M.D. (Mad Doctor)
When our backs are to the wall and we have nothing to lose, we write. When odds are insurmountable and we know we have given our all, we write. When that crap shoot we call life yields “sevens” and “elevens” late in the game, we write. Whether exorcising demons, seeking forgiveness, proclaiming cathartic guilt, or righting perceived wrongs, we put pen to paper, as if the action itself or the completed document placed in proper hands might lift the veil of angst that provided initial impetus.
I am no different from you. I am a man with no past, present, or future. I have lost a country, perhaps two, while seeking greener grass, and I have neither profession nor prospects for immediate salvation. Although pity is not something I actively seek, soothing words and a pat on the back would go far to easing the pain of unpaid student loans and an inability to attract gainful employment. I, like so many other native sons and daughters, have fallen through the cracks, and, while a national open-door policy benefits those born distant from these shores, those of us who have been left a legacy, a birthright, and a vested interest must man newly formed breadlines. The American dream is, indeed, alive and well, but currently in the hands of foreign nationals who pass by in shiny, new Lexuses, glance at us in askance, and warn their children to not mix blood with ours.
An Everyman, I am not. I am just an unemployed physician, and my only sin was a deep, heartfelt desire to help my fellow man, my countrymen, and a nation that long ago equated self-worth with honesty, integrity, and good deeds, not money and power. Back in 1976 my odyssey began, at the ripe old age of 24 years, when non-admittance to a U.S. medical school prompted a drastic course of action to make a dream come true. Tracing the path of Columbus in reverse, I made my foray into the European theater, and, with foreign language skills at a minimum, I enrolled in an Italian medical school. My action was laudatory, my quest rivaled that of Jason, and, yet, when I returned to the U.S. in 1996, I was a broken man whose seventeen years in medical school, graduate medical education, and private practice in Italy merited neither a tickertape parade nor a place in the sun. My parents had aged, my friends had moved on, and the white hair and age lines, which on another stage might have conferred deference and respect, made me all the more unrecognizable to a country that I, too, did not recognize.
Do the math. Often, fact is stranger than fiction. A national shortage of physicians currently grips this nation, with the poorest areas of the country suffering hand-in-hand with the most economically deprived areas of the world. Not only is this a travesty, but a national outrage to rival any of the tumultuous social issues of the last fifty years. We are 16,000 doctors short in the U.S., and, while physicians like myself would be willing to even work for free or for a nominal fee, the Association of American Medical Colleges (AAMC), the American Medical Association (AMA), the Educational Commission for Foreign Medical Graduates (ECFMG), the Electronic Residency Application Service (ERAS), the National Board of Medical Examiners (NBME), the National Resident Matching Program (NRMP), and on and on continue to shut us out. Not only are we barred from medical practice and graduate medical education, but foreign national physicians (non-citizens) are given preference over us for the few positions available. Outrage, I said. I should have said national disgrace!
More than 35 million Americans live in underserved areas of this country, and they suffer the slow, chronic, yet ravaging effects of diseases that would be well within our power to manage, treat, or cure were we to hire the legions of unemployed physicians forced to work non-medical jobs in this great country of ours. America’s rural and inner-city poor have been hit the hardest, as well as Hurricane Katrina-devastated regions, the Mississippi Delta, and the arid U.S. Southwest, to name a few. While current statistics show 280 doctors for every 100,000 people in the U.S., which is a shame, some areas of the country come in at only 103 for every 100,000, which is a downright crime. Mad, you better believe I am!
Increasing U.S. medical school enrollments will not solve the grave dilemma facing our nation. It will take years and years to educate new legions of physicians, and, all the while, the misery in the Mississippi Delta, Appalachia, and the 5,594 other Health Professional Shortage Areas (HPSA) will continue to grow. Meanwhile American citizen physicians like myself, who were trained in foreign medical schools, bang our heads against walls, as our country continues to abandon us in much the same way it did to American veterans during the Vietnam War. Make no mistake about it, this, too, is an unpopular war.
The old guard always fears change, and the medical profession itself is no exception. While good boys continue to flash wealth and lament the fact that they don’t earn quite as much as their predecessors, the urban poor continue to die. Medical graduates continue to flood high-powered, highly technical, lucrative fields of medicine, while at the same time both demeaning family practitioners and envisioning shiny, new BMWs, homes in the suburbs, vacation spas, and all manner of creature comforts as the graduate medical education phase of their lives draws to a close and they take their places among the empowered and the entitled. Meanwhile the years pass, and the 16,000 doctor shortage of today hits 24,000 by the year 2020, and perhaps even 200,000 by some estimates, based on a fast-growing U.S. population and an aging work force. Mad, you bet I am!
I continue to man the breadlines, being too educated to work menial jobs even if I so desired and too discriminated against by age and country of medical education to be given the opportunity to pursue graduate medical education and alleviate the suffering of my own countrymen here in the U.S. I have passed all the U.S. medical licensing examinations, I have paid all the high examination and legal fees, and, the good citizen that I am, I have followed all the AAMC, AMA, ECFMG, ERAS, NBME, and NRMP rules and regulations, only to have salt rubbed in my eyes, as doors are closed to me at the same time that foreign national doctors from China, Cuba, India, Korea, Mexico, the Middle East, Pakistan, the Philippines, South America, and sub-Saharan Africa are recruited for medical positions (governmental and non-governmental) subsidized by U.S. taxpayer dollars, my own included. Mad, I am raging mad!
I am a small fish, a David in the shadow of a Goliath-sized U.S. medical establishment. There is no way that I can win this battle, and yet I fight on. There are thousands like me here in the U.S., perhaps some living in your very community. We want to alleviate your pain, we want to be there for you, and, yet, the next time you need a family physician, you had better brush up on your foreign language skills, as you will most likely stand or sit face-to-face with a foreign national (there are more than 40,000 Indian doctors in the U.S., not to mention other nationalities), as American citizen physicians like myself beg for quarters, seek employment at Wal-Mart, and fight amongst ourselves for the scraps thrown to us by foreign national doctors. Mad, I am beet red!
I was once proud to be an American. In all honesty, I can no longer say that I am. So much injustice, so much dishonesty, so much hypocrisy, they have all taken their toll on this U.S. native son. My heartache is enormous, and my walls have been banged enough. I am a man with no solutions, only innumerable questions and an incessant desire to alleviate pain and suffering in my country of origin. As foreign physicians continue to pour into the U.S. for the few medical positions available, at the same time that I am denied access to medical positions in their homelands, the fires within me continue to rage. At 55-years-old, I don’t see them getting extinguished any time soon. Mad, I am without words!
© 2007, Albert M. Balesh, M.D. All rights reserved.
I am no different from you. I am a man with no past, present, or future. I have lost a country, perhaps two, while seeking greener grass, and I have neither profession nor prospects for immediate salvation. Although pity is not something I actively seek, soothing words and a pat on the back would go far to easing the pain of unpaid student loans and an inability to attract gainful employment. I, like so many other native sons and daughters, have fallen through the cracks, and, while a national open-door policy benefits those born distant from these shores, those of us who have been left a legacy, a birthright, and a vested interest must man newly formed breadlines. The American dream is, indeed, alive and well, but currently in the hands of foreign nationals who pass by in shiny, new Lexuses, glance at us in askance, and warn their children to not mix blood with ours.
An Everyman, I am not. I am just an unemployed physician, and my only sin was a deep, heartfelt desire to help my fellow man, my countrymen, and a nation that long ago equated self-worth with honesty, integrity, and good deeds, not money and power. Back in 1976 my odyssey began, at the ripe old age of 24 years, when non-admittance to a U.S. medical school prompted a drastic course of action to make a dream come true. Tracing the path of Columbus in reverse, I made my foray into the European theater, and, with foreign language skills at a minimum, I enrolled in an Italian medical school. My action was laudatory, my quest rivaled that of Jason, and, yet, when I returned to the U.S. in 1996, I was a broken man whose seventeen years in medical school, graduate medical education, and private practice in Italy merited neither a tickertape parade nor a place in the sun. My parents had aged, my friends had moved on, and the white hair and age lines, which on another stage might have conferred deference and respect, made me all the more unrecognizable to a country that I, too, did not recognize.
Do the math. Often, fact is stranger than fiction. A national shortage of physicians currently grips this nation, with the poorest areas of the country suffering hand-in-hand with the most economically deprived areas of the world. Not only is this a travesty, but a national outrage to rival any of the tumultuous social issues of the last fifty years. We are 16,000 doctors short in the U.S., and, while physicians like myself would be willing to even work for free or for a nominal fee, the Association of American Medical Colleges (AAMC), the American Medical Association (AMA), the Educational Commission for Foreign Medical Graduates (ECFMG), the Electronic Residency Application Service (ERAS), the National Board of Medical Examiners (NBME), the National Resident Matching Program (NRMP), and on and on continue to shut us out. Not only are we barred from medical practice and graduate medical education, but foreign national physicians (non-citizens) are given preference over us for the few positions available. Outrage, I said. I should have said national disgrace!
More than 35 million Americans live in underserved areas of this country, and they suffer the slow, chronic, yet ravaging effects of diseases that would be well within our power to manage, treat, or cure were we to hire the legions of unemployed physicians forced to work non-medical jobs in this great country of ours. America’s rural and inner-city poor have been hit the hardest, as well as Hurricane Katrina-devastated regions, the Mississippi Delta, and the arid U.S. Southwest, to name a few. While current statistics show 280 doctors for every 100,000 people in the U.S., which is a shame, some areas of the country come in at only 103 for every 100,000, which is a downright crime. Mad, you better believe I am!
Increasing U.S. medical school enrollments will not solve the grave dilemma facing our nation. It will take years and years to educate new legions of physicians, and, all the while, the misery in the Mississippi Delta, Appalachia, and the 5,594 other Health Professional Shortage Areas (HPSA) will continue to grow. Meanwhile American citizen physicians like myself, who were trained in foreign medical schools, bang our heads against walls, as our country continues to abandon us in much the same way it did to American veterans during the Vietnam War. Make no mistake about it, this, too, is an unpopular war.
The old guard always fears change, and the medical profession itself is no exception. While good boys continue to flash wealth and lament the fact that they don’t earn quite as much as their predecessors, the urban poor continue to die. Medical graduates continue to flood high-powered, highly technical, lucrative fields of medicine, while at the same time both demeaning family practitioners and envisioning shiny, new BMWs, homes in the suburbs, vacation spas, and all manner of creature comforts as the graduate medical education phase of their lives draws to a close and they take their places among the empowered and the entitled. Meanwhile the years pass, and the 16,000 doctor shortage of today hits 24,000 by the year 2020, and perhaps even 200,000 by some estimates, based on a fast-growing U.S. population and an aging work force. Mad, you bet I am!
I continue to man the breadlines, being too educated to work menial jobs even if I so desired and too discriminated against by age and country of medical education to be given the opportunity to pursue graduate medical education and alleviate the suffering of my own countrymen here in the U.S. I have passed all the U.S. medical licensing examinations, I have paid all the high examination and legal fees, and, the good citizen that I am, I have followed all the AAMC, AMA, ECFMG, ERAS, NBME, and NRMP rules and regulations, only to have salt rubbed in my eyes, as doors are closed to me at the same time that foreign national doctors from China, Cuba, India, Korea, Mexico, the Middle East, Pakistan, the Philippines, South America, and sub-Saharan Africa are recruited for medical positions (governmental and non-governmental) subsidized by U.S. taxpayer dollars, my own included. Mad, I am raging mad!
I am a small fish, a David in the shadow of a Goliath-sized U.S. medical establishment. There is no way that I can win this battle, and yet I fight on. There are thousands like me here in the U.S., perhaps some living in your very community. We want to alleviate your pain, we want to be there for you, and, yet, the next time you need a family physician, you had better brush up on your foreign language skills, as you will most likely stand or sit face-to-face with a foreign national (there are more than 40,000 Indian doctors in the U.S., not to mention other nationalities), as American citizen physicians like myself beg for quarters, seek employment at Wal-Mart, and fight amongst ourselves for the scraps thrown to us by foreign national doctors. Mad, I am beet red!
I was once proud to be an American. In all honesty, I can no longer say that I am. So much injustice, so much dishonesty, so much hypocrisy, they have all taken their toll on this U.S. native son. My heartache is enormous, and my walls have been banged enough. I am a man with no solutions, only innumerable questions and an incessant desire to alleviate pain and suffering in my country of origin. As foreign physicians continue to pour into the U.S. for the few medical positions available, at the same time that I am denied access to medical positions in their homelands, the fires within me continue to rage. At 55-years-old, I don’t see them getting extinguished any time soon. Mad, I am without words!
© 2007, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
7/30/2007 06:22:00 PM
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