, ACP Associate
Francisco Marty, ACP Associate
Bronx, New York

To state that some medical leaders in this country think that a program with a majority of IMGs is less "prestigious" than one staffed by U.S. medical graduates is wrong. The presence of IMGs in various hospitals does not in any way reflect a less prestigious environment. Some of us believe that patient satisfaction and morbidity and mortality data are more useful measures of prestige. Do data from New Jersey suggest that hospitals with IMGs offer inferior care? How does excluding IMGs from training programs translate into the creation of better internists?

The backlash against IMGs, which is largely spurred on by those interested in protectionism, must stop. Many parts of this country do not have access to primary care physicians, and it is this physician maldistribution that should be at the core of the work force debate.

Members of the College, whether they're IMGs or U.S. medical graduates (why even make the distinction?), should stand united as we attempt to address physician work force issues and managed care. A house divided will surely fall to the machinations of those interested in creating bitterness and rancor among our ranks, as well as to those interested in enriching themselves to the detriment of our patients.

Kwabena O.M. Adubofour, ACP Member
Stockton, Calif.

How dare Dr. Kothari blame the failings of his program on IMGs. I am a third-year resident in internal medicine and will serve as chief resident next year. Last year, one of our IMGs—like the ones who ruined his program—scored 100% in five areas on the ABIM board certification exam and in the 90th percentile on all the others. Expanding residency training to four years will not help Dr. Kothari's program if he can't accept responsibility for failing to get the job done in three.

J.A. Haislip, ACP Associate
Pittsfield, Mass.

The work force debate

In this era of managed care, it is comforting to know that there are still some true visionaries in our medical community who are able to recognize and appreciate genuine skill and substance. ("In the debate over work force, IMGs remain a difficult issue," February ACP Observer, p. 16.)

In his column, Dr. Fallon describes the blame that international medical graduates (IMGs) have received for medicine's impending glut of physicians and the steps taken by medical and governmental organizations to address this problem. However, he also notes the tremendous contributions these same physicians have made to American medicine.

IMGs bring various styles and clinical skills from their home countries, infusing new ideas and knowledge into the American health care system. Although I clearly understand the need to prevent physician oversupply in this country, I cannot accept the notion of doing so by denying highly qualified and potentially promising foreign physicians the opportunity to train, practice and contribute to American medicine.

We must not forget that this country was built by immigrants seeking a society where they could offer their talents, develop their skills and pursue their dreams. If we start closing the doors to this stream of foreign talent, we are only limiting our options and curbing our progress. That is not the American way.

Khalid Almoosa, ACP Associate
Milwaukee

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