The worst has not begun and today, I found it hard to go on.

[+ g56whiz]

Not notifying the person who makes the decision is a problem that frequently happens if the document is not known. One of the biggest mistakes is people put the document with their will in a safety deposit box. The person in an emergency ends up in the hospital and no one knows about the directive until the safety deposit box is opened after they are dead.?

 

The moral is that someone who is actively involved in your life should know about the directive and where the document is located with access to it.

Clergy are good for this. If you’ve got a religious connection make sure your rabbi priest or imam has access to the docs. And if that clergyman moves on, make sure you clue in the successor.

[+ Charlie]

The case I referenced was unexpected. My friend was traveling in Europe when he became ill, and the State Dept notified his family, who medevacked him back home to a hospital. He was already unconscious by then, and died a day later, before I knew about any of it. I had my copy of the POA, but I don't know whether his family knew of its existence.

[+ sniper]

Well, at least in your friend's case, it was over fairly quickly. I tend to think of the POA as "don't keep me on a machine for weeks or longer" and wouldn't be as concerned about a day or two delay.

[+ purplekow]

After 4 straight months of the general medical service for the uninsured and underinsured, I am on administrative duty for two weeks. I admitted patients every other day and night and I estimate that of the more than 200 people I admitted and of whom I took primary care, about 60 were CoVid patients and about 12 of them went to the ICU. Two came back, which is about average for this disease. Up until this week, two had come back, 5 had passed and 5 more remained in the ICU. Those numbers do not tell anything of the lives of those people. The numbers about coronavirus in the media tell even less about them because as the deaths pile up, the faces get lost, the stories get lost, the humanity gets lost. Todays media star, the sad 8 year old who lost both her parents, fades into the emotional support dog no longer with a target for its emotional support, turns into the police officer who contracted Covid while delivering a baby in the back of a squad car. The stories are told heartlessly heartfelt with wholehearted dispassion hitting a discordant note on the heartstrings. None of those stories tell the look of fear in the eye of the breathless, the tear in the eye of the pained, the tremble in the voice as the realization of the reality is spoken.

So, I was not looking forward to this administrative respite, but I really am now. The last week has seen nothing but heartache and death for my patients and there does not seem to be an end in sight. The last of the five patients I had in the ICU took an unexpected turn for the worse just as I was posting last night that he was doing somewhat better. Euphemistically called the man in the black bikini, he had an unexpected turn at midnight and he did not survive the night. I did not know these five people who died. In most of the cases I met them on the night they were admitted to the hospital and within a day or two, they were off to the ICU. Still, in each case, I felt a part of me was lost in their passing. Maybe that is always true and I am just more aware of it in these intense times. In some cases, I was the last touch they felt, the last voice they heard, the witness to the last moments of their life. And at that time, that seminal moment, it was a stranger trying desperately to get them back from the edge.

So I ask you to take a moment, perhaps quietly contemplate how the lives of the Mexican mother whose last words were "Te amor mi amor", the man in the black bikini, the senior man with Parkinson's, the stocky wide shouldered landscaper gardener, were abruptly taken. Give thanks for the 37 year old man who continues to move forward and whose laugh brought hope to me and, as it would happen, also brought hope to the intensive care doctor with whom I was discussing his care and who told me: I told him a Joke and when he laughed, I felt like maybe we would all be okay". This without knowing of my similar encounter.

Life, I guess you need to be in on the joke.

[+ tassojunior]

Many in Florida may have chosen to die at home. With painkillers how I would prefer. (I have a lot of streaming episodes to finish up now.)

 

https://www.nytimes.com/2020/05/08/us/coronavirus-florida-medical-examiner-records.html?action=click&module=RelatedLinks&pgtype=Article

[+ nycman]

The stories are told heartlessly heartfelt with wholehearted dispassion hitting a discordant note on the heartstrings.

That’s a whole lotta heart.

 

Seriously though, it’s a beautifully poetic sentence.

Life, I guess you need to be in on the joke.

Life's a laugh and death's a joke, it's true,

You'll see it's all a show,

Keep 'em laughing as you go.

Just remember that the last laugh is on you!

[+ sam.fitzpatrick]

@purplekow - You've been sharing your heartfelt journey the last few weeks, and I have appreciated it. Today one of my childhood and college friends, an ER physician in Indianapolis, posted this article on Facebook. You and Dr. Profeta are the only folks I know working emergency medicine, so I thought I would share perspectives.

 

https://www.linkedin.com/pulse/how-america-saved-us-from-covid-19-louis-m-profeta-md/?fbclid=IwAR1Q_U7DSnkdF07PGh4BHmlXqA2JoN2PEHBw_dCJUphgrzObKs7PRz3sw_E

[+ honcho]

So I ask you to take a moment, perhaps quietly contemplate how the lives of the Mexican mother whose last words were "Te amor mi amor", the man in the black bikini, the senior man with Parkinson's, the stocky wide shouldered landscaper gardener, were abruptly taken. Give thanks for the 37 year old man who continues to move forward ....

 

The least I can do; thank you again for your bravery and compassion and giving all of us a chance to see through your eyes.

[+ purplekow]

@purplekow - You've been sharing your heartfelt journey the last few weeks, and I have appreciated it. Today one of my childhood and college friends, an ER physician in Indianapolis, posted this article on Facebook. You and Dr. Profeta are the only folks I know working emergency medicine, so I thought I would share perspectives.

 

https://www.linkedin.com/pulse/how-america-saved-us-from-covid-19-louis-m-profeta-md/?fbclid=IwAR1Q_U7DSnkdF07PGh4BHmlXqA2JoN2PEHBw_dCJUphgrzObKs7PRz3sw_E

I agree with most of what he wrote and I think you will find a lot of similarities in our experiences. The one difference however is his belief that herd immunity may win the day. He has suggested he feels comfortable with allowing young people to get what is probably a mild disease for them but just keep them away from others. That shows great faith in a group of people some of whom have shown disregard for the situations others face. They flocked to the beaches of Florida during spring break and brought the disease back to places like Wisconsin and Indiana. They crowded to buy Air Jordans in Georgia. So perhaps he is more of an optimist than I am or has more faith In the ability of young people to take this seriously. I hope he is right because it seems the country is going in his direction. I expect a surge again if not immediately, certainly in the fall. I can hope that the American people do well and make us proud, because we are in need. However, if it is a half hearted attempt, it will turn out to be pride before the fall. Edited May 10, 2020 by purplekow

[marylander1940]

I a free with most of what he wrote and I think you will find a lot of similarities in our experiences. The one difference however is his belief that herd immunity may win the day. He has suggested he feels comfortable with allowing young people to get what is probably a mild disease for them but just keep them away from others. That shows great faith in a group of people some of whom have shown disregard for the situations others face. The flocked to the beaches of Florida and brought the disease back to places like Wisconsin and Indiana. They crowded to buy Air Jordans in Georgia. So perhaps he is more of an optimist than I am or has more faith In the ability of young people to take this seriously. I hope he is right because it seems the country is going in his direction. I expect a surge again if not immediately, certainly in the fall. I can hope that the American people do well and make us proud, because we are in need. However, if it is half hearted attempt it turn out tol be pride before the fall.

 

Yes but unlike other countries we have a higher number of folks with preexisting conditions that might make the virus deadly like obesity, past/present drug use, diabetes, sedentary lifestyle, etc.

 

I agree with you that even Fauci is talking about the country moving that way.

[+ purplekow]

Yes but unlike other countries we have a higher number of folks with preexisting conditions that might make the virus deadly like obesity, past/present drug use, diabetes, sedentary lifestyle, etc.

 

I agree with you that even Fauci is talking about the country moving that way.

You elect a business man president, you get someone who puts business, his own mostly but business in general as well, first. Business interests and medical interests do not have to be opposite poles but that is the narrative that is now out there. I for one, am not hopeful, but I cannot predict the future and I can hope that I am wrong.

[marylander1940]

You elect a business man president, you get someone who puts business, his own mostly but business in general as well, first. Business interests and medical interests do not have to be opposite poles but that is the narrative that is now out there. I for one, am not hopeful, but I cannot predict the future and I can hope that I am wrong.

 

I don't want to bring politics into here but you're right!

[samhexum]

Elmhurst Hospital workers to receive three-night complimentary vacation post-pandemic

 

More than 4,000 employees at NYC Health + Hospitals/Elmhurst will each receive a free, three-night vacation from American Airlines and Hyatt Hotels once the COVID-19 pandemic subsides, the airline and hotel announced last week.

 

The partnership is a showing of thanks to the doctors, physician assistants, nurses and the facilities and food employees who staffed one of the hospitals hardest hit by COVID-19. The vacation destinations will be around the U.S. and Caribbean.

 

“Every worker at Elmhurst has seen and experienced challenges many of us cannot imagine. They’ve given so much of themselves and chose to serve their community with care, compassion and equity for every patient,” said Robert Isom, president of American Airlines. “When they are able to take a break, we hope the time away will help them and their loved ones recharge and that they feel our deepest appreciation for their sacrifice and heroism.”

 

According to American, the donation is the largest total flight count ever given to an organization by the airline.

 

With the purpose of unwinding and spending time with their families after months of tireless work in the hospital, Elmhurst staff will be provided wellbeing experiences, meals and beverages and outdoor activities in Hyatt hotels.

 

“We are extremely grateful to Hyatt and American Airlines for this generous gift to our health care workers, who have been at the epicenter of the COVID-19 pandemic,” said Israel Rocha, the vice president of NYC Health + Hospitals and CEO of NYC Health + Hospitals/Elmhurst. “Our doctors, nurses and other staff on the front lines of this unprecedented health care crisis really appreciate the outpouring of support from two of America’s major companies, and we look forward to taking advantage of these well-earned vacations in the near future.”

 

JetBlue is giving away 100,000 free round-trip flights to healthcare workers

 

JetBlue, an American low-cost airline, is helping an impressive amount of healthcare workers take some well-deserved time off.

 

The airline is giving away 100,000 pairs of round-trip flights to healthcare workers across the United States.

 

“They’ve earned our love, our gratitude, and some serious R&R,” the airline said. Nominations are currently open on the JetBlue website. While you can’t nominate yourself, the contest’s rules say you can nominate as many other people as you want.

 

The 100,000 winners will receive two flights to anywhere JetBlue flies. All winners have to do is pay flight taxes and fees.

 

The contest states that 90,000 winners will be selected from random draws and 10,000 pairs of flights will be donated to New York City hospital healthcare workers, the city where the airline is headquartered.

 

To be eligible, a person must be a healthcare worker, first responder, or public health worker who is “actively serving on the frontlines of the COVID-19 response.”

 

Contest entries are asked to be submitted before May 16 and the winners will be drawn on May 18.

 

On April 28, JetBlue became one of the first American airlines to require all passengers to wear face masks during travel.

[+ purplekow]

Well after four months of doing direct patient care in a position that is supposed to be mostly educational, I was scheduled for two weeks of administration for preparatory work for the upcoming academic year. Major problem is that we usually have more than a dozen incoming residents and most of them have J1 visas. Less than half of the residents are here in the US already and the rest may not make it on time. The government red tape here and in the countries of origin is keeping the certainty of a full staff at a level of "extremely doubtful." That means there may not be residents to care for the patients and though the teaching physicians such as myself have been doing much of the direct patient care, the residents have been the ones staffing the hospital at night. There is no way the hospital can be staffed appropriately with physicians should there be more than a few missing residents. So right now I am working on filling in a schedule that should have more than forty people with only 28.

 

In addition, at the onset of the pandemic here, several of the part time physicians decided that it was a good time to retire. So we are down about three physicians who were supervising residents in clinic and doing educational rounds. This is a teaching program and although the residents, as part of their training, perform services for the hospital, those services must be educational and must not exceed the purely academic portion of their training. Those regulations from the supervising certification programs are not going to change. So the squeeze is on. We can now add physicians to the list of things the US cannot supply for itself which already includes personal protective equipment, Covid testing kits, ingredients for vaccines and medications.

 

On a happier note, though I have not been caring for him through this week, I have dropped by to see the 37 year old who has been in the hospital for more than 5 weeks and who spent about 4 of those weeks on a ventilator. He is doing so much better. His memory is clearer. Today he was eating a regular diet. His breathing is doing well with minimal oxygen. His heart rate still jumps to unacceptable levels at times, but he is getting medicated for that. He started physical therapy and he has been able to walk around the room.

 

Yesterday I asked him if there was anything he wanted from the outside world and he said no. Pizza? No. Hamburgers? No. Chocolate? No. Nylon stockings? He looked at me very confused. I explained that in WWII that nylon stockings were a frequently asked for item. He still looked confused and I told it was a bad joke and let it go at that. Donuts?.....Dunkin Donuts? he asked with widened eyes. Sure. Dunkin Donuts. Yes...yes, I would like that. What kind? Orange. Hmmm, I though, orange donuts. I was thinking that perhaps they had donuts with orange sprinkles or some pumpkin colored donuts. I told him I would try but I was not sure if they had orange donuts. Sure there is never a cop around when you need one, so I went to a secondary source of all things donuts, the nursing desk. Sure enough, the consensus was that orange donuts were in fact, glazed donuts that have an orangish glow off the multiple layers of sugar.

 

So this morning, on the way in, I stopped at the donut shop formerly known as Dunkin Donuts and which is now just Dunkin and got a dozen donuts for the nursing staff and another two glazed donuts in a separate box for the 37 year old. When I got to the hospital, I went right up to the floor and gave the nurses the box and then gowned up, masked up and went in with the donuts. He was surprised to see me as it was much earlier than I usually arrived. I gave with the D and D box. He opened it and smiled. He then took out one of the two donuts and he offered it to me. Off course, with gloves and mask and face shield, I was not in a position to accept it but I thanked him for the offer. The exchange made me wistful in that a simple act of sharing a bit of food with someone had been coopted by this disease. In any case, he took a bite. He slowly chewed and then swallowed and he put the donut back in the box.

"Thanks for the donuts. I will have more in just a bit".

 

I waved to him as I walked out. After I had shed my PPE, I looked back through the glass of the door and saw him savoring another bite. I wondered what he was thinking, sitting there, eating a donut as if his whole life had not been ripped apart and only partially put back together. My guess is he was thinking: "I could sure use a cup of coffee right now."

Edited May 14, 2020 by purplekow

[+ Just966]

Well after four months of doing direct patient care in a position that is supposed to be mostly educational, I was scheduled for two weeks of administration for preparatory work for the upcoming academic year. Major problem is that we usually have more than a dozen incoming residents and most of them have J1 visas. Less than half of the residents are here in the US already and the rest may not make it on time. The government red tape here and in the countries of origin is keeping the certainty of a full staff at a level of "extremely doubtful." That means there may not be residents to care for the patients and though the teaching physicians such as myself have been doing much of the direct patient care, the residents have been the ones staffing the hospital at night. There is no way the hospital can be staffed appropriately with physicians should there be more than a few missing residents. So right now I am working on filling in a schedule that should have more than forty people with only 28.

 

In addition, at the onset of the pandemic here, several of the part time physicians decided that it was a good time to retire. So we are down about three physicians who were supervising residents in clinic and doing educational rounds. This is a teaching program and although the residents, as part of their training, perform services for the hospital, those services must be educational and must not exceed the purely academic portion of their training. Those regulations from the supervising certification programs are not going to change. So the squeeze is on. We can now add physicians to the list of things the US cannot supply for itself which already includes personal protective equipment, Covid testing kits, ingredients for vaccines and medications.

 

On a happier note, though I have not been caring for him through this week, I have dropped by to see the 37 year old who has been in the hospital for more than 5 weeks and who spent about 4 of those weeks on a ventilator. He is doing so much better. His memory is clearer. Today he was eating a regular diet. His breathing is doing well with minimal oxygen. His heart rate still jumps to unacceptable levels at times, but he is getting medicated for that. He started physical therapy and he has been able to walk around the room.

 

Yesterday I asked him if there was anything he wanted from the outside world and he said no. Pizza? No. Hamburgers? No. Chocolate? No. Nylon stockings? He looked at me very confused. I explained that in WWII that nylon stockings were a frequently asked for item. He still looked confused and I told it was a bad joke and let it go at that. Donuts?.....Dunkin Donuts? he asked with widened eyes. Sure. Dunkin Donuts. Yes...yes, I would like that. What kind? Orange. Hmmm, I though, orange donuts. I was thinking that perhaps they had donuts with orange sprinkles or some pumpkin colored donuts. I told him I would try but I was not sure if they had orange donuts. Sure there is never a cop around when you need one, so I went to a secondary source of all things donuts, the nursing desk. Sure enough, the consensus was that orange donuts were in fact, glazed donuts that have an orangish glow off the multiple layers of sugar.

 

So this morning, on the way in, I stopped at the donut shop formerly known as Dunkin Donuts and which is now just Dunkin and got a dozen donuts for the nursing staff and another two glazed donuts in a separate box for the 37 year old. When I got to the hospital, I went right up to the floor and gave the nurses the box and then gowned up, masked up and went in with the donuts. He was surprised to see me as it was much earlier than I usually arrived. I gave with the D and D box. He opened it and smiled. He then took out one of the two donuts and he offered it to me. Off course, with gloves and mask and face shield, I was not in a position to accept it but I thanked him for the offer. The exchange made me wistful in that a simple act of sharing a bit of food with someone had been coopted by this disease. In any case, he took a bite. He slowly chewed and then swallowed and he put the donut back in the box.

"Thanks for the donuts. I will have more in just a bit".

 

I waved to him as I walked out. After I had shed my PPE, I looked back through the glass of the door and saw him savoring another bite. I wondered what he was thinking, sitting there, eating a donut as if his whole life had not been ripped apart and only partially put back together. My guess is he was thinking: "I could sure use a cup of coffee right now."

 

 

And that will definitely be one thing he remembers about his stay, its what we see as the little things that touch people so mch in a situation like that! very nice @purplekow

[+ g56whiz]

Well after four months of doing direct patient care in a position that is supposed to be mostly educational, I was scheduled for two weeks of administration for preparatory work for the upcoming academic year. Major problem is that we usually have more than a dozen incoming residents and most of them have J1 visas. Less than half of the residents are here in the US already and the rest may not make it on time. The government red tape here and in the countries of origin is keeping the certainty of a full staff at a level of "extremely doubtful." That means there may not be residents to care for the patients and though the teaching physicians such as myself have been doing much of the direct patient care, the residents have been the ones staffing the hospital at night. There is no way the hospital can be staffed appropriately with physicians should there be more than a few missing residents. So right now I am working on filling in a schedule that should have more than forty people with only 28.

 

In addition, at the onset of the pandemic here, several of the part time physicians decided that it was a good time to retire. So we are down about three physicians who were supervising residents in clinic and doing educational rounds. This is a teaching program and although the residents, as part of their training, perform services for the hospital, those services must be educational and must not exceed the purely academic portion of their training. Those regulations from the supervising certification programs are not going to change. So the squeeze is on. We can now add physicians to the list of things the US cannot supply for itself which already includes personal protective equipment, Covid testing kits, ingredients for vaccines and medications.

 

On a happier note, though I have not been caring for him through this week, I have dropped by to see the 37 year old who has been in the hospital for more than 5 weeks and who spent about 4 of those weeks on a ventilator. He is doing so much better. His memory is clearer. Today he was eating a regular diet. His breathing is doing well with minimal oxygen. His heart rate still jumps to unacceptable levels at times, but he is getting medicated for that. He started physical therapy and he has been able to walk around the room.

 

Yesterday I asked him if there was anything he wanted from the outside world and he said no. Pizza? No. Hamburgers? No. Chocolate? No. Nylon stockings? He looked at me very confused. I explained that in WWII that nylon stockings were a frequently asked for item. He still looked confused and I told it was a bad joke and let it go at that. Donuts?.....Dunkin Donuts? he asked with widened eyes. Sure. Dunkin Donuts. Yes...yes, I would like that. What kind? Orange. Hmmm, I though, orange donuts. I was thinking that perhaps they had donuts with orange sprinkles or some pumpkin colored donuts. I told him I would try but I was not sure if they had orange donuts. Sure there is never a cop around when you need one, so I went to a secondary source of all things donuts, the nursing desk. Sure enough, the consensus was that orange donuts were in fact, glazed donuts that have an orangish glow off the multiple layers of sugar.

 

So this morning, on the way in, I stopped at the donut shop formerly known as Dunkin Donuts and which is now just Dunkin and got a dozen donuts for the nursing staff and another two glazed donuts in a separate box for the 37 year old. When I got to the hospital, I went right up to the floor and gave the nurses the box and then gowned up, masked up and went in with the donuts. He was surprised to see me as it was much earlier than I usually arrived. I gave with the D and D box. He opened it and smiled. He then took out one of the two donuts and he offered it to me. Off course, with gloves and mask and face shield, I was not in a position to accept it but I thanked him for the offer. The exchange made me wistful in that a simple act of sharing a bit of food with someone had been coopted by this disease. In any case, he took a bite. He slowly chewed and then swallowed and he put the donut back in the box.

"Thanks for the donuts. I will have more in just a bit".

 

I waved to him as I walked out. After I had shed my PPE, I looked back through the glass of the door and saw him savoring another bite. I wondered what he was thinking, sitting there, eating a donut as if his whole life had not been ripped apart and only partially put back together. My guess is he was thinking: "I could sure use a cup of coffee right now."

Not all Eucharists involve wine and bread and are performed by priests in robes @purplekow.

[+ Charlie]

"We can now add physicians to the list of things the US cannot supply for itself..." Hasn't that been true for a long time?

[gallahadesquire]

"We can now add physicians to the list of things the US cannot supply for itself..." Hasn't that been true for a long time?

I was in my then-young Medical School’s first full class of 100, in 1979. They increased the number of students to 115 (or maybe 125) ... in 2009.

It reminds me of the Dan (Damn) Ryan expresswa in Chicago. Despite being four lanes in each direction, they KNEW when they built it, that it was completely inadequate.

[+ purplekow]

"We can now add physicians to the list of things the US cannot supply for itself..." Hasn't that been true for a long time?

Yes but now we cannot even import them.

[+ honcho]

"We can now add physicians to the list of things the US cannot supply for itself..." Hasn't that been true for a long time?

Yes but now we cannot even import them.

 

On facebook, this would be met with an angry-face-icon. I do not doubt the truth of it, and I'm not shooting the esteemed messenger,

but it does make me angry at the current occupant of the white house, who I believe has willfully exacerbated the situation for perceived political gain.

 

I waved to him as I walked out. After I had shed my PPE, I looked back through the glass of the door and saw him savoring another bite. I wondered what he was thinking, sitting there, eating a donut as if his whole life had not been ripped apart and only partially put back together. My guess is he was thinking: "I could sure use a cup of coffee right now."

 

I wish I could both applaud and laugh at this. *Textbook* example of black humor. Thank you again, Purplekow.

[+ purplekow]

On facebook, this would be met with an angry-face-icon. I do not doubt the truth of it, and I'm not shooting the esteemed messenger,

but it does make me angry at the current occupant of the white house, who I believe has willfully exacerbated the situation for perceived political gain.

 

 

 

I wish I could both applaud and laugh at this. *Textbook* example of black humor. Thank you again, Purplekow.

 

I agree that immigration regulations have been made more difficult by the pandemic and the closure of government offices in other countries as well as the immigration difficulty here. However, foreign born foreign graduates have been a mainstay of medical care in the US for decades. Medical education has done little to change this.

 

Immigration rules have only become more stringent.

As an example, in 2014 there were 17000 or so United States Medical School graduates in first year positions in training in the US. At the same time there were about 6600 International medical graduates in the same role. The vast majority of those international graduates were foreign born and trained and a small number were Americans who attended school internationally.

Now in 2019 there are about 18000 US graduates for just about the same number of positions meaning that there has been little movement away from international graduates in the last five years. Going back further, the numbers would probably be about the same.

So it is clear than the US has been importing physicians and in relatively large numbers. I have worked in medical education for 40 years and ever has it been thus. These FMGS are usually well qualified and hardworking individuals. They need to pass qualifiying tests to get a chance to practice here. These are physicians who support the medical care system in the US in a way that is generally underappreciated. Now, with that supply chain slowed, it will be difficult for some areas to keep up with adequate medical care and training.

[BgMstr4u]

I agree that immigration regulations have been made more difficult by the pandemic and the closure of government offices in other countries as well as the immigration difficulty here. However, foreign born foreign graduates have been a mainstay of medical care in the US for decades. Medical education has done little to change this.

 

Immigration rules have only become more stringent.

As an example, in 2014 there were 17000 or so United States Medical School graduates in first year positions in training in the US. At the same time there were about 6600 International medical graduates in the same role. The vast majority of those international graduates were foreign born and trained and a small number were Americans who attended school internationally.

Now in 2019 there are about 18000 US graduates for just about the same number of positions meaning that there has been little movement away from international graduates in the last five years. Going back further, the numbers would probably be about the same.

So it is clear than the US has been importing physicians and in relatively large numbers. I have worked in medical education for 40 years and ever has it been thus. These FMGS are usually well qualified and hardworking individuals. They need to pass qualifiying tests to get a chance to practice here. These are physicians who support the medical care system in the US in a way that is generally underappreciated. Now, with that supply chain slowed, it will be difficult for some areas to keep up with adequate medical care and training.

@purplekow, what in your opinion is the reason the US needs doctors from abroad? Is the capacity of our medical schools not large enough? Is that education too expensive? Are there just not enough US citizens going to medical school?

 

I help an older friend get to his medical appointments. One of his doctors is an American who went to the Saba University School of Medicine, near St. Maarten in the Caribbean. Although he seems as young (and cute) as Doogie Howser, and quite competent, I have not asked him why, and not sure I want to, as it might be taken as a critical question. But why do Americans go abroad for their education? As above -- is there something wrong with American medical schools?

[+ sniper]

There are a fixed number of slots in American medical schools, so if you don't get into one here, you need to go abroad. That's a conscious decision on the part of "the system."

[+ purplekow]

There are a fixed number of slots in American medical schools, so if you don't get into one here, you need to go abroad. That's a conscious decision on the part of "the system."

That is correct. The medical schools could educate more physicians here in the US, they choose not to do so. When I first started in medical education, there were about 15000 American graduates a year, that is about 40 years ago. As you can tell the number has not increased substantially. At that time, there were medical schools in the Caribbean, Europe and the Middle East training US students. In addition to that, you had the same influx of FMG physicians (Foreign Medical Graduates) plus all those US citizens who were training abroad. There was a program that probably still exists, in which after two years training abroad, US students could, if they passed proficiency examinations, transfer for clinical training here in the US. Schools would take up to about 5 of these transfers and there were about 114 schools at that time. Some did not take any. So basically US school were taking back the highest testing US born graduates, usually around 150 in total. Regulations tightened as a result of Venture capitalists taking an opportunity to provide education in small countries in the Caribbean mostly, and charge little for their citizens' tuition, gratifying the government and charging US students tidy sums. Those who have sharp memories of the invasion of Grenada during the Reagan era, know that one of the reasons used to send US troops into Grenada to topple that government, was the imminent risk of US medical students training there.

These relatively fly by night schools would get part time faculty from the US and organize a mostly large lecture series with most of the education coming from reading assignments. Some schools, such as those in Europe and Mexico were well established at training their own country's physicians, but these of shore schools had few clinical experiences and if students did not transfer out back to the US, the school would find clinical opportunities, usually at non university associated hospitals around the globe. The hospitals got manpower, the schools got training and of course, the lucrative tuition,

This was the 70s and 80s and US schools could have simply opened 20 or more positions per year each and that would have cut the need for these schools. A few more schools in underserved parts of the US would have done the trick too. They did not do that, but they made regulations for US graduates to return to the US from those off shore medical schools much more difficult and stopped the influx of US students who had circumvented the US system. Replacing those US grads were an even a larger number international graduates from foreign countries. That is where we are today except the world changed and those doctors may not get here,

[+ Charlie]

A good friend if mine was one of those American citizens (graduate of Brandeis) who didn't get into an American med school, so he went to one in Mexico and then came back to do his clinical work in the US. He went on to have a long successful career in the US as an oncologist.