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think, are not the equivalent of our own physicians. And it is not like 

 we have more of a kind; we do not have. We are getting a double 

 standard. And I think this is something we need to recognize." ^^* 



The Association of American Medical Colleges, in a recent task force 

 report, reiterated the concerns of Dr. Sprague about the emergence of 

 a double standard in American medicine. The task force declared: 



In reality, there is no examination available for measuring professional com- 

 petence. Hence we are faced with dual standards for admission and are condoning 

 the evolution of a dual system of graduate medical education. Currently a Tittle 

 over one-half of the physicians entering the American system are products of 

 accredited United States medical schools, while the balance for the most part 

 represents products of unaccredited education systems. This double standard 

 results in wide disparity in the quality of physicians admitted to deliver care 

 in the United States. It undermines the process of quality medical education in 

 this country and ultimately poses a threat to the quality of care delivered to the 

 people."* 



That the emergence of this double standard has had an adverse effect 

 on American health care is particularly evident in the fields of psy- 

 chiatry and anesthesiology, both of which have high concentrations 

 of FMGrs. According to Dr. E. Fuller Torrey, special assistant to the 

 Director of the National Institute of Mental Health for International 

 Activities, and Dr. Robert L. Taylor, who is on the staff of NIMH's 

 psychiatric training branch, an estimated 3,100 foreign trained, unli- 

 censed physicians form the bulk of the psychiatric staff at State mental 

 hospitals, prisons and institutions for the mentally retarded. An AMA 

 spokesman has estimated that the number was more like 7,500. Both 

 officials told the annual meeting of the American Psychiatric Asso- 

 ciation meeting in Dallas in May 1972 that these FMGs are a form of 

 "cheap labor." Most American psychiatrists, they said, shun jobs in 

 these institutions. But, they said, the FMG psychiatrists were no sub- 

 stitute. Many have had little or no psychiatric training in their foreign 

 medical schools ; they often have a poor command of English, if any 

 at all, and have little understanding of American culture. "Imagine 

 the difficulty, for instance, of a psychiatric resident from Korea," they 



"">* Hearings, House, Government Operations Committee, Brain Drain, 1968, p. 86 

 Dr. Dublin noted that FMGs coming to the United States "bring with them an educa- 

 tional background considerably different and often technically Inferior to that provided 

 in medical schools here" (p. 8X2) and seemed to Imply the posslbllltv of a threat to the 

 "maintenance of high standards of medical practice In this country" by attributing 

 equivalency of medical education obtained In any medical school in the world (p. 875). 

 Dr. Fein Indicated that the primary purpose of Internship and residency was education. 

 Foreign Interns and residents, "generally not as well trained," were recruited, he said, 

 "primarily for service." And he adds : "Thus it is the very sick hospitalized patient who 

 is often cared for by the poorly trained physician." Thus he concludes : "It is clear that 

 American medicine cannot easily .iustlfy dual standards. Yet dual standard exists." (Fein, 

 op. cit., pp. 86-87.) Professor Adams concludes that medical brain drain, 60 percent of 

 which comes from the LDCs, "may have caused a deterioration in U.S. medical standards." 

 He quotes from a study by the Adlal Stevenson Institute which implies this conclusion : 

 "We have not faced up to the problem of our own health manpower shortage. Good 

 medical schools have refused to lower admission standards. Supposedly this protects the 

 quality of the profession, but in fact the shortage is filled by poorlv-tralned FMGs." 

 (Adams, "Talent That Won't Stay Put," p. 79.) Professor Butter makes the same point: 

 "The brain drain of physicians has also had a significant Impact on medical care In the 

 United States. It is commonly believed that foreign medical graduates (FMGs) are not 

 as professionally competent as American medical graduates. Thus, the large number of 

 FMGs In the United States (one out of every six physicians) has led to the fear that the 

 quality of medical care in America Is being seriously lowered." (Butter, op. eit., p. 18.) 

 ^ Association of American Medical Colleges, Report of Task Force on FMGs, Mar. 22, 

 1974, p. 6. Quoted in. Sen. Edward M. Kennedy, Remarks In the Senate. Congressional 

 Record, June 5, 1974, p. S9680. 



