The US is Compromising Patient Safety by Cutting Corners for Foreign Medical Graduates

Our focus at Concerned Doctors of America is that the exceptional quality and rigor of American medical training not be compromised by States that face a shortage of doctors.

We support the efforts at the Federal and State levels to increase funding so that more three year residencies are available to medical school graduates. We also support immigration reforms that allow Foreign Medical Graduates (FMG’s) to obtain permanent residency status in the US on an expedited basis. Immigration requirements need to be modified by the US Congress to help meet the US demand for fully qualified doctors.

What we oppose is the lowering of medical residency requirements that allow FMG’s to become general practitioners, medical specialists, or even surgeons in the US. The lessening of standards creates enormous risks for the US medical system while endangering patients.


Foreign Medical Graduate (FMG): A doctor born, educated, and trained outside of the United States. FMG’s enter the US on visas and must train to US standards.

International Medical Graduate (IMG): An American-born doctor that is trained and educated outside of the United States.

These two terms are sometimes used interchangeably. However, the emphasis remains the same: FMG’s and IMG’s are doctors who were educated and trained outside of the US.

There is a dangerous trend in which US States allow FMG’s to obtain an unrestricted medical license based upon as little as a one year internship — which is not a residency — as a general practitioner. This in turn allows FMG’s with an unrestricted medical license to practice as medical specialists without having done a full three year medical specialty residency.

How does this happen?

In certain cases, some States have allowed FMG’s to use a one year fellowship in lieu of a formal residency when they take up practicing as specialists. This begs the question: How is an FMG allowed to do a one year residency and then enter a one year fellowship? Where is the regulation at the level of medical schools that allow this?

Those US States that allow this sort of workaround effectively place unqualified general practitioners into extremely demanding specialty fields — particularly surgical specialties.

The fundamental requirement of a surgeon is that he or she has the necessary training and experience to perform the procedure safely. Can FMG’s who have not done a formal three year residency under the supervision of highly experienced Board certified surgeons meet this fundamental requirement? Would you allow a loved one to undergo a complex surgery at the hands of a surgeon who has not completed a full surgical residency and a fellowship?

FMG’s that have not completed a formal residency cannot become Board Certified specialists and yet they are nevertheless allowed by some States to practice as specialists. Who is served by this except the FMG’s who are gaming the system and not giving their patients the best possible care?

In our next article we explore the regulatory context that is behind these loopholes that allow some FMG’s to game US law at the risk of patient safety.

For the convenience of the reader, this PDF from the law firm of Siskind Susser PC presents a chart of Physician Licensing Requirements by State.

Please use the page up/page down controls at the bottom of the PDF frame to scroll through the document:


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