Training U.S. citizens and permanent resident International Medical Graduates for U.S. residency
August 30, 2006
Since the year 2000, a Georgia based company co-founded by Dr. Pedram Mizani (Family Medicine) has been making a significant difference: Graduate Medical Consultants Group (GMC) has been an avid supporter of educating International Medical Graduates before they enter U.S. residency programs under controlled teaching environments in the U.S. hospitals. As a result, GMCGroup has supervised more than 19,000 medical student clinical rotation weeks in affiliation with U.S. teaching institutions and participating U.S. physicians. Here's an email interview with Dr. Mizani:
Where did you study medicine? What drew you to this field? How influential were your parents? Any of them practice medicine?
I studied medicine at St. Matthews University School of Medicine (SMU), but that was after having had passed a few hurdles. My career in healthcare started at Los Angeles College of Chiropractic. Although I was taught to be a great diagnostician and a chiropractor, I could never use them to medically treat my patients. So I took action by enrolling in SMU, graduated as a Medical Doctor with Honors, and in September of 2004, completed my Family Medicine residency at Morehouse School of Medicine as the Chief Resident.
The inter-working of body mechanics with human psyche was the impetus to my career in healthcare; it continues to be awe-inspiring to me. I used to say that all the stress, anguish, heart burn, not spending time with family and sleepless nights will be worth it if I get to save ONE life… that was thousands of patients ago, many of whom were critically ill but now continue to enjoy life!
My mother Nasrin, and sister Ellie should not be left unmentioned. They gave me energy when I was tired; helped me soothe when I was heated; and helped support every decision I’ve made. Achieving my goals wouldn’t have been possible without them.
I was the first in our entire family to become a physician. My lovely sister is now a physician as well, a 2nd year Psychiatry resident at University of California Irvine. I’m very proud of her.
What happened in your professional lives that compelled you and your partners to form the GMCGroup? Was there a specific experience that inspired you?
As a U.S. – International Medical Graduate (IMG), one must adhere to specific state medical board policies that if not prepared for years in advance, can contribute to significant setbacks in a physician’s ability to practice medicine in the U.S. Having had successfully passed all hurdles and become licensed in the State of Georgia as an IMG, my business associates and I elected to capture and research every experience, incident and potential stumbling block, both real and hypothetical, and offer them as real-world and unfeigned solution packages to each IMG who wishes to practice medicine in the U.S. The end result is the most dynamic commercial advocate of internationally trained physicians, better known as Graduate Medical Consultants Group (GMCGroup).
Months ago my wife went to the emergency room at an Oakland hospital because of stomach pains. She was there from around midnight to 6am. Although she was treated very professionally when a medic or doctor came around, it was amazing how long she was there for what turned out to be a mild case of ulcer. The shortage of staff seemed obvious. Is your project aimed at reducing these kinds of problems?
Precisely! Earlier this year, the American Medical Association (AMA) and the Accreditation Commission for Graduate Medical Education (ACGME) confirmed that we will be faced with an 85,000 to 200,000 physician shortage by year 2020. In addition, every year 6,000 of 24,000 residency slots (~25%) are filled by internationally trained medical graduates (IMG), with emphasis placed on clinical experience in U.S. teaching hospitals; we estimate that only 15% of first year IMG residents had any sort of exposure to U.S. healthcare prior to their first day of residency. Several Residency Directors were concerned that in addition to the endangering patient care, weeks and in many cases months are lost at the beginning of residency bringing IMG’s up to speed with the art of US clinical medicine, which also increases their overall liability.
My enterprise is a clinical body, comprised of >400 physicians, united primarily to train U.S. citizens and permanent resident IMG’s, who complete their basic sciences abroad in US clinical medicine and preparation for U.S. residency. Since the year 2000, we have directly supervised more than 19,000 medical student clinical rotation weeks, of which many are now licensed U.S. physicians in various specialties. As an ongoing commitment to quality control, each rotation is supervised by licensed Medical Doctors and Clinical Supervisors, and medical student rotation files and verification processes are digitally stored. Our medical students enjoy a seamless transition between rotations, and are trained across 38 specialties, many of whom are now physicians treating patients in underserved and shortage areas.
In the past month I have seen TV news programs that featured huge modern medical centers in Thailand and India providing care to American patients by U.S.-trained doctors at a fraction of what it would cost in U.S. hospitals. How much of the shortage of physicians in the U.S. also related to cost-cutting measures by hospitals? Is it just too expensive to hire doctors or registered nurses?
Certainly that may be a contributing factor, but definitely not the cause. Every year, we train an estimated 100,000 medical residents in the U.S., costing the U.S. taxpayer $11 billion annually. Medicare funds $8.8 billion (80,000 residents) of the cost, while the Veterans Administration and Medicaid help offset the other $2.2 billion (20,000 residents). Hospital budget cuts have surprisingly not significantly impacted job openings for practicing physicians… there are thousands of openings available nationwide which remain unfilled! American trained physicians practicing offshore are offered incentives to do so (tax cuts, lifestyle, etc…) but once again, that number is not even remotely comparable to the 850,000 active physician work force we now enjoy in the U.S.
The issue is that we’re just not training enough medical students in the U.S., which in turn means lower number of U.S. trained medical graduates for residency. Why you ask? The U.S. stopped opening new med schools in 1980’s till early 2001, when a 2 year school was built after lobbying for 10 years (the students transfer to another medical school for their 3rd and 4th medical school years). A 1994 article published in the Journal of the American Medical Association (JAMA) miscalculated a surplus of 165,000 physicians by the year 2000.
The U.S. physician demographics have also contributed significantly to our current state of the union: younger doctors working fewer hours; female physicians (50% of our physician workforce) are working 25% fewer hours than male physicians; physicians >55 work about 15% less than younger doctors; residents must now adhere to working 80 hour a week (compared to 100+ hours just a few years back); and “Baby-boomer” physicians will be retiring in greater numbers by 2016. Don’t forget about the shortage of 85,000 to 200,000 physicians by 2020, and the need to train 3,000 to 10,000 more physicians per year.
As for nurses, we are definitely feeling the shortage. We see it in understaffed hospitals, dissatisfied patients, medical malpractice cases, burnt out nurses who are stretched too thin, and U.S. nursing school enrollments that have dipped to all time lows. And the shortage is wide spread: the U.S. 2000 Census Bureau data indicated that within a decade, we will suffer from an almost 1,000,000 medical personnel shortage across all fields. Once again, the dollars are there to hire everyone needed (physicians and nursing staff combined), but we just don’t have immediate access to qualified individuals who fit the bill.
How can Iranian physicians trained in Iran or other countries benefit from your graduate program?
Successful completion of medical residency in the U.S. is an absolute requirement for anyone to practice medicine in the U.S., and residency program directors barely take any chances when selecting their residents. As one would expect, the youngest, most U.S. experienced doctors, with the least amount of accent, highest board scores and most recent medical school graduation year are selected to enter residency first. This automatically disqualifies a great number of our Iranian trained physicians. Although Iranians trained physicians are well qualified so far as their medical expertise, they must still compete with the American medical school graduate who scored a 95% on their medical board exams, completed 2 years of clinical studies in the U.S. and are less than 30 years of age!
I’m proud to say that although some Iranian physicians are tired of trying and have unfortunately accepted their defeat in vision of some day practicing medicine in the U.S., many remain firm and focused. I just spoke with a 52 year old Iranian Neurosurgeon yesterday who after 8 unsuccessful attempts at entering U.S. residency program, still has hope of one day not needing to sell Los Angeles Times newspapers on the street, and to become a Family Physician. He elected to enroll in our program because his chances at entering a residency will significantly increase: he is demonstrating a renewed commitment to residency directors, will exhibit months of hands-on clinical experience in the U.S. through our attending physicians, secure letters of recommendation from prominent practicing physicians, and if they elect to re-enroll in the final year of medical school, they may renew their medical graduation. This is not hypothetical, but a fact that we demonstrate daily.
What does your medical consulting group offer that is unique or better compared to your competitors in this field?
Our proven track record! As the leading entity specializing in educating the IMG, we have established relationships with medical schools, hospitals and physicians worldwide. We offer clinical rotations in 47 states and with more than 19,000 weeks of clinical rotations behind us, we’ve solved some of the most challenging IMG client issues. Chances are that if our programs don’t help an IMG get into a U.S. residency, little else will. Comment