1238 



but if it involves an explanation, they need help." Mr. Kessler noted 

 the problem of lawsuits that worry the Center's oJEcials, examined the 

 salary structure and method of payment for services, and concluded 

 with an acknowledgment by Dr. Albert that the problem in anesthesi- 

 ology was not method of payment, but, in Kessler's words, "the lack 

 of good anesthesiologists." ®°° 



Tangentially related to the matter of competence is the practice of 

 some hospitals in appointing FMGs to hospital positions without 

 ECFMG certification to graduate educational programs. "Repeated 

 episodes" of such improprieties have been reported by the Council on 

 Medical Education, to the extent that it felt compelled to issue warn- 

 ing to hospitals, State medical societies, and State licensure boards.*"* 

 Such action was taken as evidence of "a significant effort" to circum- 

 vent the ECFMG. Presumably situations like this arise from the heavy 

 demands placed upon hospital administrators and the objections of 

 many to restrictions placed on whom they could appoint to "house staff 

 positions. As one New York hospital administrator said of the certi- 



600 Ronald Kessler, "The Hospital Business— IV. . . . Accidents In Anesthesia" The 

 \Vashtnffton Post, Nov. 1, 1972, p. Al. Rep. James W. Svmlngton (D-Mo ) raised the 

 tjuestion of linguistic competence of FMGs and their cultural Incompatabllltv with Ameri- 

 cans, in hearings on the oversight of HEW programs. The problem of the FMGs he said, 

 must be considered In the light of the barefoot doctor of China who grows up in his 

 community and knows how to deal with the people and in the light of the complaints of 

 the black American community. I don't know whether you heard these complaints but 

 they are to the effect that so often the poor go -to the hospital where they are treated by 

 men who cannot even understand their language and that they are being treated by 

 people with absolutely no understanding of their cultural background." Mr. Weinberger 

 replied : "... I see nothing inherently wrong with the utUizatlon of foreign trained 

 doctors if they are qualified and if they can fulfill the need In a particular area. While 

 It may be ideal to have someone treating patients with the precise ethnic social and 

 cultural background of all these patients, I don't think we are close to appropchlng that 

 and I am not sure It is all that good an idea anyway." (Hearings, House, Interstate and 

 Foreign Commerce Committee, Oversight of HEW Health Proprams, 1973 p 56 ) 



«"i Stevens and Vermeulen. op. clt., p. 34. 



That the use of unlicensed FMGs is a fairly wide practice was Indicated in a study 

 published on June 20. 1974 in the New England Journal of Medicine. Undertaken at the 

 request of the Educational Council for Foreign Medical Graduates, the study was directed 

 by Dr. Robert J. Weiss of Harvard Univer.sity with the a-ssistanoe of his professional 

 colleaeues. Dr. Joel C. Klelnman, Dr. Ursula C. Brandt, Dr. Jacob J. Feldman. and 

 Dr. Alms C. McGulnnes. 



The report, which was based on a survey of 4,035 FMGs now working in the United 

 States, stated that a growing "medical underground" of thousands of foreign-trained 

 doctors were practicing medicine without licenses and often without supervision in many 

 American hospitals. These uncertified doctors, most of whom either failed to pass or 

 have not 3et taken the necessary American licensure examinations are, according to the 

 report, making crucial diagnostic ahd therapeutic decisions affecting t 'e outcomes of 

 patients' Illnesses. Though many of the doctors were offlclallv hired as laboratory tech- 

 nicians or assistants in various lower-level Jobs categories, they often assumed responsi- 

 bility, the report s.'ild, for patient care, without consulting licensed phvsicians. The ques- 

 tion of leg.ality of this practice was not examined by the authors of the report, but as 

 the press account said, "the findings are likely to arouse debate on whether the doctors 

 or the hospital oflScials who accede to the practice as a way of coping with a doctor 

 shortage are legally liable." 



In an interview Dr. Weiss said that the "medical underground" consisted of M.D s 

 lacking American credentials who, though called X-ray technicians, laboratory assistants, 

 or by some other title in their job description, actually act Independentlv as physicians. 

 Some perform surgery in the operating room or In the- emergency ward ; others give 

 anesthesia: many practice psychiatry; some read X rays. "A few look under a micro- 

 scope at biopsy specimens in pathology laboratories to distinguish between cancers and 

 benign tumors, for example," and. as the press report stated, "determine what course 

 the surgeon must take while the patient is anesthetized on the operating table " 



Dr. Weiss said that he became interested in studying the FMG problem after other 

 'wealth specialists detected a gap in the AMA's listing of physicians. Doctors with partial 

 licenses, he said, were not recorded in a systematic wav and that the AMA had no way 

 of learning the names of FMGs unless they entered formal training programs. To 

 emphasize his point. Dr. Weiss said that when calling one noncertlfied doctor in North 

 Carolina, the person answering the phone replied that the doctor was busy caring for 

 patients in his oflBce. AMA records cited by the Harvard research team showed at least 

 lO.onn unlicensed physicians working in the health field In 1971. The precise number 

 of FMGs practicing without license or examination certificates Is unknown. (Lawrence 

 K. Altman. "Many Foreign Physicians in U.S. Found Unlicensed," The New York Times, 

 June 20. 1974. p. 1) 



