Community Columns

Don't worry if your physician wasn't born in the U.S.

"Make sure he speaks English," she said, adding, "and knows what he's doing."

She was an acquaintance who asked me to find her a doctor -- one "without a funny name. You know what I mean?"

I did indeed. Worried she'd get a second-rate physician, she wanted a home-grown, presumably American- born and American-trained doctor -- not a "foreigner" (formally known as an "International Medical Graduate"). What she didn't know is that this request is not only harder to fill now than ever before, but also largely unnecessary.

Medical training is a long and winding road -- four years of college, four more in medical school followed by a minimum of three to six years in specialty training (residency or fellowship). The average American physician is into his or her 30s before starting to practice.

IMGs travel the same road but receive their undergraduate and medical school degrees from non-American institutions. More than 7,000 IMGs enter practice each year. They make up about 50 percent of family physicians and 25 percent of practicing physicians in all specialties, some of them medical school professors.

With very rare exceptions, all IMGs must take at least three years in residency-fellowship in a certified American university or medical center. Along the way, all students or graduates -- American and non-American -- are required to pass a three-step testing process known as the United States Medical Licensing Examination.

Given at various stages of the training process, these tests are closely monitored and measure basic and practical knowledge as well as language proficiency. No state medical license is granted without passing these tests. When all the formal training is completed there remains the last and biggest test -- specialty board exams.

More important than where a doctor comes from is the question, "Do we have enough doctors?"

What was predicted to be a surplus in the '80s now looks more like a future shortage, especially if medical care reforms succeed in covering the 47 million uninsured. American medical schools graduate about 16,000 students annually, a figure unchanged in 25 years.

Women make up about 50 percent of medical school graduates (my 1958 class had 5 percent), which warms the hearts of the women's movement but brings another problem: Female physicians are about 85 percent as productive as their male colleagues, largely due to taking time for family and child- rearing responsibilities.

Another problem: Studies show physicians are unevenly distributed, with two to three times more physicians per 1,000 population in affluent metropolitan areas than in rural or inner city regions. Compared with the rest of the state, California's Central Valley is significantly underdoctored.

My experience in observing and recruiting physicians leads me to believe that physicians, like all other people, come in all different sizes, shapes, levels of competence, compatibility and congeniality unrelated to country of origin or even early medical education. We are not so far removed from a time that people named Smith or Wellingham thought Koswalski, Nomellini or Cjeka were "funny names," too.

As the woman said, "You know what I mean?"

Allen, a semiretired Modesto physician, has served as a visiting editor on The Bee's editorial board. E-mail him at