1233 



cal care in or out of hospitals in this country, and whether they are 

 prepared for the health care of their own people. Rather, the study, 



. . . extended the accepted practice in the United States of evaluating student 

 performance through the observations of their supervisors and mentors. It did 

 not conclude that FMGs are professionally incompetent ; it did establish the fact 

 that they represent a level of competence significantly lower than the USMGa : 

 in the same program of graduate education.^^ 



Margulies and Bloch alluded to another study on the same subject 

 by Jacob C. Halberstam and Michael M. Dasco. Though using differ- 

 ent terms of reference, their findings were similar. Of special interest 

 in this study was the self -evaluation of the FMGs. The FMGs agreed 

 with their supervisors and colleagues in rating the USMGs above 

 themselves. None rated themselves as "much better" than the USMGs. 

 Half of the FMGs conceded that USMGrs did work of higher quality 

 than they, and 72 percent admitted to their own inferior knowledge of 

 basic medical sciences. Supervisors of both groups stated that the need 

 for considerable or constant supervision occurred six times as fre- 

 quently among FMGs as among USMGs.^^^ 



By both criteria, therefore, performance on examinations and per- 

 formance as interns and residents, the FMGs do not match the higher 

 standards set by the American medical profession. Margulies and 

 Bloch reaffirm their negative appraisal of FMGs in a sweeping con- 

 cluding statement to their chapter on professional qualities. "Consid- 

 ering the total lack of evidence to the contrary," they write, "we must 

 conclude that FMGs have a lower level of professional competence 

 than United States medical graduates initially, when they take the 

 ECFMG examination, during their period of graduate medical edu- 

 cation in this country, and finally at the time that they take state 

 board examinations." ^^^ 



FMG Competence: Some Critical Evaluations hy American 

 M.D.s. — Other M.D.s who have studied the medical brain drain prob- 

 lem and its impact on American health care have made similar nega- 

 tive judgments. Dr. Charles C. Sprague, dean of the University of 

 Texas Southwestern Medical School, warned the House Government 

 Operations Committee of an evolving double standard in the medical 

 profession. He said that there were five States where more than half 

 of all persons engaged in graduate medical education were FMGs. In 

 some States, more than half of the newly licensed physicians in 1966 

 were FMGs. And he issued this word of caution : "Now, these are at a 

 standard that I think by any criterion you would apply or virtually, I 



691 Ibid., p. 52.. 



sf^Ibld., p. 52. ^^ . 



^^ Ibid., pp. 55, 58. Dr. Margulies reiterated the substance of this stateinont In a letter 

 to the House Government Operations Committee, see hearings on Brain Drain, 196b. i>. 91. 

 A similar judgment is rendered in the MargiiUes-Bloch study : "The United States gets 

 a phvslcian who has been educated in a medicnl school which does not meet our standards, 

 trained in hospitals here that have done little to correct his deficiencies and who finally 

 leaves the hospital \^•illing but still doubtfully prepared to practice medicine somewhere 

 in this country." (p. 40) -^ „„ «-, 



For other judgments on the quality of FMGs. see Stevens and Vermeulen. The Ques- 

 tion of Competence," op. clt.. pp. 41-47. Tliey reach the following skeptical conclusion: 

 "In summary, hard data about the actual performance and role of the foreign pnysiclan 

 In different educational and specialty milieus are marked chiefly by their absence." They 

 make a special plea for lurther research on this problem. 



