Medical Thread

[BarakzaiAbdali]

I recently became a US citizen and I want to know if that helps me to becoming a doctor?

Yes, you can apply to state medical schools with a better chance of getting in. Good states are ones like Ohio (7 medical schools for a small populace). You can usually gain residency in these states after about a year long stay. However, at private schools, like yale, cleveland clinic, etc. they accept non US citizens as well.

[BarakzaiAbdali]

Salaam Alaykum,

Barakzai brother, after reading all 29 pages I feel as is if there is a ton of planning to do. I will plan first for getting into medical school. I will need to research some things I want to do and plan to get into medical school a bit more.

But I thought you could help me with a research topic. I love learning about other cultures especially ours and other Islamic cultures and am also interested in Afghan Women Studies. As I said in another thread I wanted to major in Global Studies and minor in BCMB.

I was thinking of doing a documentary style film of clinics or healthcare in Afghanistan. My family lives in Kabul,Ghazni, Peshawar there, I don't think I will be able to do anything in Ghazni. I have cousins going to medical schools somewhere in Nangarhar and other places. I am going for my cousins wedding in summer of 2012 so I thought it might be a great idea and it would look good on a resume for Med. School and because I will leave the USA after I am done with Medicine in the USA to practice in Afghanistan/or another third world country.

So, any topics that you think would be interesting to explore in Afghanistan or any questions that you might have? I know I want to show how medicine runs in a third would country but I want to know what you as a doctor would like to know about other cultures and these poor countries?

And Thank You Very Much, you have been a great help.

Here is a good example of what they find interesting from the renowned and elite, New England Journal of Medicine. I will address your question more fully soon:

http://www.nejm.org/doi/full/10.1056/NEJMp038253

The Battle for Access — Health Care in Afghanistan

Brigg Reilley, M.P.H., Gloria Puertas, M.D., M.P.H., and Anne-Sophie Coutin, M.D.
N Engl J Med 2004; 350:1927-1929

Recent rounds on the infectious disease ward in Mir Wais Hospital, in Kandahar, Afghanistan, found a young farmhand recuperating from meningitis sitting with the two friends who had accompanied him to the hospital. He had survived the disease, but only barely, and the episode had left him blind. In quiet tones, the man discussed with the medical staff whether his condition was permanent. In another room, a family of six was recovering from typhoid fever. The family members were fortunate that they had sought care early, because typhoid has a fatality rate of nearly 10 percent in Kandahar. The most acutely ill patient was in the female wing — a comatose teenage girl with suspected meningitis whose illness was not responding to treatment. Her mother had brought the girl to the hospital three days earlier and had remained at her bedside ever since.

Mir Wais is the referral hospital in Kandahar, and many patients with the severest illnesses in the southern part of Afghanistan — at least those who have the means — eventually find their way here (FigureRounds at Mir Wais Hospital, Kandahar, Afghanistan.). Overall, nearly 6 percent of the patients who are admitted to Mir Wais do not recover. More than half of the patients who die on the ward (57.8 percent) are children younger than five years of age, who usually die from diarrheal diseases. Late presentation is an important contributing factor to the risk of death, since most deaths occur within 24 hours after admission to the ward. Many patients, such as the blinded farmhand and the family with typhoid, have traveled considerable distances to reach Mir Wais. Death records reveal that less than a third (28.4 percent) of the patients who died were from the city of Kandahar, whereas more than one in five (21.1 percent) had traveled from another province altogether.

An hour west of Mir Wais Hospital and Kandahar is the community of Zhare Dasht, or “Yellow Desert,” which is home to about 40,000 people, most of whom are Pashtuns who have fled either drought in the south or ethnic disputes in the north. The settlement lies in the desert plain, and the last leg of the road is clearly marked with warnings not to stray from the dirt track that has been cleared of land mines. Here, Afghan doctors and other health workers, with the support of Médecins sans Frontières (MSF, or Doctors without Borders), perform about 7500 consultations each month in a setting that tests the limits of clinical skill, where there is a wide range of endemic disease and no laboratory support. Most patients are children with respiratory infections and diarrheal disease, but each year, the clinicians also see cases of malaria, trachoma, and viral hepatitis. Recently, Zhare Dasht was hit by a regional diphtheria epidemic that sickened scores of people and is known to have killed six. Unfortunately, because of violence and instability, including the deliberate targeting of aid workers, MSF was forced to suspend community-based service at the beginning of winter, the peak season for acute respiratory infections.

Conflict and instability are not new to Afghanistan. The country has struggled through decades of war and continues to rank among the worst in the world in basic health indicators such as infant and maternal mortality. Armed conflict and large displacements of the population have made accurate data extremely sparse, but according to the best estimates available, one in four Afghan children dies before his or her fifth birthday. An estimated 85,000 children younger than five years of age die each year from diarrheal disease, and 15,000 die from tuberculosis. Although important progress has been made in measles vaccinations and other projects that have rapid effects, the health care system faces chronic deficiencies, such as a poor infrastructure and a lack of trained medical professionals.

The poor infrastructure is a substantial barrier to access to medical care and one of the main reasons for late presentations by acutely ill patients. Moving between villages or even cities generally requires slow and laborious travel in four-wheel-drive vehicles. For example, to cross Afghanistan (which is approximately the size of Texas) from the provincial capital of Qala-I-Naw, in the west, to Kabul takes at least three days. The recent repaving and reopening of the Kabul–Kandahar road have reduced travel time, but the road is still too unsafe for aid workers to use. With nearly 80 percent of Afghans living in rural areas, the lack of roads, transportation, and a referral system means that medical care, especially in emergencies, is often out of reach. In the Mir Wais surgical ward, for instance, extremely late presentations of women with complications of pregnancy such as hemorrhage, obstructed labor, or retained placenta result in interventions targeted primarily at saving the mother: more than half the time, when such a woman reaches the ward, her fetus has already died.

Even if a patient manages to travel to a government clinic, there is no guarantee that he or she will find a doctor. With only 8 physicians per 100,000 people, many districts do not have a doctor at all. Especially in rural areas, it is not atypical for the formal training of a medical officer who serves as many as 25 villages to consist of no more than a few months of medical education completed decades ago. Poor salaries (about $32 a month for a physician), sometimes paid months in arrears, push the doctors to pursue private practice and to cater to patients who can afford to pay for service. In practical terms, this means that doctors who subsist solely on a government salary are generally on duty for only about five hours each day, usually from 8 a.m. to 1 p.m., even in major urban hospitals.

Many of the elements necessary for the rehabilitation of the health care system are clear. Additional doctors and nurses need to be trained and allocated, with special emphasis on rural postings and female professionals (cultural norms necessitate that women see female doctors regarding obstetrical and gynecologic matters). The transportation infrastructure needs to be strengthened so that patients can reach health care providers and so that outreach health care services or badly needed programs, such as those for tuberculosis control, can serve their communities. Access to clean water and proper sanitation facilities must be improved in order to reduce the risk of waterborne disease, one of the leading killers of Afghan children. Yet in Zhare Dasht, as in much of the southern and eastern regions of the country, where more than one third of the country's population lives, the long process of reconstruction that is necessary for addressing these problems is severely hindered by ongoing insecurity and armed conflict.

Currently, the majority of health care in Afghanistan is provided through nongovernmental organizations. It is estimated that more than 80 percent of functional health care facilities have some form of support from such organizations, often including the supply of medicines and other basic materials. In the south and east, these groups must operate with extreme caution, if they can work at all, because aid workers are perceived as supporters of the coalition's political agenda and, as such, have become targets of anticoalition forces. Members of a nongovernmental de-mining organization were recently detained by gunmen near Zhare Dasht, although they escaped with only minor wounds. Several other aid workers, both Afghan and foreign, have been murdered in similar ambushes. The inability to deliver aid means that millions of Afghan civilians are beyond the reach of humanitarian assistance, including basic health care services. Indeed, one of the main reasons that the staff of Mir Wais Hospital sees so many patients who come from considerable distances is that the reconstruction and rehabilitation of medical services in the surrounding areas have been severely limited by the ongoing conflict

In the face of such daunting barriers, some efforts have been made to focus aid on a particular health care problem. Afghanistan remains one of the worst places in the world to give birth: maternal mortality has been estimated at 1600 per 100,000 live births, with the highest rates occurring in the most remote areas. In an effort to improve the odds for mothers and infants, MSF has opened the Dashte Barchi basic emergency maternity clinic in western Kabul, with skilled midwives on call 24 hours a day. Nearly 15 percent of patients require emergency transfer, mainly owing to complications such as preeclampsia and hemorrhage. In six months, the number of patients at the clinic doubled, the number of deliveries reached 220 per month, and additional midwives had to be hired to meet the demand. This increase, which reflects the fact that the medical staff is not only qualified but also culturally acceptable (i.e., female), is indicative of the unmet demand for obstetrical–gynecologic services. But the high rate of obstetrical emergencies remains a sobering indicator of the dire needs and the potentially fatal outcome for Afghan women who have complications during delivery.


While the maternity clinic in Kabul is coping with an influx of new patients, the doctors at Zhare Dasht are discussing how to scale down services with minimal adverse effects. When MSF announced this past November that the security situation made travel to Zhare Dasht impossible, the settlement's council of elders was anxious but understanding. The elders and nongovernmental organizations pragmatically determined how to organize ambulance transportation to Mir Wais Hospital as needed. Members of the medical staff at Mir Wais, for their part, braced for yet another emergency — many of them had started to work here in the midst of an earlier crisis, a cholera outbreak in 1999, and they had provided the support and antitoxin for last year's diphtheria epidemic. The family with typhoid has gone home, opening up needed beds, and the farmhand and his friends have returned to their province and an uncertain future. The nurses at Mir Wais, always at the ready, prepared their vacated beds for the steady stream of incoming patients, double-checked drug stocks, and ensured that all was in order in case they needed to call on the patient overflow tents that had been set up behind the ward.
Source Information

From Médecins sans Frontières, New York (B.R.), Herat, Afghanistan (G.P.), and Kabul, Afghanistan (A.-S.C.).

[Ahmad Walid]

My kid sister is a lot closer to the MCAT than I am... she did very well by using a set of books called Exam Crackers for the MCATs. The key appears to be doing as many practice questions and practice tests as you can to get into the swing of things for the character of the test (many questions, many hours)

Thank You for the quick answer, I appreciate it very much. I will most likely go ahead and buy the Exam Crackers set as it is one of the best on Amazon as well.

The Battle for Access — Health Care in Afghanistan

This was an interesting and very sad article. I just finished reading it and feel very emotional. It makes you very angry when you sit in your house and this is what is happening in your homeland: . "An estimated 85,000 children younger than five years of age die each year from diarrheal disease, and 15,000 die from tuberculosis" This makes me extremely angry and saddened because this should not be happening in a country that has gotten $40 billion + in aid. But what is worst is that the people who want to help cannot help. I wish the Taliban and all others go to hell, because I know it is them. You can't help your own people because your own people want to kill you... wtf kind of dilemma is this.

The article was depressing because I doubt I will be able to do anything there because just going to Ghazni last summer for me was dangerous. Everyone says Taliban are just walking around to get somebody from abroad. But I have not lost hope, I will try to figure something out.


But anyway thank you for the response Barakzai brother, and I will be patiently waiting for any ideas or any information you want to post.

[BarakzaiAbdali]

Thank You for the quick answer, I appreciate it very much. I will most likely go ahead and buy the Exam Crackers set as it is one of the best on Amazon as well.

The Battle for Access — Health Care in Afghanistan

This was an interesting and very sad article. I just finished reading it and feel very emotional. It makes you very angry when you sit in your house and this is what is happening in your homeland: . "An estimated 85,000 children younger than five years of age die each year from diarrheal disease, and 15,000 die from tuberculosis" This makes me extremely angry and saddened because this should not be happening in a country that has gotten $40 billion + in aid. But what is worst is that the people who want to help cannot help. I wish the Taliban and all others go to hell, because I know it is them. You can't help your own people because your own people want to kill you... wtf kind of dilemma is this.

The article was depressing because I doubt I will be able to do anything there because just going to Ghazni last summer for me was dangerous. Everyone says Taliban are just walking around to get somebody from abroad. But I have not lost hope, I will try to figure something out.


But anyway thank you for the response Barakzai brother, and I will be patiently waiting for any ideas or any information you want to post.

Salamoona Ahmad Walid Brother,

While this thread is for studies related issues, I would respectfully disagree. The Taliban are what they are, which is sons of the soil fighting occupation with what little they have. I do, however, respect your difference of opinion.

Their response is a very human response. In regard to infrastructure, the Afghan government has dropped the ball. Here is an article from the Washington Post that shows the infrastructure fails once in Afghan Government hands (i.e. incompetent technocrats who are failures here in the West and basically are in power only because America props them up). The same thing happened in Iraq:

http://www.washingtonpost.com/wp-dyn...010302175.html

U.S.-funded infrastructure deteriorates once under Afghan control, report says



Roads, canals and schools built in Afghanistan as part of a special U.S. military program are crumbling under Afghan stewardship, despite steps imposed over the past year to ensure that reconstruction money is not being wasted, according to government reports and interviews with military and civilian personnel.

U.S. troops in Afghanistan have spent $2 billion over six years on 16,000 humanitarian projects through the Commander's Emergency Response Program, which gives a battalion-level commander the power to treat aid dollars as ammunition.

A report slated for release this month reveals that CERP projects can quickly slide into neglect after being transferred to Afghan control. The Afghans had problems maintaining about half of the 69 projects reviewed in eastern Laghman province, according to an audit by the Special Inspector General for Afghanistan Reconstruction.

The spending in Afghanistan is part of the $5 billion provided to U.S. military commanders for projects in Iraq and Afghanistan since 2004. The new report is the latest to identify shortcomings and missteps in the program, whose ventures have included the Jadriyah Lake park in Iraq, planned as a water park but now barren two years after a U.S. military inauguration ceremony

The dilapidated projects in Afghanistan could present a challenge to the U.S. strategy of shifting more responsibility to Afghans. Investing in infrastructure, notes President Obama's December review of the war, "will give the Afghan government and people the tools to build and sustain a future of stability

"Sustainment is one of the biggest issues with our whole strategy," said a civilian official who shared details from a draft of the report. "The Afghans don't have the money or capacity to sustain much." The official spoke on the condition of anonymity because the Defense Department is preparing a response to the audit.


Photos in the report show washed-out roads, with cracks and potholes where improvised explosive devices can be hidden. Among the projects profiled is a re-dredged canal that filled with silt a month after opening.

Multiple reports by the Government Accountability Office have noted a lack of monitoring by the Pentagon. And because formal U.S. oversight stops after a project is turned over to Afghans, it is difficult to gauge how projects are maintained countrywide.

When asked whether the Afghans have trouble sustaining projects, the U.S. military issued a statement saying it does not have the information to provide an immediate answer.

Gen. David H. Petraeus, the top U.S. commander in Afghanistan, said in Senate testimony last year that CERP is "the most responsive and effective means to address a local community's needs." He previously relied on the discretionary fund as the commanding general in Iraq, where $3.5 billion has been spent through the program. Over the past two years, Petraeus has pushed for stricter controls to stop any fraud and waste.

In response to "insufficient management," CERP guidance for Afghanistan was revised in December 2009, according to a statement by the military. The new guidance emphasizes the need to meet with Afghan leaders when choosing what to fund. It does not, however, require U.S. troops to continue inspecting projects after they are placed under Afghan control.

Under the guidance, an Afghan governor, mayor or bureaucrat must sign a letter promising to fund maintenance and operations. But an October SIGAR audit of projects in Nangahar province found that only two of the 15 files examined contained a signed letter. Nor is there formal reporting to the national or provincial Afghan governments of what was spent and built, the audit said. That makes it difficult for Afghans to know what they are supposed to maintain.

The provincial and district governments that take over the projects do not have the money to sustain them because they cannot collect taxes and they depend on the national government for funding, said Army Maj. David Kaczmarek, the civil affairs officer for Task Force Bastogne in eastern Afghanistan.

To teach the local governments how to request additional funds from Kabul, Kaczmarek helped launch a program in the summer that uses CERP dollars for the operation and maintenance of some projects.

The U.S. military tracks CERP projects with poorly maintained computer databases. Before October 2009, the database did not consistently record the villages or districts where projects were undertaken, according to military and civilian personnel who spoke on the condition of anonymity because the master database is classified.

A civilian official who examined the contents of the database for a government assessment said the military cannot account for the spending without knowing the villages and districts that were project recipients.
"Let's say the project is not working," the official said. "Why would we want to fund that project again the next year? Very little evaluation was done to decide what we fund next."

The organizational problems have also frustrated attempts to study the effectiveness of the $2 billion spent on CERP. A paper co-written by Princeton University professor Jacob Shapiro found that CERP funding helped reduce violence in Iraq. Shapiro and his colleagues have struggled over the past nine months to conduct a similar study for Afghanistan because of the database.

"There's not a sense of how the program may or may not be working in Afghanistan," Shapiro said.

Army Lt. Col. Brian Stoll tried to clean up the database while serving in Kandahar last year. He champions CERP as a way to build confidence in the Afghan government, despite the mess he found.
Projects dating to 2006 had never been closed out, said Stoll, who updated the files while working 12-hour days to audit ongoing projects in southern Afghanistan.

"We never got it all cleaned up," Stoll said. "It was like a Hydra. You get part of it cleaned up and you find some more along the way."

[BarakzaiAbdali]

Its going to be Washington University's Hospital in St Louis. That is where the next phase of my career will take me. I have one year left here Admin Khan, up in the Northeast with you folks and we should meet at some point to organize the Ahmad Shah Abdali Sher Shah Suri Merit scholarship committee.

[Admin Khan]

Its going to be Washington University's Hospital in St Louis. That is where the next phase of my career will take me. I have one year left here Admin Khan, up in the Northeast with you folks and we should meet at some point to organize the Ahmad Shah Abdali Sher Shah Suri Merit scholarship committee.

Like I've said several times - I am more than down to meet up. I'll scoop you up, just PM your 411. It would be my pleasure to meet you, and to discuss this terrific plan. :-)

We are neighbors.

[BarakzaiAbdali]

I have had the chance to observe the new ACGME rules put into place now, in the American medical system. This now means that intern physicians (previously the most hard working) now have hour restrictions that make it so that they no longer can spend more than 16 hours in 24 hour period in the hospital. This has affected all the disciplines and I have seen it enforced vigorously here.

What this means for Afghans:
1) One of the biggest complaints by traditional Pashtuns is that the medical field is not suitable to a balanced way of life. With these internship changes, which the folks in program directorship are saying, are permanent, more changes toward easier hours are over the horizon. Gone is the excuse of lifestyle incompatability. Look for changes in the direction of European workhours in the coming decades.

2) The caveat is that second year trainees and beyond pick up the slack. This may be true at the tough programs like the one here and at MGH, Hopkins, etc; but many hospitals are moving toward a shift system across all trainee years.

3) Who will pick up the slack? Well, the profession of Internal Medicine is about to get a boost. It was a less popular direction in general because of internists are a dime a dozen and the salary demands are less. Now, to pick up the slack of less resident-housestaff being available due to work hours, hospitalists (internists who work primarily in the acute care setting in the hospital) are coming into high demand. These folks finish training in a period of 3 years of residency and directly enter the work force instead of entering fellowship training. These folks command pretty good salaries immediatly, within the mid to high $ 200-300,000 range and only committ to about half 30 years baseline of work. Any extra work just supplements their salary. (Not bad... as a cardiologist, Ill have to work most of the year without breaks... but these folks, with less training take half the year off and make a large fraction of the specialists salary up if they decide to do more).

This is across the US. The number of emails from everywhere in the states, advertising lucrative hospitalist positions have radically mutiplied in the last year or so since the ACGME demanded implementation of these work hour reforms.

4) Does this affect surgery and other fields? In short, Yes. Colleagues of mine in the other specialities are noting these changes are affecting their fields as well.

5) Do I agree with these changes: Bluntly, No. I think that to be a competent physician you need to see a wide range of pathology repeatedly. My interns last year admitted 7 patients per call cycle. This year... they are luckly to admit 3. Although they have more time to decompress, rest, and potentially read... they are losing out on valuable training time. Moreover, in fellowship, we have no work hour restrictions and that step up that will occur for these new era trainees may be a rude awakening should they choose to specialize.

Nonetheless, my opinion means little and the positive benefit is that traditional households will now yield (without all the past excuses) to their children that want to do this.

[Dina]

hey. I am a new member and i found your topic here on yahoo.com. it has been very helpful thanks. i will be a new freshman in Stony Brook University as Pre-med and I wanted to know if its a good school and what i could do to get good grades and how important grades are vs mcat. my dad tells me its not worth doing premed cause it takes long.

there website is Stony Brook University, Stony Brook, New York and they have a hospital on campus. a federal one i think. i love in long island so its close for me.

[BarakzaiAbdali]

hey. I am a new member and i found your topic here on yahoo.com. it has been very helpful thanks. i will be a new freshman in Stony Brook University as Pre-med and I wanted to know if its a good school and what i could do to get good grades and how important grades are vs mcat. my dad tells me its not worth doing premed cause it takes long.

there website is Stony Brook University, Stony Brook, New York and they have a hospital on campus. a federal one i think. i love in long island so its close for me.

I am proud that the forum is a hit on the engine as it relates to Pashtuns and medicine. I am working on collecting Pashtuns from both sides of the border in a series of efforts as detailed above.

I have had residents working under me from the New York public system and all have been extremely capable and are now fellows in GI and cardiology across the nation.

Any school is a good school if you perform well, do honors level work, and do exceedingly well on the MedCAT. I was publicly educated in high school and privately thereafter and have been time and time humbled by my colleagues who worked hard through the state school systems.

Your father is 1/4 right and 3/4 wrong. It all depends on your goals sister. If your goal is to get a degree and not utilize it, but instead stay at home (also a noble and sacrifical role) then perhaps a bacclaureate degree is enough (maybe a masters). If your goal is to supplement your significant other's ability to provide and to also be educated and be able to work anywhere in the world, then medicine is a superb field.

The changes I noted above have made the field Afghan female friendly now more than ever.

In the coming decades, Afghans are going to need more female providers and the need will be great.

[BarakzaiAbdali]

There were many questions from folks here about the trajectory of medical school applications and of the field in general. I discussed previously how an artificial shortage is certainly going to keep medicine relatively untouched by the economic uncertainties. Below is the released information from the American College of Physicians. It also contains GPA/MCAT data.

My hope is that many many young Afghans pursue this direction.

From the American College of Physicians and the AAMC, enjoy:
http://www.acpinternist.org/weekly/a...1/index.html#1

More interesting info to come in the next few days
--------------------------------------------------------------------------------
First-time applicants to medical school reached an all-time high in 2011, increasing by 2.6% over last year to about 32,700 students, according to the Association of American Medical Colleges. Total applicants rose by 2.8% to nearly 44,000, with gains across most major racial and ethnic groups for a second year in a row.
The growth comes at a time when there is a growing need for doctors and a serious physician shortage, and the applicant pool is increasingly diverse, the AAMC reported last week in a press release.
The total number of applicants and enrollees from most major racial and ethnic groups increased in 2011:

• After a slight decrease (0.2%) in 2010, black applicants increased by 4.8% while enrollees increased by 1.9%.
• Hispanic applicants increased by 5.8% and enrollees increased by 6.1%.
• Asian applicants increased by 3.8% and enrollees increased by 3.3%.
• First-time female applicants increased by 3% to nearly 16,000, and first-time male applicants grew nearly 2% to about 16,700 in 2011. The percentage of male (53%) and female (47%) enrollees remained steady from last year.
• Native American applicants and enrollees decreased from 200 to 169 and 191 to 157, respectively.

The overall academic credentials of applicants remained strong, the AAMC reported, with an average GPA of 3.5 and an MCAT exam score of 29. The majority of applicants reported slightly increased rates of premedical experiences in community service and medical research, with 82.5% reporting community service experience in medical and clinical settings, 68.4% reporting nonclinical community service, and 73% reporting experience in research.
Total enrollment increased by 3% over last year, with more than 19,000 students in the 2011 entering class. Medical schools have steadily been increasing their class sizes since the AAMC called for a 30% increase in enrollment in 2006 to help alleviate anticipated physician workforce shortages. There has been a 16.6% enrollment increase over 2002, the base year used in calculating the 30% goal. Current projections indicate that medical schools are on target to reach the 30% enrollment increase by 2017.
The majority of this year's growth came from existing schools while a smaller portion came from first-year enrollees at medical education programs established in the past decade, the AAMC reported.

[BarakzaiAbdali]

Someone asked me once about the DO degree and about alternatives to the MD degree. They asked me for evidence regarding the limited nature of the DO pathway to the United States (i.e. an inability to practice abroad without the MD). They had indicated they wanted to practice abroad.

This is a recent invitation from the UAE that I received and it shows rather clearly that there are stringent requirements for translating certification and that the DO degree finds its limitations to the mainland US.

Therefore, for those that want to easily go between countries and practice abroad, the US MD degree is the optimal pathway. Some may say... well if I want to live in Saudi, why not just get a Saudi medical degree equivalent, or the Afghan or the Pakistani MD equivalent. Its mainly because many of these countries have fluid and dynamic policies that may make it so that if you are not a citizen by birth, you may not be able to open up a legitimate practice. The minute you get done there, you'll have to come right back to the states or to Europe and recertify (an arduous process):


Dear Provider

We would like to introduce you to a unique and lucrative international position. We are assisting the Government of the United Arab Emirates (UAE) in their desire to offer the finest medical care possible to their citizens. We have several positions for purely Clinical practice (zero overhead cost; malpractice coverage included). This position is at an Abu Dhabi Military Hospital (UAE base, not US) that is a JCI accredited facility, with state of the art medical equipment. Contracts are open ended and can be terminated by giving 90 days notice.
**Under the credentialing policy of the UAE Government, they will only move forward with MD candidates (They cannot accept DO’s) who are 57 years of age, or younger. You must be ABAT Board Certified with at least 3 years of practice experience beyond certification and US Medical School and training. You must have an unrestricted and unsanctioned medical license, with no significant malpractice history.
Compensation for this position is in the 90th percentile of the MGMA, and includes housing allowance, furniture allowance, and a tuition allowance for children in the American privatized school. Also included is an additional month’s salary after each year completed (i.e. you will be paid for 13 months for each completed year,, and business class accomodations each year back to the US for your vacation. The UAE does not have an income tax, and the US IRS allows a $85,000.00 tax exemption. With no professional operational expenses, and available subsidized housing, it is a financially and personally rewarding experience!
Abu Dhabi, located on the shoreline of the Persian Gulf, has a sub-tropical, arid climate. Sunny blue skies and high temperatures can be expected most of the year. There is an abundance of entertainment in Abu Dhabi including beautiful golfing courses, fine dining, sports, museums, horse back activities, and a brand new Ferrari Themed Amusement Park.
Abu Dhabi is the largest and most populated of the seven emirates that make up the United Arab Emirates, with over 80% of its geographical terrain. The emirate's population, now over 1.6 million, is expected to reach 3 million by 2030. Across the UAE, Emirati citizens make up nearly 20% of the total population; the other 80% are expatriates from Asia, Africa, Australia, Europe and North America.
The major cost of living is, of course, housing, which is covered in your employment packet. Compared to US standards, other cost of living expenses are very low. I am attaching a few links about The City of Abu Dhabi, the housing market, and personal experiences from Americans living in the UAE, for you to review. We are also beginning the process in staffing the civilian hospital (650 beds) in Dubai.

Appointments will take place and offers will be made between November 17th-19th, 2011. If you are interested in pursuing this position in your specialty further, you will be flown to New York, NY, courtesy of the facility, where you will have the meeting. Offers will be made during the discussion process, and a flexible start date will be offered.
Should you prefer to remain in the US, please advise us of your geographic interest. We have thousands of domestic positions for consideration.
Thank you for your time and I look forward to hearing back from you soon

[BarakzaiAbdali]

Ah the board exams. Just got done with one of my last subspecialty boards. First there is the general set of 3 steps of the USMLE then there is the speciality specific exam... then there is the series of subspeciality specific exams and then there is consistent timely recertification.

Its stressful again and again, having to take these exams in an all or nothing fashion... getting gray hairs with each passing level .... but I think its another reason I continue to be fascinated with medical education.

For those that are life long learners... there is no better field in my humble opinion. This well designed curriculum for life does 1 other major thing for career physicians: it makes sure you stay sharp and up to date on the most current information. This is mostly relevent to the speciality exams which are updated more often.

I felt that this was something that I did not get as an engineer. Sure there is the FE examination followed by the PE exam... but you can still practice without having taken either of these exams so a large quantitiy of graduating engineerings dont take them in the first place. You may have a little more authority to certify some building codes and designs... hence why these exams are most relevent to Civil Engineers. There is also no recertification requirements within each of the engineering specialities. The onus of staying up to date is also on you. One very well educated engineer in the private sector once told me that this was his biggest stress: the concern that he was becoming a dinosaur. The value of this system in medicine is that the older you get... the more valued you are to your team. When that old guy with white hair and a bow tie comes around to talk to your team... you know that he has been recertifying and at this for decades... he has quadruple the knowledge of us young guns.

Bottom line: I think this system that runs on auto pilot, with its aggressive demands of licensing and certification is a huge service to practicing physicians. It forces us to stay on top of the rapidly developing bedrock of knowledge.

Besides, keeping those neurons firing into old age is considered one of the ways of combating dementia!

[BarakzaiAbdali]

Ellen Shrecker writes a great essay on the challenges facing American graduates today. She discusses how the current market forces many people to shirk the full renaissance man experience that education once was and has pushed folks into vocational education (i.e. the remergence of a sort of apprenticeship model). She appears to the lament this, but the free market capitalist might say that this is a positive development as the changing nature of the job market requires people who are not simply well arounded jacks of all trades, but rather, "masters of one.":

http://www.aljazeera.com/indepth/opi...643983539.html

Why I placed this in the medical thread is that I think medicine offers the perfect solution to folks that want

A) A utilizable real world skill
B) But still desire to be well educated

Medicine, especially the surgical fields, require a person to be well trained in a skill that others cannot replicate. Yet it also offers a person the chance to reach that skill set through multiple routes, but demands some sort of preliminary degree work to occur.

Therefore, those that see a positive in having a vocational skill, but still want to have a wide breath of knowledge, should consider medicine as their calling.

[Admin Khan]

BarakzaiAbdali,

Unfortunately, even those who are passionate are beginning to see no value in a medical degree. The pain and misery, not to mention outrageous debt, is a big turn-off. That's what I have gathered from my research. Going to school for about 10-12 years, graduating with nearly half a million in debt(on average I assume)is just disastrous and simply unacceptable to most -- to say the least.

STEM majors(Computer Science, EE,CpE)seem to have it way better. Allow me to reiterate, just in case someone misinterprets my post, if someone is interested in becoming a doctor, be my guest. One should however, take into account the amount of financial headaches that comes with it. They should also look into an ABET accredited B.S/B.E degree that head-hunters are going crazy for. New York for instance is having such a hard time filling up Computer Science related jobs, that they are going as far as construction a new graduate university. Recently, Electrical Engineers are struggling as well due to the poor economy. Most EE's end up as investment bankers, unfortunately.

[Admin Khan]

An awesome program for New Yorkers:

BS MD Program