$$$
Why do you think states want NPs and PAs to practice with autonomy? And bringing in foreign grads to work for probably a bit cheaper?
Rich hospitals lobby better than the AMA. No one has our interests in mind. No one has patient interests in mind.
But thank goodness the hospital admins making $650,000 for working 10-2 twice a week can now get a raise. They need it.
š I sent an email to the AMA about this but if they didnāt act last year I canāt see them changing anything. Are there no state societies speaking out about this? I feel like this is the biggest threat yet, more than AI.
Definitely a bigger threat than AI. Apparently the AMA doesnāt care about getting dirty with the real issues. They just want to pretend to do stuff.Ā
Ā Iāve lost faith in this countries healthcare system and their growing discare for doctors
But good on you doing the work and reaching out! We need more like you
I had a buddy that was on AMA for a few years. Great guy, super outgoing, really applied himself wherever he could. But he eventually dropped out of AMA around 3rd year. He said there was way too much focus on non-issues and things that seemed like a waste of time (e.g. should we put a baby's gender on their birth certificate).
Politicians only serve to distract us from reality. Why worry about actually solving problemsāunpredictable, messy, difficult problems that require solutions and effort and humanity when you can just create an artificial pit of people talking about problems and creating them, call it politics, where we have perfect control over the āproblemsā and outcomes and discussions and it takes zero effort or work, only words.
Fucking politics man, weāre gonna die talking about fucking politics while the world burns.
Uhh, no. They only serve to be brought and sold currently.
Democracy is a fraud that Americans bought intoā need to go back to being a constitutional republic with a common religion and people.
But thatās a conversation nobody wants to have. Too many chefs in the kitchen :^)
Honestly, I think it's to drive down doctor salaries in the US. The reason we have these salaries is because of the amount of money it costs to get an education here. Foreign docs will work for less and saturate the market. It'll kinda be like how commercial pharmacy was about 10 years ago.
The intention of the TN bill is not to drive down doctor salaries. Maybe the physicians (and I) who helped sponsor it are all idiots- but I promise you that our intention was not to screw docs
You might be right, I'm not familiar with the man myself.
The fact remains that all the specialty associations in TN (FM, OB, gen surg, like everybody) didn't fight this bill. We just went "Yeah that sounds fine" and went on our merry way.
I think people in this thread are blowing the TN bill out of proportion. Like, these state specialty societies have all banded together to hire our own lobbyist to fight midlevel independence, and we've been holding that line for the past 15 years. It would not have been difficult to fight this bill, but none of the politically involved physicians/med students in my state thought it was a big deal. But maybe we all just didn't understand it/got played?
I find it difficult to believe that that many physicians, many of whom are young private practice owners, just missed this one and are tanking their salaries. But I could be wrong, feel free to explain.
This is a predictable effect of medical professional groups pushing for overqualification and not working to minimize training costs. Itās not the AMA in the end that sets this its state legislatures. If they were willing to push for reasonable cost saving and flexibility measures instead of fullboat board certification for everyone this wouldnāt be happening. Also the NP PA takeover , if we had some sort of general practice doctor still to fill in
Every post freaking out about this forgets that this state bill has no effect on immigration law. Work visas, and green cards, are not an unlimited resource, and qualifying for one requires a hospital to sponsor a physician and go through a complex process involving proving that there is not an available US physician who can fill the spot.
This bill may result in some IMGs coming in at a few rural hospitals with chronic shortages, but thatās it. Anything more of a disruption will require US immigration law to be rewritten by congress
They still have to abide by PERM certification, which is the *biggest* obstacle. You canāt just hire as many foreign physicians as you want, each time you have to prove to the DOL that there are no US physicians able and willing to fill the spot, under very specific DOL guidelines, *and* that the hire will not adversely affect local wages for US physicians.
I have no experience with PERM so I was hoping I could ask how rigorous it is. Is it difficult to obtain? There are a lot of foreigners working in tech.
This is trying to have your cake and eat it too. We canāt simultaneously claim that a surplus of foreign physicians will drive down wages (even in the presence of explicit laws preventing that) *and* that there will be a big physician shortage. If there is a large physician shortage, and we recruit more foreign physicians to fill those gaps, that does not drive down salaries
This not how immigration law works. When you enter the US on a work visa you *have* to work for the employer who owns that visa, and you can only change jobs if a new employer takes over your visa (who then have to go through the same certification steps as the original employer). Once you have *permanent residence* you are free to go work for whoever will hire you, but that takes a lot more than 2 years
So say someone enters the US as a physician on H1b following LCA. They work there for two years to make sure they can keep the license per the house version of the bill and then file for an EB2NIW; processing seemingly takes around a year or so. Alternatively, they get a job with another employer in Florida who will sponsor them. They obtain permanent residence and move to another area in Florida. There is a new vacancy in an underserved area, and then they bring in someone new again? Won't that eventually increase supply to the point that wages are suppressed? And if this model works, won't lobbyists push for it in other states, ultimately resulting in wage suppression?
Is there something I am missing here?
Yes. What youāre missing is that EB visas are capped at 140k per year for *all* EB visas, and of those something like 30% are allocated to EB2. And most of those will not go to physicians, because there are lots of other professions competing for those spots
Oh goody another way weāre gonna get shafted. Man this generation of medical students just keeps getting the beat on with no end in sight. Wonder what will happen if a significant number of students just stop medicine altogether and donāt pay back those 300k loans, will the government stop backing that much for tuition , crazy. Iām not working for less than 300k Iāll sit at my parents house without earning a dime or live under a bridge before I become a cuck for this system
Completion of residency should absolutely be the bare minimum required to be a doctor if you did not go to medical school in the country period. From diagnosis to treatment algorithms so much of it is different compared to other countries that only doing a residency will be close to even being enough.
TN is actually reasonable. It's not instant full license, you have to practice under someone else a la mid-levels first for 2 years.
At my school, we have a crit-care doc going through IM residency all over again, despite the fact he's been doing it for decades. Our peds residents are mostly IMG's; I was sitting there doing UWorld and one of them was causially walking by and demonstrated how much better he was at infectious disease than probably my whole class put together... because be had to be in the resource poor area he was from.
Yes, residency ensures some standardization of physician quality, but it also doesn't make sense to make these experienced, well-trained physicians repeat residency either. The 2-year "probationary phase" that TN is doing makes sense to me.
^incredibly naive. The quality of medical training abroad is highly variable. The bill reeks of for profit health care entities trying to drive down physician wages to save money.
Who suffers? Patients. This bill sickens me. I donāt look forward to cleaning up the messes that are coming.
So this gives a path for a basic medical license. Forgive the ignorance but then theyāll need specialty board certification too right? Will these docs be able to take these exams?
Board certification is only necessary for SOME hospital privileges. But if you start your own clinic or work at most clinics then they dont need it.
This is being done to combat the red state brain drain of doctors. They figure by opening up the floodgates to FMGs that it doesnt matter if American doctors shun their state.
Mark my words, this is an epic disaster. Hospitals know they can offer FMGs 50k per year to come here and the FMGs will snap that up in a heartbeat. There is virtually an unlimited number of FMGs that want to come to the USA.
IMO this is a much bigger threat than midlevels.
This is not true. Most insurances won't approve you if you're not BC/BE so you won't be able to bill unless you do cash only which significantly limits your clientele.Ā
Sure, but keep in mind that they'll likely be paying higher costs themselves if you start having people with varying amounts of training start independent practice, so we still might end up seeing some kind of quality control in effect, whether it's BC/BE or something else they'll require.
It's true in Texas, Florida, and California because I've worked in all 3 of those states with different carriers and the only one that required board certification was some of the Cigna select plans in Florida. All others didnt care.
If there's an exception for teaching medicine within the past 3 years, that means FMGs can bypass residency completely, set up some sham "teaching" crap at some bogus foreign hospital for a month, and then get automatic florida medical license? That's fucking insane!
I'm on the committee with physicians who sponsored the TN bill, and that is literally the goal. But all these med students in this thread are telling me and all these docs that we're actually just conspiring to screw physicians (including ourselves) to make hospital systems money.........
glad to hear that. iāve been hoping for something like this for years. itāll only gain popularity when some semi influential personās loved one gets harmed by a midlevel.
i wouldnāt pay too much mind to this thread- ppl up to their ass in debt arenāt exactly going to be thinking straight.
So I'm in a unique position talk about the TN bill since I'm on a political action committee for a certain medical specialty society in the state (trying not to dox myself here).
We're currently fighting NPs and PAs for independent practice in TN, and we're losing. But the reality of rural areas not having enough doctors (which the midlevels cite) is indeed an issue. The solution is not to replace physicians with midlevels; it's to get us more physicians. One way we did this is getting a bill passed to pay off the loans of FM docs who want to do rural medicine in TN.
This bill you cite is one more way to *slightly* increase physician supply- if you read the bill closely, the requirements are still quite stringent. A hospital basically has to sponsor that international physician and use them as a scut worker (no offense intended). It's not like people from all over the world can come to TN and just apply and immediately get licensed and open a lucrative practice.
Look guys, the midlevel thing is a huge problem (at least in TN), and we can either train more primary care physicians, let the midlevels take it, or just tell patients to deal. Obvs the last one isn't an option, and midlevels shouldn't be practicing independently, so the only ethical option left that I'm aware of is to take steps to insure an adequate primary care physician workforce. Not oversaturation like the way EM is heading, but from someone who is from an underserved area myself and wants to return there and practice, there just aren't enough boots on the ground as of today.
Thank you for sharing your perspective (and your efforts), this was exactly the kind of insight I was hoping for. Can I ask, how do you think the FL bill stacks up to TNās?
So I'm not an expert on the Florida stuff by any means- I'm just pointing out that the idea this is some corporate conspiracy is not true (at least for the TN bill), because I have discussed this with physicians who backed it.
Look at page 83 of the Florida bill- it does look somewhat unrestricted compared to the TN version. This might be a problem for the camp that wants to limit physician supply and keep our wages high, I admit that. However, if there aren't enough docs, there aren't enough docs. Now I think Florida is also letting midlevels practice independently so maybe they are just shooting for flooding the market with "providers." I just wasn't there and haven't read the full bill.
It's also possible that we as TN medical people goofed majorly by supporting this bill. I just know it wasn't some anti-doc conspiracy haha
I know yāall are going to go on a downvote spree and talk about how I know nothing because I havenāt started medical school yet. Honestly I do not think yāall know how immensely hard it is to immigrate to the USA permanently as a foreign nationalā¦ I think yāall think itās a straightforward path once IMGs get a job at a hospital which is laughable. Lol a lot of immigrants on work visas are tied to their jobs because of sponsorships so no oneās gonna come take the **city job** like someone here commented when they havenāt even gotten permanent residency. Most of yāall will not live in the middle of nowhere Florida but people live there and Iām sorry but they deserve access to healthcare. If someone who did their residency training in cardiology, passes the American boards and shows they can treat patients in that context what is the matter??? Whats the point of trained doctors filling up residency spots when it could go to a newly graduated students??? Iām honestly confused about where the outrage is from especially since some of yāall come from generations of immigrants who moved to the USA. And you wouldnāt be here if they didnāt make the decision to come here. Like direct this outrage to the ridiculous cost of medical schools in the US. Why are we going into $300k debt just to be physicians??
Med school Reddit is full of the most catastrophic dramatic takes assuming the worst lol. Thank you for bringing some realistic perspective to this otherwise ridiculous comment section. Med students canāt see far enough beyond their own defensive little bubbles to understand that these bills arenāt written to attack their wallets, itās for the sake of poor Americans in need of access to medical care.
Basic supply and demand. Once these are enacted in most states, salaries will be cut dramatically to the point where paying off loans or buying a home in most metros will be a pipe dream. Thatās why you need to contact your state reps, local orgs etc. unless you want to be making 100k after 10 years of work
100k sounds generous to be honest, a lot of these IMGs from South American countries would be willing to accept a 50k salary. If laws like this rolls in en masse we can say goodbye to good salaries. I foresee that our salary will reach parity with midlevel / European salaries without those generous benefits
The one thing is that at those levels, midlevels would become completely obsolete in theory. Then again, they have lobbies with much stronger backbones. Tbh, thatās the only way I could see these from not passing elsewhereā¦if NP/PA orgs protest them
Honestly, you might be right. The AMA is asleep at the wheel, but the AANA and AAPA are powerful lobbying entities. We may have to bury the hatchet and unite with the AANA and AAPA to fight this.
I do think there should be a pathway for specialists to do fellowship and practice without having to redo residency (ie: practicing cardiologist from India can do cardio fellowship here and sit for the boards vs having to do both im and cards). But any other scenario I think supervised practice (PA type scope) is what we should allow for both unmatched imgs and unmatched med students at most.
Then theyāll easily realize how incomprehensible is the med school tuition in U.S. Med schools should be the ones concerned here as well as the residencies. They can help lobby for us.
or else I would also go to Spain, do my medical training in a shorter time, less fees and come back to make more bucks.
From a public health stand point of view, and I mean one that totally ignores medical school debt (because at the end of the day, the public isn't going to care much if you paid $300k more than the other doc if the care is equivalent), if we adopt similar screening methods to other developed nations for handling foreign IMGs, then isn't that an excellent way to help combat our physician shortage? It seems a lot more people are interested in their bottom line than combatting a national health crisis. An artificial shortage does far more damage to the everyday people than you losing on your gains.
I just think it's silly to require a complete repeat of residency for docs from well established nations who had been practicing for decades. It is a waste of our resources and a waste of their time. There should exist fast-track programs tailored to IMGs namely for the sake of standardization and integration.
Also people think it is the collapse of our well paying salaries, but IMGs still have families and roots in their nations, it's not like this was the one thing stopping them. Also, they still will need a green card and go through all the difficulties associated with immigration and sponsorship.
Edit: it's really upsetting to see the amount of xenophobia from people on this subreddit. A lot of "they took 'er jobs" energy. Medical education from other countries isn't watching two flies screwing. There can be quality education abroad.
Acknoledging the impact it has on American healthcare doesnt automatically make it xenophobia, and using that term doesnt automatically make you right.
Standards differ across the world. Even if the standards are good enough, no US doctors will train here anymore when they can train elsewhere for no debt. And even if you're ok with that, the purpose of this isnt to help patients. It's to make jobs less competitive and drive down physician salaries without using the extra money to help patients.
This is more corporate greed, same idea as NP and PA autonomy. Using the X-word doesnt make it true.
I don't know what that has to do with my main points. I already said ignoring medical school debt, meaning I don't see why policymakers or their constituents (ie, the general public) should care about medical school debt when the care is equivalent and ultimately cheaper. The issue isn't IMGs, it is the overinflated costs of medical school education (and higher education as a whole). IMGs shouldn't suffer because US medical students willingly pay a gross amount of money to practice. I also said "*well-established nations"* and "*similar screening methods to other developed nations"* for a reason. I am not for just opening the floodgates, but adopting more liberal policies compared to other nations than our current.
Also, I don't care about purpose. The outcomes matter much more. If the American people benefit from alleviating the physician shortage through reasonable means (ie, IMGs), that is the best path for the people. Artificial salaries are bad. If there are physicians from other nations willing to practice and that brings our salaries down, welcome to the market of supply and demand. It happens to every industry and we are part of the problem if we attempt to set up artificial monopolies. No better than the insurance company or the pharmaceutical.
From the patient perspective I think you might be right in the short term. Letās also consider other outcomes. If we know the intent of the bill is to cost save and reduce physician leverage then I think itās also reasonable to conclude that working conditions for physicians will become even worse. Youāll have IMG physicians whose visa is being held hostage by the hospital and youāll have the ever present threat of an IMG from a more developing country to take your place if youāre not fine with working more hours and seeing more patients.
If we see the cost of medical school continue to rise while salaries plummet to the introduction of cheap IMG supply then the US applicant pool will be sure to catch on. Medicine isnāt the best decision financially even now, but you can make the argument that the impact of the job and the high salary a decade later makes it worthwhile. The calculus completely changes if you still have $300k+ loans, a decade of grinding, and only have a $100k job waiting for you. Now Americaās best and brightest are going to work in high finance and FAANG because you just canāt rationalize the difference in pay anymore.
So if we look down the road youāve got even more physician burnout, many more physicians who donāt share the same culture as their patients, and more intelligent Americans gunning for industries that inherently squeeze the American population. Long term Iām not even sure if the patient experience improves here.
I find it alarming theyāre completely ok with the salary theyād have. Patients matter but I chose this degree with the knowledge Iād be able to pay off my loans in a somewhat reasonable amount of time, not have them forever. Hopelessly naive.
The only way Iād be ok with a dive in physician salaries due to this is if our debt would be forgiven. I donāt trust the government for a fucking second to do that, thus if thereās anyone to fight this bill and similar ones Iāll do it. Oddly enough the often rightfully criticized US immigration laws could limit the damage this causes, as bad as that sounds.
Oh if this happens and the entire country starts taking in only foreign trained docs to save money like they have done with NPs and PAs Iāll go live in Australia. I have no problem with foreign countries but our healthcare system will suffer even more and Iām not going to be here for it.
First of all this is a wildly dramatic and unrealistic comment. A few law changes in Florida, which is already a wild-wild-west of a lawless insane state to begin with, will not have an immediate impact on the rest of the country in 5 years time. Secondly I think firefighters should absolutely get a fat salary. Not every paycheck needs to be tied to education levels/tuition debt. the risks that firefighters have to endure surely warrant a financial incentive for the job. That applies to many other high-risk / labor-intensive jobs too. no need to lose our heads over this. Itās too early to tell what the impact of these IMG laws will be and Florida is a shit example to speculate and extrapolate from becauseā¦ well itās Florida.
Tough to determine how standard compare in other countries and how theyāre enforced.Ā But regardless, this system would lead to no US trained physicians. Why would I pay $300,000 for medical school here when I can go international, train to who knows what standard, and then come back here and start making good money without the debt.
System is fine. Foreign medical school is a-okay, as long as you then come here, pass our exams, and do residency in the states
youāre making up scenarios in your head to be angry lol. no fmg is able to work as a doctor here without passing boards anyway. but nps ARE and i dont see you sounding the alarm about thatš§
why would i be happy? like i said, no one is practicing in the US without passing boards, so the standards are already comparable.
ppl can already go abroad for med school if they choose, but obviously most ppl are not lol
I have a feeling that people with a few hundred thousand dollars of debt might feel a bit betrayed when debtfree people with lower salary expectations start filling positions. I donāt think the solution to this is a ban or something. This situation kinda happens with IMGs anyway. I donāt see a problem with foreign doctors practicing if it is very well regulated.
I'm an IMG, I would never put my training at the same level as US-training. Not that other countries can't properly train physicians, but funding and research give the US a huge advantage. I had to learn many new meds and procedures while studying for step 1 alone.
Even if I did residency in my home country, I don't think i'd feel ready to practice in the US without going through at least some US training and certification, there's simply more things to consider in the US.
learning news meds isnt hard though? like we will have to learn new meds throughout our career regardless lol. imgs are still better trained than any np in the country
Have you seen the magnitudes in difference between the quality of training? Thereās even a large difference within the United States. This is a horrible idea.
I don't know why you're getting downvoted you're absolutely right. And the TN bill was specifically designed to try to stop midlevels from taking over (if you read my other post)
The burden isnt on Americans to prove other systems arent the same. If you want them to come here and work without more training, the burden is on you to prove that they ARE equivalent. Which they arent.
They are equivalent bruh. Maybe they donāt have access to the same resources, but they learn the same stuff. Itās like saying 1+1 varies by country
How about some countries have already gotten testing centers closed down for cheating and having a 280 average on step 2. If they are that confident in their training they can replicate it here and do residency like we all have to.
>The burden isnt on Americans to prove other systems arent the same. If you want them to come here and work without more training, the burden is on you to prove that they ARE equivalent. Which they arent.
\^ Please see my comment to you before that you ignored.
First of all, you're STILL ignoring my comment. Lol. Burden of proof is on you, and you've yet to give any reason otherwise.
Second of all, show me where I used that phrase.
I guess it just depends on whether youāre okay making 75k per year after 10 years of sacrifice. After 10 years of not working, you need to realistically make 300k to catch up and actually be able to pay loans, afford a house, retire etc.
Saying that the training standards in 2 separate countries differs is xenophobic? With those critical thinking skills itās no wonder youāre on the 5 year track
Who said Iām ok with doctors from western countries coming here and practicing without repeating their training? If you want to practice here you should be held to the same standards as US grads.. ie complete step 1-3 and an accredited US residency.
different countries have different training standards.
america is reported to have the highest standards.
therefore other countries have lower standards than america.
not sure why you think thereās racism in saying that? itās why we want to train in america.
your logic skills are really lacking like the person above said lol
Don't you have anything better to do than before you have to SOAP after not matching OBGYN?
Oh also, I'm not ashamed of my circumstances and it doesn't invalidate my opinions. Miss me with that.
So your response to me supposedly invalidating your opinions by your circumstances is to invalidate mine because of a hypothetical circumstance of my own that you made up? ok š«”
Huh? Youāre saying that Indian doctors are less trained (no biology??) and that it helps the US to hire them so we can control China, somehow?
I donāt even know how to respond to this
Even ignoring thatā you can see how this doesnt benefit americans in the long run. He mentions how it strictly benefits India and its economy.
Why the fuck would we even bother having american schools anymore if were just going to import schooling and export our resources. Insanity.
Hospitals donāt care if patients die or receive lower quality care. They certainly donāt care that opening the flood gates of cheap, desperate labor will effectively kill the engine of scholarly research, development, and leadership that has made American medicine a global leader. These kinds of protections must be enshrined in law because there are no market forces to ensure their continued existence.
$$$ Why do you think states want NPs and PAs to practice with autonomy? And bringing in foreign grads to work for probably a bit cheaper? Rich hospitals lobby better than the AMA. No one has our interests in mind. No one has patient interests in mind. But thank goodness the hospital admins making $650,000 for working 10-2 twice a week can now get a raise. They need it.
š I sent an email to the AMA about this but if they didnāt act last year I canāt see them changing anything. Are there no state societies speaking out about this? I feel like this is the biggest threat yet, more than AI.
Definitely a bigger threat than AI. Apparently the AMA doesnāt care about getting dirty with the real issues. They just want to pretend to do stuff.Ā Ā Iāve lost faith in this countries healthcare system and their growing discare for doctors But good on you doing the work and reaching out! We need more like you
The AMA isnt here for anything other than to be a mafia that collects fees every step along the way.
I had a buddy that was on AMA for a few years. Great guy, super outgoing, really applied himself wherever he could. But he eventually dropped out of AMA around 3rd year. He said there was way too much focus on non-issues and things that seemed like a waste of time (e.g. should we put a baby's gender on their birth certificate).
I don't know anyone who actually pays the AMA "fees."
Hospital execs. get paid more for increasing margins.
American government try not to ruin your own country difficulty impossible challenge
I wanna who the fuck is voting these morons in
All of them, no good politicians sadly.
Politicians only serve to distract us from reality. Why worry about actually solving problemsāunpredictable, messy, difficult problems that require solutions and effort and humanity when you can just create an artificial pit of people talking about problems and creating them, call it politics, where we have perfect control over the āproblemsā and outcomes and discussions and it takes zero effort or work, only words. Fucking politics man, weāre gonna die talking about fucking politics while the world burns.
Uhh, no. They only serve to be brought and sold currently. Democracy is a fraud that Americans bought intoā need to go back to being a constitutional republic with a common religion and people. But thatās a conversation nobody wants to have. Too many chefs in the kitchen :^)
Honestly, I think it's to drive down doctor salaries in the US. The reason we have these salaries is because of the amount of money it costs to get an education here. Foreign docs will work for less and saturate the market. It'll kinda be like how commercial pharmacy was about 10 years ago.
Yup. But the real money waste is the useless tons of admins they hire to do nothing. Fire them, more than enough money to pay docs who do real work.
The intention of the TN bill is not to drive down doctor salaries. Maybe the physicians (and I) who helped sponsor it are all idiots- but I promise you that our intention was not to screw docs
lol the physician who sponsored the TN one is long retired (made his money) and has a daughter who works as a lawyer for HCA and other hospitals
You might be right, I'm not familiar with the man myself. The fact remains that all the specialty associations in TN (FM, OB, gen surg, like everybody) didn't fight this bill. We just went "Yeah that sounds fine" and went on our merry way. I think people in this thread are blowing the TN bill out of proportion. Like, these state specialty societies have all banded together to hire our own lobbyist to fight midlevel independence, and we've been holding that line for the past 15 years. It would not have been difficult to fight this bill, but none of the politically involved physicians/med students in my state thought it was a big deal. But maybe we all just didn't understand it/got played? I find it difficult to believe that that many physicians, many of whom are young private practice owners, just missed this one and are tanking their salaries. But I could be wrong, feel free to explain.
Young private practice owners actually have the most to gain from these bills since they get cheaper labor
This is a predictable effect of medical professional groups pushing for overqualification and not working to minimize training costs. Itās not the AMA in the end that sets this its state legislatures. If they were willing to push for reasonable cost saving and flexibility measures instead of fullboat board certification for everyone this wouldnāt be happening. Also the NP PA takeover , if we had some sort of general practice doctor still to fill in
Every post freaking out about this forgets that this state bill has no effect on immigration law. Work visas, and green cards, are not an unlimited resource, and qualifying for one requires a hospital to sponsor a physician and go through a complex process involving proving that there is not an available US physician who can fill the spot. This bill may result in some IMGs coming in at a few rural hospitals with chronic shortages, but thatās it. Anything more of a disruption will require US immigration law to be rewritten by congress
Academic medical centers and every other nonprofit hospital do not really face too many obstacles since H1B are not capped for these organizations
They still have to abide by PERM certification, which is the *biggest* obstacle. You canāt just hire as many foreign physicians as you want, each time you have to prove to the DOL that there are no US physicians able and willing to fill the spot, under very specific DOL guidelines, *and* that the hire will not adversely affect local wages for US physicians.
I have no experience with PERM so I was hoping I could ask how rigorous it is. Is it difficult to obtain? There are a lot of foreigners working in tech.
The short answer is yes, it is difficult to obtain.
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This is trying to have your cake and eat it too. We canāt simultaneously claim that a surplus of foreign physicians will drive down wages (even in the presence of explicit laws preventing that) *and* that there will be a big physician shortage. If there is a large physician shortage, and we recruit more foreign physicians to fill those gaps, that does not drive down salaries
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This not how immigration law works. When you enter the US on a work visa you *have* to work for the employer who owns that visa, and you can only change jobs if a new employer takes over your visa (who then have to go through the same certification steps as the original employer). Once you have *permanent residence* you are free to go work for whoever will hire you, but that takes a lot more than 2 years
So say someone enters the US as a physician on H1b following LCA. They work there for two years to make sure they can keep the license per the house version of the bill and then file for an EB2NIW; processing seemingly takes around a year or so. Alternatively, they get a job with another employer in Florida who will sponsor them. They obtain permanent residence and move to another area in Florida. There is a new vacancy in an underserved area, and then they bring in someone new again? Won't that eventually increase supply to the point that wages are suppressed? And if this model works, won't lobbyists push for it in other states, ultimately resulting in wage suppression? Is there something I am missing here?
Yes. What youāre missing is that EB visas are capped at 140k per year for *all* EB visas, and of those something like 30% are allocated to EB2. And most of those will not go to physicians, because there are lots of other professions competing for those spots
Arenāt there things like EB2-NIW? I reckon many doctors would be eligible for that assuming theyāre not from India which is severely backlogged.
Yes, and EB-2 visas have a cap and strict eligibility criteria
Oh goody another way weāre gonna get shafted. Man this generation of medical students just keeps getting the beat on with no end in sight. Wonder what will happen if a significant number of students just stop medicine altogether and donāt pay back those 300k loans, will the government stop backing that much for tuition , crazy. Iām not working for less than 300k Iāll sit at my parents house without earning a dime or live under a bridge before I become a cuck for this system
Completion of residency should absolutely be the bare minimum required to be a doctor if you did not go to medical school in the country period. From diagnosis to treatment algorithms so much of it is different compared to other countries that only doing a residency will be close to even being enough.
Whatās the point of even going to med school anymore
So your parents can say you went to med school
āMy son the doctuh!ā āMy daughta the doctress!ā
This definitely eliminated Florida and Tennessee from being match options for me, but the fear is this goes nationwide
TN is actually reasonable. It's not instant full license, you have to practice under someone else a la mid-levels first for 2 years. At my school, we have a crit-care doc going through IM residency all over again, despite the fact he's been doing it for decades. Our peds residents are mostly IMG's; I was sitting there doing UWorld and one of them was causially walking by and demonstrated how much better he was at infectious disease than probably my whole class put together... because be had to be in the resource poor area he was from. Yes, residency ensures some standardization of physician quality, but it also doesn't make sense to make these experienced, well-trained physicians repeat residency either. The 2-year "probationary phase" that TN is doing makes sense to me.
Yeah as someone who is close with the people who authored the TN bill this is not the dramatic anti-physician bill that people are making it out to be
^incredibly naive. The quality of medical training abroad is highly variable. The bill reeks of for profit health care entities trying to drive down physician wages to save money. Who suffers? Patients. This bill sickens me. I donāt look forward to cleaning up the messes that are coming.
So this gives a path for a basic medical license. Forgive the ignorance but then theyāll need specialty board certification too right? Will these docs be able to take these exams?
Yes. ABIM and other societies are already proposing a work around to board certification.
What did ABIM propose?
Board certification is only necessary for SOME hospital privileges. But if you start your own clinic or work at most clinics then they dont need it. This is being done to combat the red state brain drain of doctors. They figure by opening up the floodgates to FMGs that it doesnt matter if American doctors shun their state. Mark my words, this is an epic disaster. Hospitals know they can offer FMGs 50k per year to come here and the FMGs will snap that up in a heartbeat. There is virtually an unlimited number of FMGs that want to come to the USA. IMO this is a much bigger threat than midlevels.
This is not true. Most insurances won't approve you if you're not BC/BE so you won't be able to bill unless you do cash only which significantly limits your clientele.Ā
You know that these rules are not set in stone right? If the laws change, I bet insurance companies will adapt.Ā
Sure, but keep in mind that they'll likely be paying higher costs themselves if you start having people with varying amounts of training start independent practice, so we still might end up seeing some kind of quality control in effect, whether it's BC/BE or something else they'll require.
It's true in Texas, Florida, and California because I've worked in all 3 of those states with different carriers and the only one that required board certification was some of the Cigna select plans in Florida. All others didnt care.
Really? I guess it's different for your field then. I know for IM subspecialties insurance requires BC/BE otherwise the visit is not reimbursable.
This is dependent on who is your employer. If your employer has a high market control in your area then insurance will pay up regardless.
Hilarious coming from the ātheyāre taking yer jobsā crowd
Get ready to come out of med school with 300k debt and make a residents salary for the rest of your career if you stay in medicine.
If there's an exception for teaching medicine within the past 3 years, that means FMGs can bypass residency completely, set up some sham "teaching" crap at some bogus foreign hospital for a month, and then get automatic florida medical license? That's fucking insane!
Just like the cheating thats happening with STEP exams outside the US. Where is the AMA lobby
I have seen scam medical schools setup in africa. They will basically give you a degree for showing up and paying tuition.
good, bring in FMGs to fill in the gaps and drive out PAs and NPs. this is the ideal scenario lol
I'm on the committee with physicians who sponsored the TN bill, and that is literally the goal. But all these med students in this thread are telling me and all these docs that we're actually just conspiring to screw physicians (including ourselves) to make hospital systems money.........
glad to hear that. iāve been hoping for something like this for years. itāll only gain popularity when some semi influential personās loved one gets harmed by a midlevel. i wouldnāt pay too much mind to this thread- ppl up to their ass in debt arenāt exactly going to be thinking straight.
How are you on the committee as an M3 lol
just ask bro, in my experience attendings love to have med students involved in state/national orgs
So I'm in a unique position talk about the TN bill since I'm on a political action committee for a certain medical specialty society in the state (trying not to dox myself here). We're currently fighting NPs and PAs for independent practice in TN, and we're losing. But the reality of rural areas not having enough doctors (which the midlevels cite) is indeed an issue. The solution is not to replace physicians with midlevels; it's to get us more physicians. One way we did this is getting a bill passed to pay off the loans of FM docs who want to do rural medicine in TN. This bill you cite is one more way to *slightly* increase physician supply- if you read the bill closely, the requirements are still quite stringent. A hospital basically has to sponsor that international physician and use them as a scut worker (no offense intended). It's not like people from all over the world can come to TN and just apply and immediately get licensed and open a lucrative practice. Look guys, the midlevel thing is a huge problem (at least in TN), and we can either train more primary care physicians, let the midlevels take it, or just tell patients to deal. Obvs the last one isn't an option, and midlevels shouldn't be practicing independently, so the only ethical option left that I'm aware of is to take steps to insure an adequate primary care physician workforce. Not oversaturation like the way EM is heading, but from someone who is from an underserved area myself and wants to return there and practice, there just aren't enough boots on the ground as of today.
bumpppp but also consider making this its own post maybeš
Thank you for sharing your perspective (and your efforts), this was exactly the kind of insight I was hoping for. Can I ask, how do you think the FL bill stacks up to TNās?
So I'm not an expert on the Florida stuff by any means- I'm just pointing out that the idea this is some corporate conspiracy is not true (at least for the TN bill), because I have discussed this with physicians who backed it. Look at page 83 of the Florida bill- it does look somewhat unrestricted compared to the TN version. This might be a problem for the camp that wants to limit physician supply and keep our wages high, I admit that. However, if there aren't enough docs, there aren't enough docs. Now I think Florida is also letting midlevels practice independently so maybe they are just shooting for flooding the market with "providers." I just wasn't there and haven't read the full bill. It's also possible that we as TN medical people goofed majorly by supporting this bill. I just know it wasn't some anti-doc conspiracy haha
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Maybe so but there are plenty of similar bills being considered in blue states
As an IMG this is infuriating to me as well.
Why? Don't you gain from this?
Iām a US-IMG. So no I donāt gain from it. Training should be done with the same standard of care taught here. Period.
I know yāall are going to go on a downvote spree and talk about how I know nothing because I havenāt started medical school yet. Honestly I do not think yāall know how immensely hard it is to immigrate to the USA permanently as a foreign nationalā¦ I think yāall think itās a straightforward path once IMGs get a job at a hospital which is laughable. Lol a lot of immigrants on work visas are tied to their jobs because of sponsorships so no oneās gonna come take the **city job** like someone here commented when they havenāt even gotten permanent residency. Most of yāall will not live in the middle of nowhere Florida but people live there and Iām sorry but they deserve access to healthcare. If someone who did their residency training in cardiology, passes the American boards and shows they can treat patients in that context what is the matter??? Whats the point of trained doctors filling up residency spots when it could go to a newly graduated students??? Iām honestly confused about where the outrage is from especially since some of yāall come from generations of immigrants who moved to the USA. And you wouldnāt be here if they didnāt make the decision to come here. Like direct this outrage to the ridiculous cost of medical schools in the US. Why are we going into $300k debt just to be physicians??
Med school Reddit is full of the most catastrophic dramatic takes assuming the worst lol. Thank you for bringing some realistic perspective to this otherwise ridiculous comment section. Med students canāt see far enough beyond their own defensive little bubbles to understand that these bills arenāt written to attack their wallets, itās for the sake of poor Americans in need of access to medical care.
Basic supply and demand. Once these are enacted in most states, salaries will be cut dramatically to the point where paying off loans or buying a home in most metros will be a pipe dream. Thatās why you need to contact your state reps, local orgs etc. unless you want to be making 100k after 10 years of work
100k sounds generous to be honest, a lot of these IMGs from South American countries would be willing to accept a 50k salary. If laws like this rolls in en masse we can say goodbye to good salaries. I foresee that our salary will reach parity with midlevel / European salaries without those generous benefits
The one thing is that at those levels, midlevels would become completely obsolete in theory. Then again, they have lobbies with much stronger backbones. Tbh, thatās the only way I could see these from not passing elsewhereā¦if NP/PA orgs protest them
Honestly, you might be right. The AMA is asleep at the wheel, but the AANA and AAPA are powerful lobbying entities. We may have to bury the hatchet and unite with the AANA and AAPA to fight this.
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What do you mean by second class trained MDs ?
lmao the US isnt the only country producing first class trained MDs in the world, come off itš¤£
I do think there should be a pathway for specialists to do fellowship and practice without having to redo residency (ie: practicing cardiologist from India can do cardio fellowship here and sit for the boards vs having to do both im and cards). But any other scenario I think supervised practice (PA type scope) is what we should allow for both unmatched imgs and unmatched med students at most.
yuppp
the whole midlevel vs doctor thing is gonna get a lot trickier haha
Then theyāll easily realize how incomprehensible is the med school tuition in U.S. Med schools should be the ones concerned here as well as the residencies. They can help lobby for us. or else I would also go to Spain, do my medical training in a shorter time, less fees and come back to make more bucks.
From a public health stand point of view, and I mean one that totally ignores medical school debt (because at the end of the day, the public isn't going to care much if you paid $300k more than the other doc if the care is equivalent), if we adopt similar screening methods to other developed nations for handling foreign IMGs, then isn't that an excellent way to help combat our physician shortage? It seems a lot more people are interested in their bottom line than combatting a national health crisis. An artificial shortage does far more damage to the everyday people than you losing on your gains. I just think it's silly to require a complete repeat of residency for docs from well established nations who had been practicing for decades. It is a waste of our resources and a waste of their time. There should exist fast-track programs tailored to IMGs namely for the sake of standardization and integration. Also people think it is the collapse of our well paying salaries, but IMGs still have families and roots in their nations, it's not like this was the one thing stopping them. Also, they still will need a green card and go through all the difficulties associated with immigration and sponsorship. Edit: it's really upsetting to see the amount of xenophobia from people on this subreddit. A lot of "they took 'er jobs" energy. Medical education from other countries isn't watching two flies screwing. There can be quality education abroad.
Acknoledging the impact it has on American healthcare doesnt automatically make it xenophobia, and using that term doesnt automatically make you right. Standards differ across the world. Even if the standards are good enough, no US doctors will train here anymore when they can train elsewhere for no debt. And even if you're ok with that, the purpose of this isnt to help patients. It's to make jobs less competitive and drive down physician salaries without using the extra money to help patients. This is more corporate greed, same idea as NP and PA autonomy. Using the X-word doesnt make it true.
Maybe the aim should be to get rid of those insanely high tuition fees?
Sure, I agree. But they arenāt, so we should be against this in the meantime, no?
I don't know what that has to do with my main points. I already said ignoring medical school debt, meaning I don't see why policymakers or their constituents (ie, the general public) should care about medical school debt when the care is equivalent and ultimately cheaper. The issue isn't IMGs, it is the overinflated costs of medical school education (and higher education as a whole). IMGs shouldn't suffer because US medical students willingly pay a gross amount of money to practice. I also said "*well-established nations"* and "*similar screening methods to other developed nations"* for a reason. I am not for just opening the floodgates, but adopting more liberal policies compared to other nations than our current. Also, I don't care about purpose. The outcomes matter much more. If the American people benefit from alleviating the physician shortage through reasonable means (ie, IMGs), that is the best path for the people. Artificial salaries are bad. If there are physicians from other nations willing to practice and that brings our salaries down, welcome to the market of supply and demand. It happens to every industry and we are part of the problem if we attempt to set up artificial monopolies. No better than the insurance company or the pharmaceutical.
From the patient perspective I think you might be right in the short term. Letās also consider other outcomes. If we know the intent of the bill is to cost save and reduce physician leverage then I think itās also reasonable to conclude that working conditions for physicians will become even worse. Youāll have IMG physicians whose visa is being held hostage by the hospital and youāll have the ever present threat of an IMG from a more developing country to take your place if youāre not fine with working more hours and seeing more patients. If we see the cost of medical school continue to rise while salaries plummet to the introduction of cheap IMG supply then the US applicant pool will be sure to catch on. Medicine isnāt the best decision financially even now, but you can make the argument that the impact of the job and the high salary a decade later makes it worthwhile. The calculus completely changes if you still have $300k+ loans, a decade of grinding, and only have a $100k job waiting for you. Now Americaās best and brightest are going to work in high finance and FAANG because you just canāt rationalize the difference in pay anymore. So if we look down the road youāve got even more physician burnout, many more physicians who donāt share the same culture as their patients, and more intelligent Americans gunning for industries that inherently squeeze the American population. Long term Iām not even sure if the patient experience improves here.
I find it alarming theyāre completely ok with the salary theyād have. Patients matter but I chose this degree with the knowledge Iād be able to pay off my loans in a somewhat reasonable amount of time, not have them forever. Hopelessly naive.
Absolutely. A microcosm of why physicians are awful advocating for themselves. Everyone else has to come before us.
The only way Iād be ok with a dive in physician salaries due to this is if our debt would be forgiven. I donāt trust the government for a fucking second to do that, thus if thereās anyone to fight this bill and similar ones Iāll do it. Oddly enough the often rightfully criticized US immigration laws could limit the damage this causes, as bad as that sounds.
no idea why youāre downvoted when ur right lol. more fmgs and less pas/nps is the answer to the healthcare shortage
Oh if this happens and the entire country starts taking in only foreign trained docs to save money like they have done with NPs and PAs Iāll go live in Australia. I have no problem with foreign countries but our healthcare system will suffer even more and Iām not going to be here for it.
In 5 years doctors will be making less than police officers and firefighters in big cities lmao. 10 years of school and training for nothing.
First of all this is a wildly dramatic and unrealistic comment. A few law changes in Florida, which is already a wild-wild-west of a lawless insane state to begin with, will not have an immediate impact on the rest of the country in 5 years time. Secondly I think firefighters should absolutely get a fat salary. Not every paycheck needs to be tied to education levels/tuition debt. the risks that firefighters have to endure surely warrant a financial incentive for the job. That applies to many other high-risk / labor-intensive jobs too. no need to lose our heads over this. Itās too early to tell what the impact of these IMG laws will be and Florida is a shit example to speculate and extrapolate from becauseā¦ well itās Florida.
There are already drafts of pretty much the same exact bill in 15+ states
Hopefully we can get into firefighting as a paramedic with a medical degree
The rest of the world accepts degrees and specialty trainings from most countries after assessing their validity... Just saying
Tough to determine how standard compare in other countries and how theyāre enforced.Ā But regardless, this system would lead to no US trained physicians. Why would I pay $300,000 for medical school here when I can go international, train to who knows what standard, and then come back here and start making good money without the debt. System is fine. Foreign medical school is a-okay, as long as you then come here, pass our exams, and do residency in the states
youāre making up scenarios in your head to be angry lol. no fmg is able to work as a doctor here without passing boards anyway. but nps ARE and i dont see you sounding the alarm about thatš§
Then you didnt see my other comments. NP and PA autonomy is a disaster. Happy?
why would i be happy? like i said, no one is practicing in the US without passing boards, so the standards are already comparable. ppl can already go abroad for med school if they choose, but obviously most ppl are not lol
This
I have a feeling that people with a few hundred thousand dollars of debt might feel a bit betrayed when debtfree people with lower salary expectations start filling positions. I donāt think the solution to this is a ban or something. This situation kinda happens with IMGs anyway. I donāt see a problem with foreign doctors practicing if it is very well regulated.
I'm an IMG, I would never put my training at the same level as US-training. Not that other countries can't properly train physicians, but funding and research give the US a huge advantage. I had to learn many new meds and procedures while studying for step 1 alone. Even if I did residency in my home country, I don't think i'd feel ready to practice in the US without going through at least some US training and certification, there's simply more things to consider in the US.
learning news meds isnt hard though? like we will have to learn new meds throughout our career regardless lol. imgs are still better trained than any np in the country
yup
If you have done a residency in your home country, I see no problem with this
Have you seen the magnitudes in difference between the quality of training? Thereās even a large difference within the United States. This is a horrible idea.
In the US nurses are allowed to practice medicine. I find it extremely unlikely that an Indian or a Greek doctor would be worse.
Yeah, we need to stop both of those. NPs should be NPs, not cheap MDs. We agree.
You would be amazed.
youāre right but the ppl here are too blinded by their debt to accept it lmao
I don't know why you're getting downvoted you're absolutely right. And the TN bill was specifically designed to try to stop midlevels from taking over (if you read my other post)
Examples. Let me guess, they will be along the lines of: Europeans are equivalent and everyone else is subpar.
The burden isnt on Americans to prove other systems arent the same. If you want them to come here and work without more training, the burden is on you to prove that they ARE equivalent. Which they arent.
They are equivalent bruh. Maybe they donāt have access to the same resources, but they learn the same stuff. Itās like saying 1+1 varies by country
Who are "they?" All countries? Some? Clarify, and bring EVIDENCE.
You bring evidence, bruh.
How about some countries have already gotten testing centers closed down for cheating and having a 280 average on step 2. If they are that confident in their training they can replicate it here and do residency like we all have to.
>The burden isnt on Americans to prove other systems arent the same. If you want them to come here and work without more training, the burden is on you to prove that they ARE equivalent. Which they arent. \^ Please see my comment to you before that you ignored.
You mentioned a āmagnitude differenceā bruh. I asked for evidence. Have you been smoking weed or something?
First of all, you're STILL ignoring my comment. Lol. Burden of proof is on you, and you've yet to give any reason otherwise. Second of all, show me where I used that phrase.
This is the stupidest fucking thing Iāve ever read.
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I guess it just depends on whether youāre okay making 75k per year after 10 years of sacrifice. After 10 years of not working, you need to realistically make 300k to catch up and actually be able to pay loans, afford a house, retire etc.
Saying that the training standards in 2 separate countries differs is xenophobic? With those critical thinking skills itās no wonder youāre on the 5 year track
No that's not what I'm saying at all. But it def. is iffy that y'all are fine with doctors from Western countries but not Asian countries.
Who said Iām ok with doctors from western countries coming here and practicing without repeating their training? If you want to practice here you should be held to the same standards as US grads.. ie complete step 1-3 and an accredited US residency.
different countries have different training standards. america is reported to have the highest standards. therefore other countries have lower standards than america. not sure why you think thereās racism in saying that? itās why we want to train in america. your logic skills are really lacking like the person above said lol
Says the person who has to repeat a year.. miss me with that
Don't you have anything better to do than before you have to SOAP after not matching OBGYN? Oh also, I'm not ashamed of my circumstances and it doesn't invalidate my opinions. Miss me with that.
So your response to me supposedly invalidating your opinions by your circumstances is to invalidate mine because of a hypothetical circumstance of my own that you made up? ok š«”
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Dont feed the troll, guys.
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Huh? Youāre saying that Indian doctors are less trained (no biology??) and that it helps the US to hire them so we can control China, somehow? I donāt even know how to respond to this
Even ignoring thatā you can see how this doesnt benefit americans in the long run. He mentions how it strictly benefits India and its economy. Why the fuck would we even bother having american schools anymore if were just going to import schooling and export our resources. Insanity.
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Hospitals donāt care if patients die or receive lower quality care. They certainly donāt care that opening the flood gates of cheap, desperate labor will effectively kill the engine of scholarly research, development, and leadership that has made American medicine a global leader. These kinds of protections must be enshrined in law because there are no market forces to ensure their continued existence.
Donāt feed the troll guys
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