re: Medical residency spots being taken by foreign students

There used to be significant financial benefits for taking minority or foreign grads for residences. Don't know if those are still in place, but I'm sure they are. Just look at the staffing of the programs. Medical education and producing quality physicians hasn't been a priority since the early, early 2000's. Now it's just a bunch of triage nurses with an MD.

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US grads don’t want to go to someplace like Shreveport

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are you retarded?

There’s a lot in what you’re saying that I think people outside medicine miss—especially the point about how different the selection into primary care looks now compared to a generation ago.

I do wonder how much of what you’re seeing is about changes in training vs changes in incentives. When you’ve got big differences in pay, workload, and prestige across specialties, it seems like that’s going to shape who ends up where, even if the raw talent pool hasn’t changed as much as it feels.

What you’re doing with training your own people is interesting - it almost sounds like you’re rebuilding the kind of apprenticeship model that used to exist more informally. Do you think the system as a whole could support more of that, or is that only workable at the practice level?

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What's Trump gonna do about it...

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He said he was going to let in 600,000 Chinese students so our universities can stay open.

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how financial incentives play into your PCP's office more and more likely to be staffed with IMG's and/or NP's.

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And they don't teach them how to make money. When I finished in 2003, I was kept on as part time staff to teach endoscopy, derm procedures, joint injections, gyn procedures etc. The shite you can make money on. I got $100k/year for one day/week. I did it for a little over 3 years before they decided a cheap arse foreign grad could do it, even though he had zero experience and had done less than 10 scopes in 3 years, but somehow they got someone to sign off on his credentialing. Within a year, they had to shut down the GI lab and they lost the $500k plus revenue I was producing them. 5 years later they were broke and shut down. Academics HATE other doctors making money, even if it benefits them. The program director, a phD, was livid that I made $100k for 1 day a week and he only made $150k/year. He produce zero revenue and contributed zero to medical education. I don't know wtf he did other than collect a check. Even he couldn't answer me when asked. He coordinates things was basically his answer. I was also teaching other things such as EKG interpretation, PFT's, ER and inpatient procedures and readily available for questions regarding pt care. The system is broke.

They since are re-opening this July with 4 IMG's. The staff they have assembled is absolutely atrocious. I have yet to be contacted on being a preceptor or even giving advice on educational matters despite having a resume that blows everyone available to them out of the water. They don't want to get better. If you're not a minority or female, you're not getting on staff. I don't give a shite, but this DEI bullshite has destroyed medicine and pretty much every other industry.

What you’re describing actually feels like a pretty important signal about where the system might be drifting.

If people who are motivated to build something like that are mostly finding willing learners outside the traditional MD pipeline, that suggests there’s something about how physicians are being selected or socialized now that’s shaping what they’re looking for early in their careers.

The apprenticeship piece is interesting too - medicine moved pretty hard toward standardization over the past few decades, but it seems like some of the practical and financial aspects of practice don’t transmit as well in that model.

Do you think what you’re doing is something that could scale or does it more depend on having a very specific kind of practice and personality driving it?

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Do you think what you’re doing is something that could scale or does it more depend on having a very specific kind of practice and personality driving it?

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It could, but I am in a unique situation. Not that it couldn't be duplicated elsewhere. The old system allowed the mentor to make money of the apprentice. In return, the better mentors were able to prepare them for practice or get them in with better specialists in their desired field. The doctor that started our practice in the forties did this. Most of our top, older specialists came through here before moving on. It didn't hurt that he was President of the AMA way back and had a huge network. I saw the advantage of that and have tried to keep it going. The problem is that the system intervened and you have to go through their residencies to be certified and get credentialed. Many don't have the foresight or patience to apprentice for a year or two before moving on. Hell, even the doctor I brought in thinks he knows better and he's broke. He was top 10% of his class and one of my chief residents when I was a student. He lets his ego get in the way and has floundered. He still makes a income that is well above average, but only because of the extremely low overhead environment I've created and a few smaller industrial accounts I've given him.

The biggest problem with scaling up is how the current system is set up. Let physicians train in or out of the system and take their boards. It won't take long to see the benefits of being able to train with the best doctors you can find versus those educators in the traditional system that have either failed in private practice or never tried.

I have been talking with our Governor, Tom Cotton and Bruce Westerman about out of the box ideas to help rebuild rural healthcare and with Alice Walton through a proxy. Not even going to act like I know her. She's starting a holistic medical school in NWA and the first 4 classes have free tuition. I'm all for alternative and natural treatments as well as incorporating eastern medicine, diet etc into healthcare, but my concern is the real deal medical training may suffer. There's a place for both, but there's a lot of fluff in the curriculum. They never seem to consult the right people before they drop billions of dollars on shite, then they feel compelled to stay the course.

They are also taking our food and businesses. There are 20 KFC's in Mumbai and about half that many in Tampa. A chicken sammy combo meal is 328 Indian rupees (about tree fitty) and the same thing is $8.79 in Tampa.