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I'd be interested in knowing what percentage of mds in NV studied abroad. Let's face it, with few exceptions, LV doesn't exactly draw the cream of the crop in any profession. It's a tough choice, LA Jolla, or LV.
You mean to go to La Jolla to live or go there for health care?
People complain about it here, bet most don't even live here. Or dont use the system.
I don't think its so much a health care problem but a health insurance problem with crappy offerings.
Hubs has a rare disease. It's fine now but when it acts up, its ugly and will eventualy kill him.
There is a doctor here who treats it, and the other closest is in Denver.
The scary part about this is I know
someone else who has it and is in her 30's. Hubs is 70 and just got it 2 years ago.
No its not contagious, its enviromental. Msot of us will never/or could ever get it.
OH OK! That is interesting, guess they paid you off. Don't blame you, what good what it do to take on Satan. https://goo.gl/images/Q9Bh5o
I can honestly say I have some great doctors who care about my & hubs health. Better than the last palce. I can't say As I move here at 40+ and hardly ever went to doctors.
But it took awhile. I have this strange feeling I wrote this before.
They didn't "pay me off", silly. I came about the information while doing a consulting gig. I've consulted for a lot of big healthcare groups ( and small ones ).
When hospitalized, the nursing staff is the most important thing. You can have the best doctor in the world ( and there ARE some really good ones here) but when you have a nurse walk into a room, pick up random trash off the floor, and not change gloves or wash hands before reaching to adjust someone's catheter, there's a problem. And I've seen it.
100% agree with you. That's the truth. And there's plenty of nurses at the hospitals here that are lazy/don't give proper or safe care, too. And of course there's a handful of good ones too.
I'd be interested in knowing what percentage of mds in NV studied abroad. Let's face it, with few exceptions, LV doesn't exactly draw the cream of the crop in any profession. It's a tough choice, LA Jolla, or LV.
There are many, many foreign doctors here practicing in town. In fact, I'd say 75%+ in the hospitals I work in are foreign educated.
They didn't "pay me off", silly. I came about the information while doing a consulting gig. I've consulted for a lot of big healthcare groups ( and small ones ).
Ok - sorry - didn't mean it as it sounded. Your job sound interesting.
Yes there are many doctors here from overseas. MY understanding & NLVgal might be able to confirm this. They still have to go through medical school here. Or maybe that depends on the state.
Does CD have it's own grammer or spell check, mine is not working with CD.
I can address what the international medical graduates go through to work in the United States from experience.
Yes, Las Vegas is International Medical Graduate (IMG) friendly. There are several steps they go through to practice medicine here and it takes several years.
In short, the reason Las Vegas has so many foreign doctors is because there is a doctor shortage in Nevada. This is partly due to reimbursement rates for physicians and the monopoly by the insurance providers in the region, and until recently the former lack of medical schools and residency programs being expanded. Where Nevada should be in the thousands of doctors per captia they're in the hundreds. The international medical graduates fill that gap, but it is still not enough. Nevada is right near the bottom at 49th or 48th for doctors per capita.
As IMGs they go through a rigorous process. First they apply through the Educational Commission for Foreign Medical Graduates (ECFMG) here in the United States.
They can only apply for it if they've completed medical school in their home country and that country's medical school is approved and recognized by the ECFMG in the United States. Not all medical schools make the list but there are around 400 of them that do.
Then they sit for the United States Medical License Examinations (USMLE). These are the same exams that the United States Medical Graduates (USMGs) sit for starting in their second year of medical school. For IMGs this portion is like doing medical school all over again because they have to start from the beginning again and independently study the material for months and take the practice exams to see where they stand before sitting for the Steps. You're only allowed to take the exam once unless you fail the exam. Otherwise, you're stuck with your score and a failed attempt is a mark against them, so it's very serious they get the best score possible as these scores open doors. If it's been years since they studied this material they may wait a year or longer of studying before even sitting for the first exam.
For the USMLE's there's several Steps:
Step 1: Tests your basic knowledge of biology, mathematics, physics, so forth. It's one day - 8 hours - broken into 60 minute blocks.
Step 2 is in two parts.
Step 2 CK: Tests your clinical knowledge on diseases and everything you learned in medical since the basic stuff. It's one day - 9 hour exam - broken into 60 minute blocks.
Step 2 CS: Tests your clinical skills. This is set up as an actual clinic where actors pretend to have symptoms and the medical students preform the tasks of a physician from assessing symptoms, preforming an examination to diagnosis and writing a report. It's only offered in five cities around the country: Philadelphia, Chicago, Atlanta, Houston and Los Angeles.
Step 1 and both parts of Step 2 are needed to become ECFMG certified and eligible to apply for the National Residency Matching Program (NRMP) through the Electronic Residency Application Service (ERAS). The NRMP is known as "The Match".
The Match is where fourth year USMGs and IMGs apply to residency programs across the United States in September of every year and travel to hospitals across the country from Sept - Feb for interview invitations.
Then the Rank Order Lists (ROL) for the hospitals and the applicants are submitted in February and they run the algorithm. The algorithm matches the hospitals preferences of who they want to hire with the applicants preferences of where they want to do residency. By mid-March every one learns where they Match. Match day is called "Black Monday". Ours was on March 17th. St. Patrick's Day. The day my husband and I met which was ten years prior to our "Match" day. I love that tidbit. However, the students don't find out where they matched until that Friday. From "Black Monday" until the official "Match Day" on Friday there is "the scramble". The scramble is now called SOAP since it went electronic. It's for everyone else that didn't match to find a spot in a residency program that didn't fill a slot. Thus "the scramble" for hospitals to fill their programs up and students who didn't match to find a placement. Something like 5% of USMGs don't match each year for various reasons, but it's almost assured that they will compared to the IMGs.
Out of the IMGs only 50% of those that apply for the ECFMG certification become eligible for the NRMP.
Out of that half that apply for the NRMP on average only 50% them match into a residency program.
So the 25% left of the International Medical Graduates going threw the process here are the cream of the crop.
Plus most of them have already completed medical school and residencies in their home country and have been doing private practice for several years. This was the case with my Husband.
Well, first he had to serve his mandatory military duty in the Army of his home country as a doctor of a medical point serving 2,500 soldiers. Then we did private practice in a resort town of 250,000 people mainly serving foreign tourists which used English as the primary language. It was a European certified clinic so they billed through European insurance companies.
Because these IMGs have completed medical school, residency training programs and most did private practice prior to coming to the United States the ECFMG allows them to sit for their Step 3 of the USMLE if they wish too and well before the USMGs are allowed to.
USMGs typical sit for Step 3 after their first year of Residency is complete. The first year is called "Intern year" where they are under direct supervision of a practicing physician.
Step 3: Allows them to practice medicine without direct supervision. This takes the training wheels off so to speak. IMGs that take Step 3 prior to applying for the match have an edge due to this as it makes them a more attractive candidate when going threw the application process.
The medical new year across the United States is July 1st. So 4th year medical students can find out where they matched in March. Then make plans to move there before graduation in May or June. Then they move and start Residency at whichever hospital program they matched at. The Match is a legally binding contract. So they have to go wherever it is they matched or risk not being eligible to apply for the match again because they didn't fulfill their contract. Sometimes they can switch programs and residency specialties after completing the first year if they can find a spot elsewhere. Not impossible but not common.
Some specialties are on a different cycle and have different tracks for application times and interview seasons. I think ophthalmology and urology are on similar but separate tracks.
Residency is what IMGs have to repeat when coming to the United States in most instances. Residency can be anywhere from 3-7 years with the option of an additional chief year or administrative year. Then if they want they can apply for another residency or a fellowship which is a sub-specialty of a previous residency. In other countries this could be considered getting your PhD on top of your Masters. So residency is a Masters program in some countries and Fellowship is a PhD. My SIL did her PhD at Johns Hopkins in Baltimore for Cardiology. She's an International and EP Cardiologist in her home country. My BIL is an Orthopedic Surgeon and also did his PhD in this at Johns Hopkins. Both are the top of their careers in their home country but here they'd have to repeat the the process from the start like all the rest of the IMGs.
Fellowship lasts anywhere from 1 - 4 years. When applying for Fellowship they apply in July of the year they area going to graduate Residency and they interview until November and find out where they match in December. Then they complete residency in June and move for fellowship starting on the same Medical New Year date of July 1st across the country for most Residency and Fellowship programs.
We did our residency in Las Vegas and we're in Portland for fellowship. We've lived in two countries, 4 States and 10 cities for medicine. Due to the additional Immigration process we weren't always able to live together. It took three years of our marriage for my husband to immigrate to the United States. Which is a whole other story I'm happy to close the chapter on. Our journey has been a long one and it never really ends to tell the truth. Though we are done with immigration with Naturalization. There's still continued medical education and the re-certifications of the medical boards every few years. So there's always more training and exams to stay practicing in medicine, but after you get out of training it does get better some.
There are a lot of nuances that I didn't go into on here with the matching process. As just laying out the basic outline can be overwhelming for those reading it that have no idea what goes into this entire process.
Hope this helps clarify some things.
Last edited by Merrily Gather; 11-20-2017 at 11:56 PM..
Reason: added to the last few paragraphs
I feel for you for just having to type that. What a situation. So why do many of the foreign doctors first go to northern Nevada, typically do one year and then travel south to practice in the Las Vegas area?
I feel for you for just having to type that. What a situation. So why do many of the foreign doctors first go to northern Nevada, typically do one year and then travel south to practice in the Las Vegas area?
I feel for you for just having to type that. What a situation. So why do many of the foreign doctors first go to northern Nevada, typically do one year and then travel south to practice in the Las Vegas area?
I'm guessing, but likely because Reno is where the med school is located. We are supposed to be getting one soon, which might alleviate the shortage of doctors somewhat, but because the insurance companies here like to pay 20% LESS than Medicare, we will likely still be short.
I'm guessing, but likely because Reno is where the med school is located. We are supposed to be getting one soon, which might alleviate the shortage of doctors somewhat, but because the insurance companies here like to pay 20% LESS than Medicare, we will likely still be short.
What's up with that? When I lived in Nevada I would occasionally hear people claim that the Nevada Dept of insurance was cherry picking which health insurers could sell in the state, basically creating a monopoly - is that true?
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Hubs is 70 and just got it 2 years ago. 
