Would this worry you or am I a horrible person?

I am trying to find a good GP for regular doctor visits but I am having a really hard time of it. When I go to my insurance company’s website they have a list of all of their approved doctors in my area and they break down whether or not they are accepting new patients right there on the site (which is marvelous!) but they also provide you with a lot of other information, some of which is kind of frightening to me.

They list on the site where the doctor graduated from medical school and the large majority of the doctors went to med school in Guatamala or Bucharest or other places that don’t lead me to think of “excellent education system” when I see the name and location of the school. If they were listed as going to universities in Toronto, London, Prague, Hong Kong, or any number of other cities or countries I wouldn’t have blinked but doctors being educated in places that are known for corruption or being unable to provide clean drinking water to their citizens don’t really inspire me to trust that they are turning out competent doctors.

I am also bothered by the fact that I am bothered by this. If this were my plumber, landlord, childcare provider, accountant, or any other service provider it wouldn’t bother me at all. I feel horrible about myself that I don’t really trust that a doctor from these places is as good as one from another nation. I am generally pretty open about giving people a chance (those people who remember my thread about going on a date with a PETA member know this!) but for some reason these doctors from what I consider to be questionable medical schools bother me despite the fact that they are obviously licensed to work in the US. After going through the list of doctors who accept my insurance and are accepting new patients and have educations that don’t scare me enough to make me want to perform my own medical care at home I came up with about 10 out of 150 possible choices. If I went back through the list with a fine toothed comb I could probably find others but seriously, 10 doctors?

So am I worried about nothing when I see a doctor who graduated from medical school in Paraguay or is my fear justified?

I would feel the same way. When it comes to my health, I wouldn’t risk it.

The supply of doctors in the United States is artificially limited because there aren’t enough medical schools. The resources that are needed to create a new medical school in the United States are so extreme that it’s almost never done, and consequently we’re encountering a shortfall that’s going to get worse once the baby boomer retirement really gets rolling. To make matters worse, a lot of doctors are getting lured to profitable specialties, such as plastic surgery, leaving even fewer to enter general and family practice. That’s why you find so many doctors who went to medical school outside the country.

As to whether those foreign medical schools are any good, I only recall an expose from about ten years ago, probably on 20/20 or 60 minutes, looking a medical schools in Mexico. Their answer was “no”, but of course that’s not definitive.

The best answer is probably, it depends on the doctor and the school.

Reminds of the old joke we tell:

Q: What do you call the guy who ends up graduating at the bottom of the med school class?

A: Doctor

That and the one known as hey- the only equation you’ll have to know in med school is this one: “P= M.D.”

But people invariably are concerned about things like this all the time, and it’s a fair point. I’d say ask around and see if anyone you know can recommend any of the doctors on the list, or if you can look them up and see if they have a good reputation or not.

For me, it would depend - I wouldn’t necessarily mind a Paraguayan person who went to a med school in Paraguay. I’d mind as hell an American who did, because it sure looks like they couldn’t get into a US school.

I am the same way, and it doesn’t bother me. I am also the same way about comparing medical schools within the U.S. If I have a choice between someone from Darthmouth and someone from someplace I never heard of, all other things being equal, I go with what I know to be good.

Does it also list where they did their residency?

No, it doesn’t. If I found out they did their residency at Sloane Kettering or something that would be enough to make me think that they are probably an okay doctor. At this point I don’t even know that I should care where they went to school because I just need to see a doctor about a non-emergency but less than pleasant medical situation and no one can see me. I am getting pissed off because even the guy from Bucharest has a 3 week wait to get in to see him. I went to a doc-in-a-box yesterday who refused me care since I didn’t have a cold or some other acute problem and she referred me to about 18 doctors who could see me today, not one of which takes my insurance. Thank goodness I don’t live in one of those countries with socialized health care, otherwise I might not get the medical care I need in a timely manner! :mad::(:mad::(:smack:

I don’t have an answer to your question. (Well actually, I do, sort of: This probably wouldn’t bother me too much, after all these doctors did have to qualify for licenses to practice medicine in the US, which I’m pretty sure don’t get handed out to just anyone. But no, I don’t think that it makes you a horrible person that it does bother you.) But I do think you should have given this thread a better title, so the medical Dopers would be more likely to read it and give you their informed opinions.

This is what I was thinking too. If it doesn’t on the insurance’s website the clinic’s website will probably have the information. The clinic I go to has a little blurb about each doc, where they went to school, residency, hobbies, etc.

As a current medical student, I think you’re doing yourself a disservice with this attitude. For one thing, medical school curriculums are roughly the same the first two years (we all have to take the same test at the end of our first year), which is where much of the basic science and pathophysiology is learned. Furthermore, the schools that are ranked “higher” on lists like Newsweek are research schools. Students and faculty there have access to top-notch clinical trials and research facilities, but the school’s emphasis isn’t necessarily on producing good clinicians, which is essentially what most people who are searching for a doctor need. You need someone who is going to listen to you describe your symptoms, try to figure out what you’re not saying and try to tease out hidden meanings in your statements which you might not even realize, ask the right questions, and come up with the most likely diagnosis, all while not alienating you as a human being. I think basic clinical skills are much more essential than brilliant research minds at the primary care and much of the specialist level. There is a whole separate list of rankings for schools in terms of how well they teach clinical skills . . . Hopkins and Harvard are way down on the list, and I believe number one is University of Washington (which is also a really good research school, but I digress).

And finally, even if you are going by the “prestigious” research rankings, you might be surprised at what schools are listed where. A lot of them are predictable, but would you guess that Washington University consistently ranks higher than Columbia? And that University of Texas Southwestern is higher than Brown by a good margin?

Oh, and in regards to the OP . . . no, of course you’re not a horrible person, your health is your most valued possession and of course you would want it in good hands! That being said, again as a current medical student (albeit a first year), I think far and away the most important factor in determining how effective and productive your physician-patient relationship is, is how well the physician communicates with you and how comfortable they make you feel. I know a lot of people who say they don’t care about bedside manner, they only care about the skill level of their physician, but I think that “bedside manner” is a very important component of a physician’s skills as a clinician. Again, most things that you would see a primacy care doctor for don’t require him to have very thorough knowledge of obscure diseases, and if you were to need someone capable of that, they could always refer you. More than that, I think that you need a physician who can take a good history and conduct a good interview, and manage to solicit all the important facts for a situation that you, the patient, would not think to reveal.

Zsofia brings up a good point, that there is a difference between a Paraguayin who trained in Paraguay and an American who trained in Paraguay, because the American probably couldn’t get into med school in America. However, there are many reasons why someone can’t get into medical school in the states, many of which again have no impact on the physician’s final ability as a clinician. Also, many times training in another country can make a doctor a more savvy diagnostician than one trained in the States, simply because here we tend to rely heavily on tests and numbers and in other countries, they rely more on the history/interview and physical information.

Okay, I’m done ranting but if you’d like me to expand on any of these points I’m happy to do so. Regardless, the most important thing is that you feel comfortable and safe with your physician, and that you trust their capabilities, and that you feel like you can tell them anything you need to. I think the best way to get this information is to read patient reviews of doctors that they have on some websites. If that is not possible, maybe doctor-shop until you find one you like? I know that that is time-consuming and maybe not possible with your insurance plan, but I thought I’d throw it out there. And if quality/location of education and training is ultimately important to you, or you feel less comfortable and safe with a doctor from certain countries, that is a perfectly valid choice for you to make as a patient, and you should definitely not feel guilty about something like that.

You can think of the MD as a baseline: passing the USMLE and completing US residencies and fellowships ensures a proficient physician.

As for the waiting times, much of the patient stuff can be handled by PAs or APRNs.

From personal experience, I have seen both good and bad from med schools like this.
One was totally incompetent and we probably could have sued and won.
Another was quite competent, but obviously was not up to date with new procedures, and had limited English ability; they both were worthless when it came to current treatments.

That said, we have encountered many other foreign born, or foreign educated doctors who are not only competent, but really, really good and know what the hell they are doing! One is Iraqi, another comes from Ghana and another is from Iran…all are excellent!

On the other hand, I have to go back to a doctor here in Las Vegas sometime soon for a specific procedure and I despise this guy. I have asked other doctors about him and they all agree that he is, indeed, highly qualified but yes, a total jerk. You have never met a more arrogant asshole in your entire life until you meet him; he will tell you at LEAST three times in the first ten minutes that he graduated from HARVARD, and BTW, did I mention I am a HARVARD graduate, and while I was studying at HARVARD…I just want to stand up and slap him. Still, he is supposedly the best in town for this specific procedure, so I will just nod and smile and bite my tongue.

Where can I find such a list?

I wouldn’t worry about where a doctor got her education. Half of all the medical students anywhere are in the bottom half of their graduating class. But in order to practice here, they have to pass a series of tests that in theory would rule out the incompetent.

My concerns about a person who graduated from Bucharest would be: Is this a native of some country who thinks s/he can speak English, but who actually can’t? Because one thing I want to be able to do is communicate with my health providers.

I have rejected doctors for even thinner reasons. The two-doctor partnership that delivered my first two children added a third partner, an oriental woman. I did not like her. I didn’t like her at all, even though in theory I thought it would be great to have a woman doing my obstetrical care. So I changed doctors.

I’m sure she was very, very smart, and very, very well educated. She was young, though, and was a bit hesitant. I happen to know she was at the top of HER class. But to me she seemed cold, and I could only understand about one word of every three she said–and she didn’t talk a lot. The two men were very easygoing and joked around, but they were confident. I had the sense they knew what they were doing. I didn’t get that from her.

I had friends who had the same doctors who, indeed, thought I was a horrible person, and racist, and even sexist. And the woman I switched to, who was also smart and well-educated, made a few rather horrible errors that fortunately didn’t result in a bad outcome, but they sure could have. I’ll bet the new doctor wouldn’t have made those errors, and it was a one-in-three chance I’d get her anyway.

But there you go, picking a doctor is kind of an emotional decision as well as an intellectual one.

My family, including myself, has had some pretty serious medical problems over the last few years unfortunately some resulting in very early death and some narrowly avoided. Just like any other job, there are bad doctors, passable ones, and super-stars. I have “fired” too many to count especially residents but my nuclear family has four stellar ones now with great support staff out of the ones that we selected.

You can’t be less than very smart to make it through medical school in the U.S. It is super-competitive but that is only part of the picture. Bedside manner, office hours, office management, and appointment availability are extremely important. All of our primary care physicians are fairly young but that may be just by chance but my primary care physician takes same-day appointments if you really need it as does my daughters pediatric clinic. They also have a 24/7 nursing line to call. They all know our family personally and can make things happen if something goes wrong and they have several times before. They don’t teach that in medical school.

Primary care doctors often take interviews from prospective patients and that is what I do. It is like a job interview for them although they may or may not like it. You just bring in a list of questions about how their office operates and how that may fit in with your needs. You can request one especially if it is a new practice and I have had great luck with it. I would have no problem with an Ethiopian doctor taking out my appendix in an emergency but I want someone to relate to if I see them on a regular basis so I prefer American doctors about my age male or female just because of the issues mentioned above. Other people want different things however. Some females prefer male gynecologists for example because they think they will be more objective. When it comes to an extreme specialist like a surgeon, I don’t even care if they speak fluent English, I just want the best technical person available to fix the problem.

I’ve mentioned before on the boards that Mr Kitty has cystic fibrosis. He was misdiagnosed for 48 years. What finally led to the proper diagnosis:

  • His primary care physician- a Cuban (who, god help me, dresses sort of like a cowboy and sounds exactly like Ricky Ricardo)- sent him to a thoracic surgeon for a lovely little operation where they pour water into the lungs and suck out all the mucus.

  • The surgeon, an Argentinian, recognized FROM THE X-RAYS the bacteria that was the root of Mr Kitty’s symptoms (it’s been a while since this was explained to me, so I may have some of the details wrong, but essentially this particular bacteria causes mucus plugs that… fill the lungs a certain way, so the x-rays of people infected by the bacteria all look alike. It’s a common infection in the doc’s neck of the woods, not so much here).

  • After the operation, the surgeon sent him to the Nigerian (seriously! :smiley: ) pulmonologist, who (after getting Mr K through a brief hospitalization and starting him on the RIGHT medications for a change) handed him off to his Indian partner.

  • The partner sat with Mr K for over an hour getting a full history. We have a copy of her notes from that appointment… within the first 5-6 lines, she wrote ‘CF?’ :smack: She’s the one that sent him for the salt test, and the rest is history.

  • Just to give props to the Yankee docs, it was a Greek up in Massachusetts who put Mr. K on oxygen for the first time. Unfortunately, it was ‘right idea, wrong execution’ situation; turns out he retains CO2, so the oxygen- while very necessary- made him worse until we added in a bipap machine.

Alternately, my PCP until this year, a born-and-bred Arizona transplant and resident at a local ‘family medicine’ clinic, did the majority of his assessment and diagnosis via what appeared to be a blackberry. Ask a question-input answer-ask another question-rinse, lather, repeat. I really liked him- he was personable, funny, empathetic, and overall a pretty good doc- but sort of got the feeling that I could’ve done the work myself on webmd and just shown up to get a prescription.

I joke that if we didn’t have the third world docs, we never would have gotten a proper diagnosis for Mr K. :slight_smile: So while I understand your hesitancy, I also agree with the other posters that a foreign doc studying in a foreign country is quite different from an American one doing the same thing, and it really does come down to your comfort level with them in person- can you communicate with them, do they know their stuff, are you getting quality treatment.

Not necessarily. Maybe he wanted an MD without owing a quarter million dollars. My own family doctor is American but went to college and med school at McGill because it was cheap. He married a local woman and stayed. Now you will say that McGill is okay and it is, but maybe someone went to med school in Paraguay because he could afford it. A very important question is how has he kept up with new developments in medicine.

You can check this site to see what other people think of the doctors on your list.