The Fate of Foreign Medical Graduates in Neurological Surgery (1969)

F REE migration of professionals, although governments often impose restrictions, is regarded by some as a right rather than a privilege. In any event, movement of intellectuals has had profound beneficial effects in many countries. Interchange of intellectuals between countries of approximately equal development usually represents no loss either way of human capital. However, migration to a highly developed industrial country from a less developed country may represent for the latter country a significant loss in human capital and in financial resources. For example, 300 Latin American physicians enter the United States as immigrants each year; this equals in number the output of three moderate-sized medical schools. Moreover, the immigration of foreign medical graduates from all countries to the United States in 1967 was equal to about one third of the number of graduates of American medical schools. The loss to the less developed country may be disproportionately high because of the relatively small number of educated individuals in that country. The loss of medical graduates from lesser developed countries is particularly onerous for the homeland because of the relatively greater length of training of physicians, the added cost involved, the small reserve of medically trained personnel, and the limited financial capacity to support medical schools. There are significantly increased needs for medical service in this country. The population growth, social pressures demanding medical care as a right, improved financial capacity of many people to finance medical care, insurance plans, and more time-consuming medical procedures are among the most obvious factors. In the year 1966-1967 27% of all hospital internships and 30% of all residencies were filled by foreign medical graduates (hereafter referred to as FMG's). In 1967-1968 the residency percentage rose to 32. This proportion will no doubt increase further because it will be very difficult for the needs of this country to be met through the slow processes of expanding present medical class size and increasing the number of schools. The Educational Council for Foreign Medical Graduates has been established as a quality control mechanism. On the Council sit two representatives each from the American Hospital Association, The American Medical Association, The American Association of Medical Colleges, the Federation of State Medical Examiners, and two members selected from the public at large. The Council is responsible for the administration of the ECFMG examination, which must be passed before an FMG can qualify for an internship and thereby enter the residency training program in any hospital where the FMG carries responsibility for patient care. The standard for the admission of FMG's as a group is significantly lower than the level of accomplishment of North American medical school graduates. There are, of course, great variations among the graduates of foreign medical schools in their ability to pass the ECFMG examination. There is probably a natural selection operative among FMG's that favors elimination of less qualified men from the neurosurgical applicants, but as educators we need to be concerned about the total picture. Two years ago the percentage of FMG's among U.S. neurosurgical trainees was 17%; one year ago it had increased to 21%. This trend may mean, although not necessarily, that the quality of the FMG accepted into neurosurgical programs is also changing. In many of the other specialties the per-