For those interested in Caribbean

Nontraditional Premed Discussion
21
  • Adoc2be Said:
  • DRFP Said:
Most of the Caribbean schools have stateside Clinicals but

there are Greenbook

and Bluebook clinicals to consider

Some states require Green book and others Blue book are ok still others there are no requirements



eh, can you explain what that means?

Also, what do you mean in your post after this one abour residency... I thought match was based upon course completion, USMLE, and interviews? So, at that point, medical school attended means a bit less (unless trying for Johns Hopkins or something like that)...

Also, the state of Minnesota licensing board response to where I could find the list for MN of approved schools, was a link directing me here:

http://www.faimer.org/resources/imed.html

Which really confuses me because as you and Richard have been saying, any country can get an IMED designation (any being loosely used here)... So what would that tell you from the MN Board's perspective?



OK

Greenbook clinical is when you do Surgery where there is a Surgery residency

Bluebook is where you do a Clinical where there is a residency but not the specialty

Peds with a Family practice residency would be blue book.

Cores should be mostly greenbook and

Electives in many states are fine not being green or blue book

Licensing is tricky

Each state is Case by case

Also we are talking about the 1st license not years afterward.

Doctors who have practiced in a state for years with a license can apply for reciprocity in another state.

California is the only state I know of that does not care and will not license a grad from a school not on their list.

A school will only be listed on Imed if the country's government sends official documents that the school holds a charter from them.

WHO is the same.

Just a few years ago people were starting medical schools in South American and Caribbean countries and bribing officials to use letter head to make it seem the government did charter the school.

Since 2007 this has 100% stopped because Imed requires correspondence from the country and a few more documents to back up the charter.

A simple letter will not do anymore.

The current schools ( most of them) are legit as far as that goes but some are poorer at education verses others.

MN approved list is IMED? Then as long as the school is not Banned I guess its ok. But always read the Rules and Laws about a states License procedure.
22
  • DRFP Said:
MN approved list is IMED? ...But always read the Rules and Laws about a states License procedure.



Aye, I was stunned the link was only thing sent regarding foreign medical school & licensing. Kind of feels like it'd be okay at AUC or Ross, but who wants to spend that kind of money to become an M.D. and then get refused a license?!

I know of a person who went to AUC but have yet to hear how the individual fared upon returning to MN.

RE the licensing for CA:

As long as it was one of the four that I attended, conceivably, if I wanted to practice at some point in CA, I'd be okay (presuming everything else was in order USMLE, boards, etc). Right?
23
  • Adoc2be Said:
  • DRFP Said:
MN approved list is IMED? ...But always read the Rules and Laws about a states License procedure.



Aye, I was stunned the link was only thing sent regarding foreign medical school & licensing. Kind of feels like it'd be okay at AUC or Ross, but who wants to spend that kind of money to become an M.D. and then get refused a license?!

I know of a person who went to AUC but have yet to hear how the individual fared upon returning to MN.

RE the licensing for CA:

As long as it was one of the four that I attended, conceivably, if I wanted to practice at some point in CA, I'd be okay (presuming everything else was in order USMLE, boards, etc). Right?



The above 4 are the "ivy" league of the Caribbean. Below is something I wrote about a year ago in another posting

The issue with licensing becomes even more problematic and more of a gamble when you examine the nuances of what goes on. In every state, the law creates a medical board or other administrative entity to make specific rules/standards, review applications, and issue licenses. Some years ago, California's medical board starting reviewing the off-shore medical schools, including occasional site visits, to establish if the schools should be on their approved list. This list is dynamic as 10 years ago, St. Matthews was on the list but was removed about 5 years ago. So a medical school on the list now, may not be when you graduate. Several state medical boards, such as vermont, michigan, and kansas, have adopted the California list as part of their licensing standard. Many others have similar lists, usually school's whose graduates are banned from obtaining a licenses. Yet with the physician shortage, some states, such as Arkansas( Link to article) and Georgia, are removing prohibitions on IMG/FMG licensing. Its all rather confusing really.

(below from a ValueMD posting)

LIST OF STATE/COUNTRY MEDICAL BOARDS that approve or disapprove medical schools and list them

Texas approved list (you don't have to supply additional documents for these schools)

http://www.tmb.state.tx.us/professionals/physicia n...

Kansas approved list

http://www.ksbha.org/medicalschoolsapprove dunappro...

North Dakota Disapproved list

http://www.ndbomex.com/DisapprovedMedSchools .pdf

California list of approved schools

http://www.medbd.ca.gov/applicant/schools_rec ogniz...

California list of disapproved schools

http://www.medbd.ca.gov/applicant/sc...napproved.h...

Indiana list of disapproved medical schools

http://www.in.gov/pla/bandc /mlbi/instinfo.html

Alabama list of schools that require additional documentation

http://www.albme.org/Default.aspx?Page=PysicianApp...

Oregon List of disapproved schools (some medical in list)

http://www.ossc.state.or.us/oda/unaccredited.html

Michigan list of disapproved schools (some medical in list)

www.michigan.gov/documents/Non-accredi tedSchools_7...
24
  • gonnif Said:
  • Adoc2be Said:
  • DRFP Said:
MN approved list is IMED? ...But always read the Rules and Laws about a states License procedure.



Aye, I was stunned the link was only thing sent regarding foreign medical school & licensing. Kind of feels like it'd be okay at AUC or Ross, but who wants to spend that kind of money to become an M.D. and then get refused a license?!

I know of a person who went to AUC but have yet to hear how the individual fared upon returning to MN.

RE the licensing for CA:

As long as it was one of the four that I attended, conceivably, if I wanted to practice at some point in CA, I'd be okay (presuming everything else was in order USMLE, boards, etc). Right?



The above 4 are the "ivy" league of the Caribbean. Below is something I wrote about a year ago in another posting

The issue with licensing becomes even more problematic and more of a gamble when you examine the nuances of what goes on. In every state, the law creates a medical board or other administrative entity to make specific rules/standards, review applications, and issue licenses. Some years ago, California's medical board starting reviewing the off-shore medical schools, including occasional site visits, to establish if the schools should be on their approved list. This list is dynamic as 10 years ago, St. Matthews was on the list but was removed about 5 years ago. So a medical school on the list now, may not be when you graduate. Several state medical boards, such as vermont, michigan, and kansas, have adopted the California list as part of their licensing standard. Many others have similar lists, usually school's whose graduates are banned from obtaining a licenses. Yet with the physician shortage, some states, such as Arkansas( Link to article) and Georgia, are removing prohibitions on IMG/FMG licensing. Its all rather confusing really.

(below from a ValueMD posting)

LIST OF STATE/COUNTRY MEDICAL BOARDS that approve or disapprove medical schools and list them

Texas approved list (you don't have to supply additional documents for these schools)

http://www.tmb.state.tx.us/professionals/physicia n...

Kansas approved list

http://www.ksbha.org/medicalschoolsapprove dunappro...

North Dakota Disapproved list

http://www.ndbomex.com/DisapprovedMedSchools .pdf

California list of approved schools

http://www.medbd.ca.gov/applicant/schools_rec ogniz...

California list of disapproved schools

http://www.medbd.ca.gov/applicant/sc...napproved.h...

Indiana list of disapproved medical schools

http://www.in.gov/pla/bandc /mlbi/instinfo.html

Alabama list of schools that require additional documentation

http://www.albme.org/Default.aspx?Page=PysicianApp...

Oregon List of disapproved schools (some medical in list)

http://www.ossc.state.or.us/oda/unaccredited.html

Michigan list of disapproved schools (some medical in list)

www.michigan.gov/documents/Non-accredi tedSchools_7...



I agree with what you posted, but Texas for instance had a Banned list and approval list then withdrew it after Law suits.

St. Mathew's approval with California? I thought they were never approved? Hmm I will look into that later.

Also the Cali approval process:

The school must pay a fee to begin

then Pay for the travel and the visit

then pay another fee

then pay for more visits

I understand it adds up to thousands and then California may not approve the school.

Many schools do not think its worth it for just one state.

I want to point out something too

You can only work in one state at a time

Once license it will not be taken away

Reciprocity happens even if things change

Is all this for sure? No but in history this is how it has worked.

I think the point to take home is

Try to stay in the US if you want a Guarantee

If you go outside the US (not only the Caribbean) you are taking a risk.

Canada is very very FMG unfriendly and it's very hard for Canadians to practice there if they did not go to a Canadian or US medical school. It could get that way here in the US. So far a few states as posted are FMG unfriendly.

No matter if I agree with that or not it is reality.

One last thought

the Big 3 AUC, ROss and SGU have been around for over 30 years and are successful and have been grandfathered into the Federal student loan system. No Caribbean school can get the loans, congress closed the door years ago. Only these three schools, I do not think any state will stop licensing these grads. Other schools yes possible but these 3 schools are California approved and I doubt they will get banned by other states, too many doctors have come from these schools all over the US now.


25

This entire discussion may soon be moot. I found out some interesting things from my mentor last month.


The federal government subsidizes residency programs through medicare taxes. If anyone has been paying attention to current events over the last 4 years, you know the federal government is flat broke. This federal deficit is likely to be intergenerational. The last federal deficit began at the outset of World War II and ended around 2000 at the end of the Clinton administration - lasting 60 years! This means many residency programs will be closing their doors. For the first time, not all US medical school graduates are going to be guaranteed a residency spot. Primary care spots can be and are increasingly handed over to PAs and NPs. If ACGME (allopathic) residencies can’t provide enough spots for US medical school graduates, they certainly are not going to consider Caribbean or other foreign graduates. Caribbean and other FMG/IMGs will be the first to be locked out, followed by DO graduates. The DOs, however, have an ace up their sleeve - they have the option of matching into either ACGME or AOAGME (osteopathic) residencies. Since MDs cannot match into AOAGME, the DOs have a safety net. Since all Caribbean schools are allopathic, their graduates cannot match into AOAGME spots. Therefore, if they get locked out of ACGME spots, they graduate with a quarter million dollars worth of debt hanging over their heads and no employment prospects for the forseeable future - not a good position to be in regardless of where you stand on the quality of education you receive at an off-shore medical school.

26

Hi DRFP,


You mentioned earlier that you “skipped a few classes in premed and it cost me.” Which classes would you recommend? I am just finishing an arduous 2.5 year premed post-bacc and getting ready to take the MCAT and apply. The only extra classes I’ve taken are Quantitative Analytical Chem and one anatomy class. I’ve taken the prerequisite two semesters each of Gen Chem, Organic, Physics, and Bio. I got a B+ in Quant and A’s in all the rest.


If I can fit in one or two more classes, what did you struggle with the most that I could take now? Biochem? Something else?


Thanks a ton!

27
  • lign Said:
Hi DRFP,

You mentioned earlier that you "skipped a few classes in premed and it cost me." Which classes would you recommend? I am just finishing an arduous 2.5 year premed post-bacc and getting ready to take the MCAT and apply. The only extra classes I've taken are Quantitative Analytical Chem and one anatomy class. I've taken the prerequisite two semesters each of Gen Chem, Organic, Physics, and Bio. I got a B+ in Quant and A's in all the rest.

If I can fit in one or two more classes, what did you struggle with the most that I could take now? Biochem? Something else?

Thanks a ton!



Yes Biochem is a great course to take before Med school if you have time.
28
  • TicDocDoh Said:
This entire discussion may soon be moot. I found out some interesting things from my mentor last month.

The federal government subsidizes residency programs through medicare taxes. If anyone has been paying attention to current events over the last 4 years, you know the federal government is flat broke. This federal deficit is likely to be intergenerational. The last federal deficit began at the outset of World War II and ended around 2000 at the end of the Clinton administration - lasting 60 years! This means many residency programs will be closing their doors. For the first time, not all US medical school graduates are going to be guaranteed a residency spot. Primary care spots can be and are increasingly handed over to PAs and NPs. If ACGME (allopathic) residencies can't provide enough spots for US medical school graduates, they certainly are not going to consider Caribbean or other foreign graduates. Caribbean and other FMG/IMGs will be the first to be locked out, followed by DO graduates. The DOs, however, have an ace up their sleeve - they have the option of matching into either ACGME or AOAGME (osteopathic) residencies. Since MDs cannot match into AOAGME, the DOs have a safety net. Since all Caribbean schools are allopathic, their graduates cannot match into AOAGME spots. Therefore, if they get locked out of ACGME spots, they graduate with a quarter million dollars worth of debt hanging over their heads and no employment prospects for the forseeable future - not a good position to be in regardless of where you stand on the quality of education you receive at an off-shore medical school.



The big three Caribbean schools are funded by Federal Student loans, Directors of some residency programs are graduates of one of these schools now ( I know of 2 or 3 now) this makes these three better choices then other schools like my school ( Aureus)

AS far as DO schools "Locked out" never going to happen.

The money problems of the Feds will not cause the residency programs to collapse, in fact there is talk of expanding the residencies. Increasing them.

But premeds and medical students love to scare themselves and others about this.

This kind of talk was here when I first looked Medical school in 2003..............

It makes no sense to mess this up it would cause a huge crises in health care in the US.
29
  • DRFP Said:
The big three Caribbean schools are funded by Federal Student loans...



Medical schools are not funded by Federal student loans; they are funded (stateside at least anyways) by a combination of funding mechanisms: student tuition, research grants, endowments from benefactors, and (in the case of public schools) taxes.

Federal student loans go to the students to finance their education, not to the schools to finance their operation; although one could argue that the loans cover tuition which in turn funds a school. However, Caribbean schools are not exclusive to US citizens so not all of their students receive federal student loans; citizens of other countries can and do attend Caribbean medical schools including the "big 3". Plus, I'm not sure how many off-shore programs' students are eligible to receive Federal student aid. It varies by school. None of this has any bearing on how well their graduates will fare in the residency match.

  • DRFP Said:
Directors of some residency programs are graduates of one of these schools now (I know of 2 or 3 now) this makes these three better choices then other schools like my school (Aureus).



Not if their graduates can't match. The fact that "[d]irectors of some residency programs are graduates of one of these schools" has no bearing on the number of residency spots a particular program offers, no bearing on who's accepted to them, no bearing on funding, and no bearing on whether a particular program stays open.
30
  • DRFP Said:
AS far as DO schools "Locked out" never going to happen.



I made no mention of DO schools, only that their graduates in coming years will have an increasingly difficult time matching into allopathic (ACGME) residencies. However, since DO graduates have the option of matching into either osteopathic or allopathic residencies, they may actually end up faring better in the long run than their allopathic counterparts who have no choice but to apply for allopathic residency spots. Graduates of both types of schools will be competing for an increasingly dwindling number of residency spots. In a few years, it is predicted there will be more medical school graduates than US residency spots whether you care to acknowledge that or not. This means IMGs/FMGs will be the first to get locked out of US allopathic residencies and they do not have the option of matching into US osteopathic resdiencies. That's a precarious 'catch 22' to be in.

  • DRFP Said:
The money problems of the Feds will not cause the residency programs to collapse...



Yes it will.

  • DRFP Said:
But premeds and medical students love to scare themselves and others about this.



My source is credible and firsthand; it is from one of my medical school professors, specifically my mentor. I am not getting this info from premeds or other medical students or SDN.

  • DRFP Said:
This kind of talk was here when I first looked Medical school in 2003



I hope you're right. Let us know when you match.

  • DRFP Said:
It makes no sense to mess this up it would cause a huge crises in health care in the US.



Yes it certainly will. We already have a huge crisis in health care in the US and it will probably get worse before it gets better.
31
  • DRFP Said:


MN approved list is IMED? Then as long as the school is not Banned I guess its ok. But always read the Rules and Laws about a states License procedure.



Below is from the MN license application. Apparently if you can do at least 2 years medical residency and get an ECFMG certificate, ur good to go

************************* ****

1. Graduate of a medical school listed in the World Directory of Medical Schools.

2. Successfully complete two years of US/Canadian graduate, clinical medical training in an accredited

program unless 1) admitted as a permanent immigrant to the United States as a person of

exceptional ability in sciences pursuant to rules of the U.S. Department of Labor or 2) issued a

permanent immigrant visa as a person of extraordinary ability or as an outstanding professor or

researcher and has a valid medical license in another country; or 3) licensed in another state and

practiced 5 years without disciplinary action in the US/Canada, completed one year US/Canadian

accredited training and passed SPEX within three attempts in 24 months prior to licensing.

3. ECFMG certificate.

4. Successfully complete the USMLE, FLEX, LMCC or state exam. Applicants licensed in another state

must pass the SPEX exam within three attempts if it has been more than 10 years since taking the

initial licensing exam unless currently certified by a specialty board of the American Board of Medical

Specialties, of the American Osteopathic Association Bureau of Professional Education, of the Royal

College of Physicians and Surgeons of Canada, or of the College of Family Physicians of Canada
32

Mind if I post that to my blog? I’m going to do a post on Caribbean schools and will add link back to OPM.

33
  • TicDocDoh Said:
  • DRFP Said:
The big three Caribbean schools are funded by Federal Student loans...



Medical schools are not funded by Federal student loans; they are funded (stateside at least anyways) by a combination of funding mechanisms: student tuition, research grants, endowments from benefactors, and (in the case of public schools) taxes.

Federal student loans go to the students to finance their education, not to the schools to finance their operation; although one could argue that the loans cover tuition which in turn funds a school. However, Caribbean schools are not exclusive to US citizens so not all of their students receive federal student loans; citizens of other countries can and do attend Caribbean medical schools including the "big 3". Plus, I'm not sure how many off-shore programs' students are eligible to receive Federal student aid. It varies by school. None of this has any bearing on how well their graduates will fare in the residency match.



Yes you can split hairs that way if you want, but few can afford the 150 to 200K it costs to attend medical school in 2011.

Tuition is around 40K alone a Year, I would believe that indirectly the Big Caribbean three are funded through these loans since they would go out of business without the students ability to pay tuition.

So argue that the money does not go directly to the school, but wait it does, it gets dispersed to the school and then the money that is left over from paying tuition for that semester is then given to the student.

If that semester has an increase in fees then I would get less money that semester.

And yes AUC, SGU and Ross enjoy the federal student loan money plus private loans like Med achiever, none of the other Caribbean schools can get Federal student loans. These three were grandfathered in.

I think your argument that there will be no Residencies is not accurate, I just read that around 2000 IMG's and FMG's prematched in 2011.

I don't have proof though.


34
  • DRFP Said:
I think your argument that there will be no Residencies is not accurate...



DRFP,

Just to clarify, I was not claiming that there will be NO residencies, only that there will be fewer residency spots to accommodate the surge in US medical school graduates in the coming years when the total number of US medical school graduates is expected to exceed the total number of US residency spots. The federal government finances GME spots through Medicare contributions (i.e. taxes). Medical school enrollment is not financed by Medicare. The 2 processes are mutually exclusive. It's entirely possible for the federal government to defund some US residency programs, reducing the total number of GME spots, while at the same time US medical schools collectively increase enrollment. If there are not enough ACGME spots to accommodate all US grads, then there certainly won't be enough ACGME spots to accommodate IMGs/FMGs. The nice thing about DO grads is that they get a choice between AOAGME or ACGME. There are no DO schools in the Caribbean so Caribbean grads don't have that same choice; it's ACGME or nothing.

  • DRFP Said:
...I just read that around 2000 IMG's and FMG's prematched in 2011.



Historically, many residency programs have unfilled residency spots wherein the total number of US residency spots exceeded the total number of US medical school grads - this gave FMGs/IMGs a chance to enter the American GME system. But, you can't assume that what holds true at present in 2011 will still hold true 4 or more years from now.
35
  • TicDocDoh Said:


Historically, many residency programs have unfilled residency spots wherein the total number of US residency spots exceeded the total number of US medical school grads - this gave FMGs/IMGs a chance to enter the American GME system. But, you can't assume that what holds true at present in 2011 will still hold true 4 or more years from now.



While I am not the most enthusiastic supporter of off shore schools themselves, though I am have no qualms with the doctors who come out of them and are successful, I cant imagine the expansion of US MD and DO programs will grow quickly enough to fill the slots for residency. In 2011 there were 26158 total allopathic slots with 23421 for PGY1 and 2737 for PGY2. Yet there were only about 18,000 US MD and DO grads. Over 4500 IMG/FMG matched. While I do agree slots will become more competitive as the number of US MD/DO graduates increases, I speculate that the weaker schools, mostly for economic reasons, will start losing ground and close and the stronger schools will be left standing
36
  • TicDocDoh Said:


Historically, many residency programs have unfilled residency spots wherein the total number of US residency spots exceeded the total number of US medical school grads - this gave FMGs/IMGs a chance to enter the American GME system. But, you can't assume that what holds true at present in 2011 will still hold true 4 or more years from now.



Yes and No

The future is like this:

A large number, very large number of physicians are older - retiring or leaving the profession voluntarily.

That is leaving a huge gap and need.

Two solutions

replace Doctors with NP's and PA's which legally and in reality are not as trained or experienced as physicians.

Or

Increase the residency spots to train and keep up with the demand.

At some point sanity will have to play into the fact that Senator or Congressman XYZ wants a "Doctor" when they are sick not an Assistant.

This country needs to wake up we are going from number one in healthcare to number 2 or 3, you do not replace Physicians with lesser trained people and stay on the cutting edge of medicine.

You realize with the attitude some have of bias against FMG and IMG Physicians they are creating the crises we have now? That bias is picked up by congress.

Something like this:

Dr. Snobb graduate of Johns Hopkins, Surgeon speaks to congressman Believeanythingadoctorsay s:

Look John Q.,who did a surgical clerkship with me, is from AUC, he went to Columbia for undergrad but did not have a high enough gpa (3.2) for a US medical school, he then went on to study 2 years on a 3rd world island and 2 years in the US, after passing the USMLE, at some of the best hospitals in the US along side US students. While he has passed the USMLE steps 1 and 2 with high percentiles and performed as well and sometimes better then most in clerkships, this graduate will never be as good as our own US graduates.......... Really?

Dr. Snobb the difference in this graduate's history and a US graduate's history is 2 years of Basic science, one in the Caribbean and one in the USA.

Dr. Snobb is lost in an unproven bias...... SAD!


37

DRFP,


There’s a lot of truth to your post.


I don’t think Medicare was ever originally intended to be a funding mechanism for the nation’s GME; it was intended to be a way to pay for the healthcare of the elderly. Clearly, a better mechanism is needed to fund GME - one that’s tied to society’s needs and isn’t so vulnerable to political whim.


On a different note, I just found out today FWIW that the faculty mentor that’s been my source of information is, herself, an FMG.

38

DFRP -


You make some good point. I do feel that one of your generalizations is unwarrented.


I just wanted to point out that we are NOT number one in healthcare. As far as infant mortality, we are generally #14th or lower. Every country with a lower infant mortality than ours has a 2-tiered health system in which the majority of low-risk women are attended and delivered by nurse-midwives. So, using non-physician providers does not automatically reduce quality of care. The important factor is a health system where people are referred to the appropriate level of care.


Kate

39

Just to drive home the point I was making in my earlier posts, here is an excerpt from an e-mail I received from one of my classmates just a few minutes ago:


“Colleagues,


Your action is needed!


The Michigan Legislature is looking to cut almost all state graduate medical education (GME) funding this week. This is an important issue that threatens our ability to seek out residency programs within Michigan. Our state has entered a time where increased GME funding is needed to try to build more residency spots, but now we are expected to lose millions in funding. We highly suggest contacting your state legislators immediately to ask for their support within the senate.


Attached you will find a suggested letter to send to your legislators.”


So apparently, my mentor’s predictions are already coming true, at least at the state level.

40
  • Kate429 Said:
DFRP -

You make some good point. I do feel that one of your generalizations is unwarrented.

I just wanted to point out that we are NOT number one in healthcare. As far as infant mortality, we are generally #14th or lower. Every country with a lower infant mortality than ours has a 2-tiered health system in which the majority of low-risk women are attended and delivered by nurse-midwives. So, using non-physician providers does not automatically reduce quality of care. The important factor is a health system where people are referred to the appropriate level of care.

Kate



I understand, Its hard for a Americans to believe anything else then we are number one. We are not.

The Health care situation in the US is getting worse not better. We kid ourselves into believing its at a high level yet anyone who is in the trenches knows the game, if insurance doesn't pay a procedure is not done unless the person will dies without it. During my clinical years I can't count the number of people who did not get the treatment they needed or medications because they were low income. Many middle to upper income people believe lower income people are lazy and get everything free. That is a small number. With out getting to political here, I Lived in England for a year under their health care and went to school with a large number of Canadians as well in clinicals, nothing is as bad as the US press and people think it is. Because the Health insurance companies will loose billions if we change the playing field to the advantage of the health care consumer, the propaganda has been spread wide that change equals disaster. The Insurance companies want the ability to continue to deny claims and charge what ever they want to create as much profit as they can squeeze from people. IMHO Health care insurance should be Not for profit.

He who conducts the study holds the key to the end result of the Statistic. Depending on many factors Statistics can Lie.

As far as Medicare and state funding of GME, why not the Hospitals?

Why not create a fee for insurance companies?

Why medicare? to me its crazy.

This who country is in trouble

Medicare funding residencies and there is not enough

Public Schools cutting more and more teachers

Public Schools now charge between 2000 and 4000 a year per kid in fees to parents. (recent articles)

States are beginning to replace Doctors with PA's and NP's

AN average person working for 10 an hour cannot get Medicaid to cover their family of three costs at least 300 a month. So this person is supposed to pay rent and buy food and pay for fees at the public school and survive on about 1200 take home a month and pay 300 of that to Health insurance? Most do not carry it then.

When they are really sick they go to the hospital, are minimally taken care ( we do the needed necessary life threatening care) then they have a huge bill that goes to collections.

Tell me again we are #1 in health care because of infant mortality?

  • In reply to:
The important factor is a health system where people are referred to the appropriate level of care.

That is not possible if the lower level provider is not Knowledgeable enough to make the correct Diagnosis, Yes I'm saying that PA's and NP's make mistakes more often then Physicians on complicated, rare diagnosis or complicated health issues.

While some NP's and PA's can practice at a high level after years of experience, its experience in their focus and not as much as all around as a physician. Also mind you, not all PA's and NP's reach the higher level.

I argue why even consider replacement of Physicians with NP's and PA's, it was never meant to be this way. It's like giving a drug that 50% of the time prevents death without a cure over a drug that not only prevents death 100% time but cures!

Please this is my opinion its ok to debate me and change my mind.