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Mission Residency Podcast: Episode 2

The difference between winning & losing? Whether or not you have the RIGHT people on your team.

Tim Duncan…Kyrie Irving . . .Dirk Nowitzki…Tim Duncan….Tony kukoc…Yao Ming…Manu Ginobli…Pau Gasol…

What do these  NBA Players have in common?

1) They’re all international players that brought their talents to the United States & became superstars.

2) They all are CLUTCH players…when the game was on the line, they WANTED the F’ing Ball.

3) And they all played crucial rolls on their teams in in pursuit of World Championships.

You take away their production and by numbers alone, their teams don’t win like they did.

Oh, one other thing.  Those last 3 players  I mentioned – Ginolbi, Ming, and Gasol  – all winners – have another thing in common: Their home countries – China, Italy, and Spain . . . are LOSING not to number 23. . . . but to number 19: Covid-19.  And for all their skill, experience and, most importantly, desire, this opponent is out of their league.

If you’re listening to this, quarantined . . . worried and scared, wondering what happens if I get sick…and there weren’t enough enough doctors to help everyone. What if I told you there were 4,968 people that are completely qualified right HERE in the United States, ready, willing, and able to help save us.  Doctors that have met every single piece of medical training criteria that graduates from Columbia, Harvard, and Johns Hopkins Medical school have met. And I’m NOT talking about Retired doctors that they’re calling back to hospitals….

That’s right…Like Italy and China have ALREADY done, the US is now calling on RETIRED, Doctors & Nurses to come BACK into the hospital to help overwhelmed & understaffed hospitals.   Most of them are over age 60 years old . . .That’s right.  We’re asking the population that is MOST at risk to dying from Covid-19 exposure to go back in and put their lives at risk. 

WHY?  Who else can we ask?

Now what if I told you that on March 19th,  2020, when the pandemic was on the verge of reaching a tipping point, when what we do TODAY will determine how many live and die in the weeks, months, even years ahead.  – That those 4,968 doctors with YEARS of actual experience were told that they had to wait another YEAR to work as physicians in the United States.

Now, before a group like anti-immigration groups wonder if these highly skilled foreign-born men and woman are here LEGALLY – yes, they are.  How do we know this? 

A) Many of them are US-Born students that went abroad to train & simply coming home.

B) the remaining on work/student visas like J-1, EAD, and f-1 Student visas.  And those that aren’t allowed to work without their visa can get sponsored any residency program willing to support & process the paperwork. 

What puts American Medical Graduates (AMGs) & International Docs (IMGs) on the same playing field? The USMLE = The Bar Exam for Lawyers.

For those worried that they lack the knowledge & training to measure up to doctors that graduated from US-Based Medical Schools (otherwise knows as American medical graduates, or AMGs for short), here’s what you need to know:

US Medical Graduates are required to take the United States Medical Licensing Examination, broken down into 3 major Steps…

USMLE Step 1 – Basic/Core Medical Science – like Anatomy, Physiology & Pharmacology, to name a few subjects.  It tests the foundational sciences/concepts essential to practice medicine.

USMLE Step 2 Clinical Knowledge, abbreviate Step 2CK covers clinical knowledge regarding all specialities with respect to interpreting symptoms, narrowing down a differential list of possible conditions, diagnostic studies, and appropriate treatments

USMLE Step 2 Clinical Skills, 2CS for short- It’s a live practical exam with standardized patients that tests their ability to work & communicate with patients with a range of issues.

These are the USMLE Steps that must be passed before the start of residency training, whether you’re an american medical graduate or international medical graduate.

What puts IMG’s and AMG’s on DIFFERENT playing fields?

There’s one more exam that an AMG’s don’t have to take before they begin working as a resident in a hospital. Why? It’s an exam made to test residents.  It’s called the Step 3.

USMLE Step 3 – This 2-Day final exam tests how a candidate understands and puts into practice  concepts critical in providing the best  patient care. Put simply, based on everything you’ve learned, at the end of the day . . . do you know how to save a life?  This exam is a Pre-Requisite for the majority of state licensing boards.

AMGS don’t have to take that exam.  You know who does? International Medical Graduates that are looking to be sponsored to work LEGALLY under an h1-b Visa.   And Green Card Holders or US Citizens that don’t need the visa technically don’t HAVE to take it, it’s almost a requirement because the docs they’re competing for residency slots with HAVE it.

Covid 19 is not a Chinese Virus.  It’s not a US Virus.  It’s a WORLD Virus.

Hospitals in Italy are overrun . . . and they don’t have the advantage that we have…sitting there waiting to be put back into the game.

So why aren’t nearly 5000 doctors still jobless?

1) Program directors would love extra help, but there isn’t enough resources & funding for space, faculty & visa sponsorship

2)  They struggle with the Interview Process: When they interview, they’re given anywhere between 5-15 minutes to prove to them why the belong here.  That’s not because they wouldn’t otherwise WANT to get to know them better. . . there are simply too many qualified applicants & not enough time in the day.

Why would you want Old Graduates that completed medical school years ago? One Word: Experience.

Right now there’s a taxi cab driver in NY that could save your life…one that has infectious disease experience that’s driving people around to pay his application costs to get into residency.

There’s a physical therapist MORE qualified to treat an infectious disease case than a 1st year

medical student out of Harvard.  She’s a PT because it was the fastest way she could find to support her family while applying.  Oh, and she’s worked through the SARS epidemic back home before & knows how to deal with the stress.

IMGs have seen & treated diseases that doctors don’t really see in the hospital anymore.  Tuberculosis.  Polio….even leprosy. 

That experience matters.  When an AMG has to insert an IV or intubate a patient, on day 1 of residency, that would be the first time they would have to do it as the lead medical staff on a case.  For an IMG, they would’ve done that and more hundreds of time – on their own- with no senior attending to back them up & sometimes with no electricity or air conditioning.  I spoke to an IMG named Anu last night that has literally triaged and treated 120 patients in ONE DAY.

Their Chances to Match were lowered because they made mistakes building their application . . .

In all the years I’ve been working with IMGs, there are a few things that have always been true. 

1) If they failed any of the exam I mentioned earlier, they can struggle getting even 1 interview….even when they did pass the exam the 2nd time with flying colors 

2) They’re given very little individual formal guidance on how to navigate the Maze of residency application.  You choose ANY profession where you’re left to guess your way to certification & you’d get similar mistakes.

If the AMGs can pass the USMLE in one shot, why can’t they?  

Well, AMGs throughout Med School are literally TRAINED SPECIFCALLY for The USMLE’s. They take the Step 1 shortly after completing the Step 1 material in Medical School.   

Why is it harder for an IMG? 

  1. They haven’t seen basic medical science material since medical school, which can range from 1 to 5+ years.  What have they been doing since?  Practicing medicine or rotating at US Clinical experiences, raising families, and studying for the USMLE’s…sometimes all at the same time.
  2. When they were in med school, they were trained to pass their OWN countries medical exam – which are VASTLY different in their testing method
  3. English is often NOT their 1st spoken or written language.  For some, they didn’t even grow up with the SAME ALPHABET.   Imagine taking the exam of your life in chinese characters or russian cyrillic.  Now realize that that’s what foreign-born, non-native english speaking doctor had to do… and they STILL passed the exam.

Corona virus is proven to be the most deadly with our oldest population . . . why are we

sending them back to the war front?

This is personal for me – my 80+ year old father that practiced in New York for most of his career as an anesthesiologist, is talking about wanting to go back in to help.   If it wasn’t for his heart condition or the fact that he can’t get back from the Philippines (on vacation) because of travel restrictions, we might not stop him.  Why, because that’s doctors do.  They’re wired to help whenever & wherever it’s needed, even at the cost of their own health.

In the US Military right now, we have 65,000 immigrants fighting for the US, with about 35,000 of them being non-US Citizens. Willing to die to protect and save their adopted new home country.  We honor them because we see them as the protectors of our freedoms.

We have International’s Medical Graduates that are ready to come off the sidelines and jump right onto the frontlines . . . to protect your life, liberty and the pursuit of happiness.   If you’re wondering if that’s what’s at stake – how does quarantine feel so far?

Having had 11 years of experience getting to know thousands of these doctors on a personal level, I’m telling you right now: This is like leaving a 36 year old Michael Jordan on the bench when he’s in his prime.    Get to know these doctors & you can decide for yourself.  In the next podcast, I’m going to talk to a few of these IMGs . . .

About the Writer: Dr Brian teaches for www.MissionResidency.  While born & raised in NJ as a US Citizen, he’s an IMG himself, completing his medical school training in the Philippines in the early 2000’s.  He created Mission Residency’s to help IMG’s tell their stories through proper communication. With every success, he’s made mistakes (some small, some HUGE) along they way.  A big believer in 2nd chances, inspire the next generation of doctors to make the most of their every opportunity – to do the right thing for them, their families and their patients.

“We don’t judge our students on mistakes of the past.  I care about who that person is today.   As long as they’ve learned from them to be a better version of themselves today, that’s how I measure potential.  Growth Matters.” ~ Dr Brian

Full Disclosure: “I had business friends saying don’t do this, it’ll hurt Mission Residency’s enrollment (the IMG Training organization I teach for).  If 4,500 from this past application process and a large majority from the upcoming application cycle (who eventually will be qualified) are taken in – bypassing the regular interview season – that there’ll be nobody left to help get into residency.  Yes, it’s likely.  So why’d I post this?  Simple: If our ultimate goal is to get IMG’s jobs and improve patient care, then who cares about the bottomline. We’re supposed to leave this world better for our kids, right?  Helping these doctors get in when they’re most needed is Mission: Accomplished for me

For the last 11+ years, Mission Residency's singular focus has been helping IMG's Match.  Our experience has allowed us to develop training that goes BEYOND simply preparing you for interviews. 

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