1239 



fying process of the ECFMG examination: "The ECFMG should 

 simply publish the results and let the hospital decide whether it wants 

 a man who got a score of, say, 50. In my opinion, it's better to have 

 a poorly trained intern than no intern at all." ^"^ 



A Stimvming Up of Views on FMG CompeteTwe. — In sum, the com- 

 petence of FMGs is questioned by American doctors, some of whom 

 are prominent figures in the medical profession. Concern has been ex- 

 pressed for the development of what Dr. Sprague feared might be a 

 double standard in medicine, a situation that contains at least a poten- 

 tial threat to the heretofore high standards of American medicine. 

 '\\Tiatever the reason, recent evidence shows that the confidence of the 

 American people in the medical profession has declined sharply over 

 the past 6 to 7 years.*"^ 



On the other hand. Secretary of HEW Weinberger defended the 

 competence of FMGs and favorably assessed their impact on Ameri- 

 can health care. He told the House Subcommittee on Public Health 

 and Environment, "I don't have any feeling that they [FMGs] should 

 take the place of anyone else," i.e. USMGs. He contended that FMGs 

 are not "necessarily . . . any better than anybody else but they are an 

 available source and they are being utilized." Nor did he accept the 

 proposition that utilizing FMGs "necessarily means that we are sub- 

 jecting our people to any less good care or that we are engaged in any 

 practice that is morally reprehensible." *°* 



TERMIIsrATING CAREER EXPECTATIONS OF AMERICAN PREMEDICAL 



STUDENTS 



Except for occasional Congressional comment, much of the litera- 

 ture on medical brain drain views the problem from the perspective 

 of the FMG. Virtually no attention has been given to -its negative 

 effects on the career expectations of qualified American premedical 

 students. Sources generally refer to the doctor shortage and cite vari- • 

 ous problems arising from the inflow of FMGs who are expected to 

 reduce that shortage, but they fail to consider the qualified American 

 premedical students who in effect are denied medical careers by two 

 interacting forces, namely, the short supply in American medical 

 schools and the extensive inflow in FMGs to relieve the doctor 

 shortage. 



"^ Ibid p. 29. The director of a Paterson, N.J. hospital expressed similar views: "It's 

 easy to sit behind a desk In Chicago and frame ideals about quality of care. But a sup- 

 posedly nonqualified doctor can put on a tourniquet and give the usual drugs and plasma 

 for shock to tide the patient over until an American trained doctor gets there. And 

 thfit's better than having the patient die." (p. 30). 



•03 On Dec. 9, 1973, Louis Harris published a poll that attempted to ascertain the 

 confidence of Americans "in the people who are running" such major institutions in 

 American life as medicine, higher education, military, media, Congress, etc. Gradations of 

 opinion were classified as "a great deal, only some, or hardly any confidence." In the 

 poll medicine was rated as the highest institution In which there was "a great deal of 

 confidence," 57 percent (In 1972, It was 48 percent) ; the Federal Executive Branch was 

 rated lowest with 19 percent (In 1972, it was 27 percent). But the 57 percent for medicine 

 represents a substantial drop from the 1966 figure of 72 percent (the Federal Executive 

 Branch had a 41 percent rating In 1966). Thus Mr. Harris concludes: "Basically, by any 

 standard there has been a fall in respect and confidence in the people running almost 

 every major U.S. institution compared with 1966, when we first measured it." (The Wash- 

 ington Post, Dec. 9, 1973, p. L8, and Louis Harris, Confidence and Concern : Citizens View 

 American Government, In remarks of Sen, Edmund S. Muskle (D-Me,), Cons;re»sional 

 i^ewr'/. Dec. 3, 1973, pD. S21704-S21706. ) 



•0* Hearings, House Interstate and Foreign Commerce Committee, Overtight of HBW 

 Health Programs, 1973, pp. 53-54. 



