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Editorials: Point and Counterpoint |

Rebuttal From Drs Allman, Perelas, and Eiger FREE TO VIEW

Richard Allman, MD; Apostolos Perelas, MD; Glenn Eiger, MD
Author and Funding Information

CORRESPONDENCE TO: Apostolos Perelas, MD, Department of Medicine, Einstein Medical Center Philadelphia, 5501 Old York Rd, Klein Bldg, Ste 331, Philadelphia, PA 19141


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4):897-898. doi:10.1016/j.chest.2016.01.010
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Dr Mandel’s case for not exploiting international medical graduates (IMGs) is a strong one and we appreciate his historical overview. We concur that deficient programs that historically may have recruited IMGs served neither the educational needs of their residents nor the medical needs of the community. However, we do not make the leap to a view that the best way to prevent this exploitation is to limit entry of IMGs to graduate medical education (GME). Rather, we argue that strong oversight as provided by the Accreditation Council for Graduate Medical Education ensures that GME is fulfilling the highest standards. In addition, the lesser appeal of internal medicine and some of its subspecialties to USMGs has rendered Dr Mandel’s argument less compelling.

We share Dr Mandel’s concern about the “brain drain” from developing countries. The “push factor” from impoverished regions to the United States for superior training and practice opportunities is real. Despite the moral implications of this reality, we acknowledge Article 13 of the Universal Declaration of Human Rights allowing the free movement of people between borders to fulfill their aspirations. The United States is a nation of immigrants and has a long tradition of respecting individual autonomy and the right of people to prosper based on merit. Instead of preventing IMGs from entering the United States, we propose encouraging them to return to their home countries, at least for a period of time. Helping these countries develop a modern infrastructure and health-care system might allow them to keep their brightest medical graduates. We also recognize a domestic “brain drain” in which USMGs choose not to go to less desirable areas. This “brain drain” has been alleviated by IMGs. Are we prepared to turn off that supply in the face of an American cultural resistance to being told where one must practice?

We concur with Dr Mandel’s concerns that training programs not exploit residents and fellows; that concern is unrelated to the training of high-caliber IMGs. IMGs will continue to be an important pool of trainees, faculty, and direct providers of patient care in many specialties.

With increasing numbers of USMGs and resistance to the expansion of residency caps, we acknowledge the pressures confronting advocacy for the inclusion of IMGs in GME. We suspect that USMGs will always receive preferred treatment in the recruitment process, especially for the most competitive of specialties. Nonetheless, for reasons of diversity and welcoming ingrained in our national and professional heritage and for the good of our profession, we respectfully disagree with Dr Mandel and restate our belief that training programs and our profession and society are best served with a diverse pool of trainees, irrespective of the country of origin.

The need for practitioners and clinical educators will remain in those specialties that find recruitment more difficult. To turn our backs on a gifted cohort of applicants is to neglect a vital resource of clinicians, educators, and scientists. The major tasks are to bring the numbers of residency programs in line with societal needs, to provide robust oversight of the quality and experience of those programs, and to recruit the best and brightest.

References

Mandel J. . Counterpoint: Should the United States provide postgraduate training to international medical graduates? No. Chest. 2016;149:895-897 [PubMed]journal
 
United Nations. Universal Declaration of Human Rights. Article 13. 1948.
 

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References

Mandel J. . Counterpoint: Should the United States provide postgraduate training to international medical graduates? No. Chest. 2016;149:895-897 [PubMed]journal
 
United Nations. Universal Declaration of Human Rights. Article 13. 1948.
 
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