America from the Outside, Medical Education Edition


Mulago National Referral Hospital, in Kampala

“Now, slaves are paying to go and be slaves.”

That’s from a prominent Ugandan academic and physician as he was speaking at a surgeon’s conference I (rather implausibly) attended recently in Soroti.

He was referring to an offer an American teaching hospital gave to a few expert, experienced Ugandan physicians to practice in America for a few months.

The catch? “Practice” is a relative term. The Ugandan physicians wouldn’t be allowed to touch a patient.

The hospital may as well have said, “We want you to come learn in America, but, your years of practical knowledge and training notwithstanding, we don’t trust you to help an American.”

There’s been a lot of great discussion about Catherine Rampell’s article in the New York Times on the onerous regulations and ridiculous strictures that bind foreign physicians – many of whom have years of experience – in their quests to practice medicine in America. Among other things, foreign physicians often have to redo residency – a grueling, underpaid entry point.

Welcome to America.

The one thing the article left out was how these regulations look and feel to foreigners living outside of America. The view isn’t pretty.

Implicit assumptions abound: your country can’t train its clinicians, you can’t take care of patients, you’re not good enough, we can’t trust you, etc. etc. (As Karan Chhabra notes in an excellent post, there’s no evidence to support this – the opposite, actually).

It seems deeply condescending, and I have to imagine it must feel awful to be on the receiving end. The Ugandan physician’s quote above is a bit… extreme, but captures the frustration he and many of his colleagues share.

To be sure, America’s hospitals need to ensure that patients receive excellent care, and these strictures are one way to accomplish that.

But I imagine there are more respectful ways to keep patients safe while also appreciating the expertise of a foreign-born doctor, in a way that maintains their dignity and autonomy.

Surgeons can be supervised by the Chief of Surgery of the hospital. Ditto for anesthetists and other procedure-based roles. A Medicine physician could round with the attending for a few weeks to establish she knew enough to go it alone. An entire residency program seems unnecessary.

We Americans don’t have a monopoly on talented physicians or worthwhile medical education. Let’s stop pretending we do.

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