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Editorials: Point and Counterpoint |

Rebuttal From Dr Mandel FREE TO VIEW

Jess Mandel, MD
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CORRESPONDENCE TO: Jess Mandel, MD, University of California, San Diego School of Medicine, 9500 Gilman Dr, Mail Code #0606, La Jolla, CA 92093


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


Chest. 2016;149(4):898-899. doi:10.1016/j.chest.2016.01.012
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I thank Drs Allman, Perelas, and Eiger for their excellent arguments in favor of continuing to offer postgraduate training in the United States to international medical graduates (IMGs). We clearly agree on a number of important points: that IMGs currently comprise a significant portion of the US physician workforce, that the current US medical education infrastructure is incapable of fully meeting the nation’s need for physicians, and that IMGs are a convenient (for our country) source of physicians for meeting this shortfall.

However, we part ways in terms of what we view to be the most ethical path forward. Whereas the authors invoke “the altruistic tradition of medicine” to support the current practice of accepting IMGs into the US health-care system, I believe that the current practice is anything but altruistic. Rather, it is a means for the United States to meet its workforce needs on the cheap and in doing so, create a “brain drain” of capable physicians in other parts of the world.

This chain of events has real and harmful consequences for individuals living in the countries of origin of IMG physicians, and we should not be a party to it. Although it may make us feel virtuous to welcome IMGs to the United States for postgraduate training and beyond, this sense of virtue is false given the downstream costs inflicted on some of the globe’s most vulnerable populations who are thereby deprived of access to care.

Because the contribution of IMG physicians to the US workforce is so great and our ability to produce the number and type of physicians that we need currently is underdeveloped, it would be imprudent to instantly cease to offer postgraduate training to IMG physicians. However, we need to set a path toward this goal. The status quo is morally unacceptable and therefore we need to begin the laborious process of aligning US health-care education and training capacities with US workforce needs. The ethically dubious era of draining capable brains from around the world so that we can avoid making the necessary investments in US physician training and clinical infrastructure needs to pass into history.

References

Allman R. .Perelas A. .Eiger G. . Point: Should the United States provide postgraduate training to international medical graduates? Yes. Chest. 2016;149:893-895 [PubMed]journal
 

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References

Allman R. .Perelas A. .Eiger G. . Point: Should the United States provide postgraduate training to international medical graduates? Yes. Chest. 2016;149:893-895 [PubMed]journal
 
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