Extract from American Constitution:
AMENDMENT XIV
Passed by Congress June 13, 1866. Ratified July 9, 1868.
Note: Article I, section 2, of the Constitution was modified by section 2 of the 14th amendment.
Section 1.
All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.
In sumary:
MDs have three routes of their whereabouts: currently, a lot of misnomers have been using within the medical licensing system (this proves the system confusion and awkwardness): all the doctors who already earn their medical degree are only called medical graduates, only when they have their licenses then they will be called medical doctors. This is indeed a very wrong misnomer and concept and also a demeanor to our highly educated people.
This misnomer is not only found in America, but also in other countries. The misnomer does not justify itself for we adopt it from foreign countries or they adopt it from us. The accurate terminology is any and all medical graduates who have earned their MD degrees should be called medical doctors.
THERE ARE THREE DISTINTIVE GROUPS OF MDs IN THE UNITED STATES:
1- Domestic trained: US citizens or foreigners who graduate medical schools inside American soil
2- US-FMDs/US-FMGs: US citizens (native-born or naturalized) who graduate medical school outside American soil
3- IMDs/IMGs: non-US citizens who graduate medical school outside American soil and purposefully attempt to get medical doctor career in the United States via visiting visas.
Appendix for Chapter VIII q. 43 to 51 from the Sunrise Book for Business and Professionals Development Sacramento Office of The Governor
WHO ARE USFMDs: (USFMDs/USFMGs versus IMDs/IMGs)
To actually understand the insightful depth of the core problem of the American medical licensing, we should understand the cultures of US-FMDs; how they do in their new homeland, we get to the mentality of this proposal.
The American public has a vague idea about the whereabouts of their physicians. There are domestic trained MDs yet US citizens and a small percentage is domestic trained yet non-US citizens as foreigners apply into US medical schools. This group is of a very small percentage, but they do exist.
However, the larger portion of foreign trained medical doctors much more complicated because even the same concept as foreign trained physician, there are different groups with slightly different characteristics yet critical for us to understand the slightly differences to be able to address the issue more accurately.
There are foreign trained yet they are born in the US, grow up in the US, and graduate their undergraduate and graduate degrees in the US before applying into medical schools. Then, they choose to go to medical schools in foreign countries; the main reason is to reduce the load of student loans as a domestic trained MD’s burden on graduation, no less than at least 250,000 dollars! This type of US-FMDs usually goes to medical school in the Caribbean since these schools are somewhat close to homes, but they can go to any school on anywhere of the world as long as the schools are approved by the IMED list (International medical education directory) so that they can return to practice in the US.
Another type of US-FMDs, who are born, grow up, and actually had their medical school trained in their foreign countries. These doctors immigrated to the US via permanent immigrant visas. A lot of situations are family reunions with different kinds of permanent immigration visas; but, importantly, they work on their own without any help from medical licensing system for obtaining their permanent visas to enter the US legally. These doctors, of course, want to become MDs and be able to practice in the new homeland. That is actually windfall benefits for the American people. However, these doctors who came to the US in the permanent immigration pathway are not very well informed about the licensing system and so they usually take longer time to figure out what and how they have to work on to get their licenses. This is actually not their mistakes for the ignorance and unawareness of the new country information especially the intricate medical licensing of the US. It is the country responsible unable to help them adequately. These permanent legal immigrant doctors obtain their legal American resident status as of green card holders and eventually become US-citizens. They struggle to settle down their lives in America. They work all kinds of jobs and do their citizen duty, paying tax and attending other duties in communities alongside with waddling through the licensing process all by themselves purchasing commercial medical licensing examination materials available on the market for their reviews before to sit for the real USMLEs, not like domestic trained or other IMGs who are still in medical schools and have their professors prepare “dinner tables” ready for them. Yet, the social-economic structures have not been designed to support their returns to medicine to use their skill set and knowledge to help community at their levels of expertise. This is why I believe this group of doctors should be called a distinctive name as US-FMDs. It can be grouped together no matter where they are native-born in the US or foreign-born-naturalized citizens because as an immigrant based country, there is no discrimination between a native-born versus a naturalized citizen.
Civilized versus uncivilized (jungle) freedom:
These US-FMDs, the naturalized citizen groups, are of more challenging in the licensing process to compare with all groups of MDs. This is because they are the one who are literally on their own. They have the least information and least supportive circles. They do not come to the US with the main and foremost purpose of gaining medical doctor career for themselves like the international medical doctors as described below. However, medicine is like a religion, they would of course want to return to practice medicine in the US one way or another. This is why they usually get behind the other groups and that is not their mistakes for their innocence, honesty and responsible to their lives in the new country. They usually graduate from medical school at least over five years and especially have worked in their previous countries and the time line for preparing a permanent visas takes longer than visiting visas. Many of them takes over two to five to even ten years (in case of siblings sponsorship) to get permanent immigrant visas. Many of these USFMDs with permanent immigrant visas seek immigration for the purposes of pursuing personal freedom and liberty choices following their ancestor legacies in America. They actually respect American Constitution and their premier declarations of all men are created equal and have the rights to pursue freedom, liberty and happiness. This is exactly my own life saga and the purpose of my immigration to the United State fifteen years ago. In other words, they do not only think or do not put it as the priority that coming to the US to become a MD with privileges like the later groups I will describe more in details. American freedom is the kind of civilized freedom in comparison to the uncivilized (jungle) ones.
What is civilized freedom? To simplify the definition, an example is to get in line and wait for our turn to get the services since so many people who come before and after us also need the same service. That is the civilized behavior that human beings respect each other and not behave like animals to jump into the crowd using the salvaged rule of the stronger will always wins and rule the world; this is jungle freedom, the rule of the forest!
These USFMDs are generally a more neutral and innocent group of MDs with less aggressive behaviors toward medical licensing. However, to put onto a scale of justice to measure for their endeavors, we should candidly admit that this group of US-FMDs is the best. They do everything by the DYI fashion (Do-It-Yourself) from trying to learn about the very intricate procedure of licensing, credentialing their medical school transcripts from their previous countries, purchased expensive commercial USMLE review materials and enroll into commercial USMLE review services to work on their own for sitting for their USMLEs and can pass those high-proficiency examinations. However, they are the ones who are treated the worst. They are age and origins discriminated and are cut in front of their lines in the licensing process by the group of international medical graduates IMGs/ international medical doctors.
They are like the hidden diamond treasure that the American public has not been aware of. They need to be polished to shine. This PhA-eAML project is trying to do exactly this mission! It is time we should restore justices for society and make a better life for all of us.
Why this has been for over six decades since the ECFMG established in 1956 USFMDs of this group have still been mistreated and still staying out of sight, unaware of by the American public? For the natures and characteristics of this groups, it must be the government to step in to help this group of USFMDs or they will continue to be mistreated and social unfair unjust indefinitely.
Understand the problem, I have initiated this project, working as a sole volunteer since 2010 when I passed the USMLE step 1 and working on my USMLE step 2 CK. Many other individual USFMDs also initiate their own campaigns. I have tried to do my part of contribution to bring justice and fairness to this group of USFMDs so they can return to practice medicine and help communities to relieve the problem of MD shortage. However, I have encountered much of blockades, deterrence, and indifferences from many organizations, individuals that are either directly or indirectly involve in the process of licensing I have tried to reach out for help. One of them is the ECFMG itself. They ignored us. They state that the ECFMG certificates, such a realistic and practical certificate for mid-level providers, are only use for one sole purpose is to apply into medical residencies and ECFMG certainly does report annually after each NRMP match day that more than half of these USFMDs do not get matched. Where have been these USFMDs going on with their lives? If we could find out, there must be a lot of heartbroken stories to tell. Please read the appendix of USFMDs stories.
Also, many other individuals of USFMDs who initiate the campaigns also get my supports. However, since this is such a heterogeneous group of people who come from all angles and corner of the world and life and so naturally they are very different in opinion. So although they are all oppressed and mistreated, it is hard for them to become a very strong group to fight back with the injustice monopoly licensing system. This is why the government that represents the American people should realize this is indeed a hidden treasure and free gifts from those USFMDs to the American people and they should be used properly their expertise level of medical doctors. This has been for too long overdue since 1956. And this is why I believe it is my citizen duty to be one of the whistle-blowers to speak up and make the government realize the intricate issue and step in to help us.
Other USFMDs also tried to contact with ECFMG for help and was rejected. Many other doctors contacted ECFMG complaining they have invested a lot of all and everything for this certificate and now it is useless. ECFMG replied them that this is their own problems! Which means if a USFMD could not get matched; it is because they are incompetent to be admitted into the program! The problem of USFMDs mistreated terrible, thousands of them for over six decades, are realistic! ECFMG makes the report annually and they know more than anyone else that annually over 50% of USFMDs do not get matched, called unmatched and have to go into SOAP (Supplemental Offer program) which really does not help at all for getting any slot left after the main match. It is rather wrong that ECFMG has stirred up a pessimistic, inferior complex, shamefulness on individual USFMDs who cannot get a residency slot in the national matching program NRMP annually so these mistreated USFMDs only go frustrated but would stay silent from speaking up the truth. ECFMG wants that these USFMDs believe they are rejected because of their own under-qualified status, not the faults of residency and licensing. ECFMG invented a program named ECHO, which stands for ECFMG Certificate Holder Office, the idea is to help those USFMDs/IMGs to improve better chances to get matched. However, the ECHO program actually does not help any USFMDs get a real position but wasting time to get online to listen to ECHO sponsored seminars and talks. This is only a superficial program that does not change the bad situations. ECHO said USFMDs must improve their profiles by doing volunteering and unpaid clinical work, resumes, personal statements, letters of recommendations, to try to get involved into prestigious organizations as memberships (e.g. the Alpha Omega Alpha, the Gold Humanism Honor Society), etc. Actually, these elements do not actually help the wrong system and even push USFMDs further into being exploited by the wrongdoings. They are jokes; ECFMG know this. ECFMG avoid to admit of USFMDs are mistreated. Please read appendix my emails to Emanuel Cassimatis the CEO of ECFMG. The ECHO said USFMDs should not mention political issue even these closely attach to their life experiences that has made up the individual characters. On the other hands, ECFMG has been issued too many visas for non-immigrant visitor MDs from foreign countries and this has added into the disturbing immigration problem of America violating American Constitution of ripping off the rights of USFMDs as outsourcing jobs right at home!
Many USFMDs end up to live in homeless shelters and their families have to look for government helps to apply for food stamps and their kids are living in a very low standard of life. Other USFMDs who went to medical schools in the Caribbean still have big student loans that they cannot start to pay back and the banks have put liens on their properties that make them to claim bankrupted; their situations got even worse. They have a hard time to look for even simple labor jobs. There are a small percentage of domestic trained MDs, about five percent, also cannot get matched and fall into exactly the same situations since domestic trained MDs with much heavier student loans.
USFMDs are from different origins and cultures rendered it hard to unite in their opinion. But, they still deserve justice for their contribution and hard work, instead they have been mistreated.
The other group of foreign-trained MDs is similar to the group that immigrates to the US with legal permanent visas. However, this group of MDs does not immigrate with legal permanent visas. They have the clear purpose to come to the US for personal medical doctor development purposes yet they promise to return to their countries upon finishing their residencies, yet they never do their promises. They are, on the other hand, very well-informed about licensing in the US, since they usually are still right in medical schools and are prepared all their didactic USMLE materials by their medical school professors. They tried to obtain any kinds of visas just for the purpose of entering the US. They get a lot of help from the current organizations (ECFMG, and many residency programs sponsor visas) that are directly involved in the medical licensing systems: ECFMG (The Educational Commission for Foreign Medical Graduates) usually offers those foreign MDs J1/H1 visas as called exchanged visitor visa program. The big profit for this program is that those applicants for exchange visas are all FREE for services; there is NO charges for their visa services while all other permanent visas are paid (which are the MDs with legal permanent visas have to pay all their expenses and all the fees when they apply for their permanent visas to immigrate to America. (Please see appendix about exchange visa program free of charge). These non-US-FMDs get even more benefits from cutting in front of the line USFMDs have been waiting for so long. It is estimated that the general funding for residency program to train one PGY1 and up is around 200,000 dollars per year. This funding comes from Medicare, which comes from tax-payers, US-FMDs are citizens who do their duties paying taxes and these residency programs give the jobs to foreigners. It is called outsourcing jobs right at home! (please read appendix about the expenses for training MDs in medical residencies.)
This is one of the unfair treatments that cause unjust toward US citizen FMDs because the non-immigrant types of visa MDs are more beneficial in many ways. They are often fresh graduates from medical schools from foreign countries. The residency programs often love to get fresh graduates, and that is also age discrimination against USFMDs. Besides ECFMG sponsors J1/H1 visas for those foreign MDs, residency programs also offer to sponsor visas for foreign MDs who they like their applications while US citizen FMDs usually graduate from medical schools longer since the time lost in their immigrant process. Those visiting visas MDs are fresh, and they apparently know to take advantages on their own privileges to get in front of the line, which they should indeed stand in line like US citizen FMDs. (Please see appendix: It is NOT OK to ruin our Democracy by greed and wrongdoing!) This group should be called IMDs/IMG as international medical doctors or international medical graduates to distinguish from USFMDs/USFMGs as US citizen foreign medical doctors or US citizen foreign medical graduates as the two separate groups.
Extract from American Constitution:
AMENDMENT XIV
Passed by Congress June 13, 1866. Ratified July 9, 1868.
Note: Article I, section 2, of the Constitution was modified by section 2 of the 14th amendment.
Section 1.
All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.
In sumary:
MDs have three routes of their whereabouts: currently, a lot of misnomers have been using within the medical licensing system (this proves the system confusion and awkwardness): all the doctors who already earn their medical degree are only called medical graduates, only when they have their licenses then they will be called medical doctors. This is indeed a very wrong misnomer and concept and also a demeanor to our highly educated people.
This misnomer is not only found in America, but also in other countries. The misnomer does not justify itself for we adopt it from foreign countries or they adopt it from us. The accurate terminology is any and all medical graduates who have earned their MD degrees should be called medical doctors.
THERE ARE THREE DISTINTIVE GROUPS OF MDs IN THE UNITED STATES:
1- Domestic trained: US citizens or foreigners who graduate medical schools inside American soil
2- US-FMDs/US-FMGs: US citizens (native-born or naturalized) who graduate medical school outside American soil
3- IMDs/IMGs: non-US citizens who graduate medical school outside American soil and purposefully attempt to get medical doctor career in the United States via visiting visas.