A New Way To Mitigate Physician Resistance by Aaron Levine MD


Dr. Sanjay Gupta of CNN recently did a story on UCLA staffing inner city clinics with physicians from Latin America countries. For the sake of brevity, the doctors were in the United States, presumably the Los Angeles area, and were working in nonmedical jobs. These included from snippets housekeeping, building trades and lawn care. The doctor interviewed represented the program. UCLA paid for them to study and take American Medical Examinations. I presume the ECFMG or Flex, but neither was specifically identified. Those who passed were trained and they now staff the community clinics. On a positive side, a vital resource is not wasted. These doctors can talk to many of the people in their own language, Spanish. The doctors are presumably paid more than they received for manual labor, get more respect, and (hopefully) better working conditions and prestige. This is to their benefit. No negative sides were mentioned. Money was not mentioned, but presumably they accepted lower salaries than others demanded. This could keep costs down, but may sidestep the clinical training programs traditionally taken in this country.

There was an article in the AMA News more than 20 years ago that stuck in my mind. Some Irish doctors were recruited to staff a hospital directed HMO in upper New York State. The local doctors refused to work for the hospital at the salaries offered. The hospital received some waiver as a physician shortage area due to the HMO needs. The Irish doctors were recruited at a salary greater than the government set salaries in Ireland, but less than the local doctors demanded. The article spoke of how the doctors could be replaced after a few years if they developed unreasonable demands. The community had a bonus. These doctors could speak to the locals in their native language, English.

Many may not recall the debates over the ratification of NAFTA in 1992. Ross Perot described the “sucking sound” of jobs going to Mexico in the Presidential election. Arguments existed over Mexican truck drivers coming to the US. I called the AMA at the time and asked what organized medicine’s position on this was? I was told there was none. Each state licensed its own physicians and was medical licensure was therefore exempt form NAFTA. I pointed out the Senator Rockefeller of West Virginia proposed, separately as a quality measure, a national medical license that allowed doctors to treat people on Medicare and Medicaid but would not allow them to treat individuals otherwise in the 50 States. This bill never passed. The AMA investigated and I received a call about the revised opinion on NAFTA.

We hear of the shortages of PCPs and how PAs and NPs will fill in the gaps. Many older, not yet retired specialists, have discussed retirement and can not be replaced.The costs of the electronic records, reduced reimbursements, the sustained growth debacle, and ICD-10 added to costs that may not be offset by the remaining few years of practice available. Early retirement is then a viable option. This adds to the shortages of specialists that already exist.

Now, either my paranoia is present or I am prescient of a future event. The three events I described above now can be placed into a new perspective. There are 25 million people with health issues being added to the population after the AHCA, let alone millions from revision of immigration policies. Physician shortages are happening. It takes too long to train American doctors. There are comments that I read about shortening medical school and residencies each by a year. This lowers student debt and gets people out as specialists.  But I can also see an new approach to allow immigration and the creation of a license for foreign trained doctors recognized as specialists in their own country. This would allow them to practice here without meeting board certifications (unless reciprocity is also forced). This is not meant to dispute the quality of these doctors. I suspect this action or threat of action will be used to mitigate any resistance by American doctors to the changes coming.


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “A New Way To Mitigate Physician Resistance by Aaron Levine MD

  1. Robert
    October 9, 2013 at 3:41 am

    Three comments
    Concerning IMG’s who cannot pass America’s boards- how dare we place the poor (through no fault of their orn or the elderly, who were an active part of this country’s growth and development and who served the American people in the hands of substantially trained IMG’s . What a great demonstration of gratitude to the American citizens.
    Secondly, after three separate attempts , even in Spanish, IMG’s in Florida failed the PA boards and were deemed as having far less education and knowledge than a Florida PA. They just wanted to take care of Spanish Americans–a case of bigotry and unconstitutional fairness.
    Thirdly, in 1995-96 when I was president of the New York State Soiety of Physician Assistants, IMG’s felt they could move from their countries and from Florida and other states to become PAs in NYS. Dana Stanhope, then director of the Harlem Hospital established a program where an initial PA exam was given. All the students received grades in the forties. They were then placed in an accelerated PA program for one year and went through the same didactic studies as a Harlem Hospital PA, the end result ,a failure rate if 100 percent.
    The NYS Board of Medicine passed a law that prohibited IMG’s from taking American Medical Rquivalancy exams or the P a Boards.
    Point- iMG’s are not a substitute forbmedical care in this state.
    There are enough PAs and NPs who have the education and the practice to help fill the gap that we will soon see and only time will demonstrate their effect. In the mean time, they are doing 90 percent of what their physician counterparts are doing with the same results.
    Robert M. Bkumm, MA, PA-C, DFAAPA.
    Past president of NYSSPA, AASPA, ACC, APSPA, Vice Oresident of PAs for Tomorrow.

  2. Pat
    October 8, 2013 at 12:55 pm

    Yeah, U.S. doctors have spent too many years undercutting their own power to stop now. Apart from liberally using the word “cerveza”, I’ll be damned if I learn Spanish. Just make sure you print the disability check in English.

  3. Sir-Lance-a-Lot
    October 8, 2013 at 10:38 am

    A time-honored technique: bring in foreign scabs.

    Sadly, instead of bashing heads, American doctors will bend over backwards to show them the ropes as they vacate their old offices.

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