I recently travelled to Dallas, Texas to attend the annual meeting of the Society of Academic Emergency Medicine. I looked forward to learning about how techniques and processes related to emergency medicine can be improved in Pakistan.

What really caught my attention was ‘new-age medicine’ i.e. the fast changing landscape of healthcare in the US in the face of ongoing reform.

This development poses a new set of challenges for Pakistani medical graduates looking to move to the US.

Below, I highlight some of the things I learned on this tour. It would help our current and future medical graduates to keep in touch with these developments and stay equipped for the future they envision for themselves:

Obamacare is here to stay

The much debated and often derided, Affordable Healthcare Act (AHA) – mellifluously called “Obamacare” – has created a flurry of activity in the healthcare and non-healthcare domains in the US.

Whatever the debates surrounding it, it is noteworthy that the programme potentially impacts emergency care, as well as non-emergent care of the sick and injured, given that it is expected to bring more than 25 million uninsured Americans into its fold.

The influx has the potential to affect job markets (short and long term) and choice of specialty training given the encouragement for pursuing primary care fields. Under AHA, I suspect that biomedical research agendas (with inherent funding streams) will likely also change over time.

A medical environment rife with gender-sensitivity

A new generation of students and employees – the ‘millennials’ (those born in the 80s and 90s) – are flooding the workplace. These young people, many of them being ‘Twitter and Facebook medicine’ junkies/techies, heavily rely on social media usage in medicine and academia.

That means one is expected of swift communication and exchange of feedback in real-time, while adequately avoiding or resolving any possible conflict and staying sensitive to gender-based concerns; because it is feedback given (or received) by a male or female is received and reacted to in different ways.

A team, not individuals

The bottom-up approach to team dynamics in which each person is considered worthy, and therefore all are equally effective change agents.

Culturally sensitive care back in the limelight

Patient satisfaction surveys are becoming more integral parts of physician performance indicators. When you are culturally sensitive to the needs of the patient than you are more likely to care for them versus considering them mere numbers in lines.

The sessions had a lot more to offer, but while I was taking notes, I found myself both excited and daunted; excited because health reform, if positive and sustainable, can lead to great things; but daunted by the idea of how this fast-paced fast changing landscape of healthcare reform in the US might impact foreign doctors.

I was part of that workforce not too long ago. Historically, there has always been a limit to the number of international medical graduates (IMGs) in residency and fellowship positions across the US. However, with American medical school graduate numbers increasing and fewer residency positions available for IMGs, this is growing into a bigger concern today.

Here’s why:

An increase in medical school positions in the US is not being accompanied by an increase in residency positions due to 1997's residency position cap instituted by Medicare, the national social insurance program which pays for many of these positions.

Thus, more US medical students (reflected in a 30 per cent increase by 2016) will be competing for more or less the same number of residency positions (projected to be evident as early as 2015).

This will mean stiffer competition for IMGs, not only for applicant from Pakistan, but also from India, Bangladesh, Africa, and so on.

I wonder how the future will pan out for my current batch of medical school mentees in Pakistan. Although many are formatting their training towards the US, how many are adequately prepared to get there?

I feel that most medical students whom I come across in Karachi and elsewhere, are still too single-mindedly focused on getting the ticket to America – USMLE scores and US electives. Both are important, but it’s also crucial that they acclimatise themselves to the changing medical landscape in the US.

A few recommendations and suggestions below are based on what I have learned from my recent trip to Dallas – and I am happy to debunk those who might believe that nothing useful can be learned from Texas.

(1) Although most IMGs have a good grasp of what they want for the short term, i.e. USMLE "success" in terms of top notch scores, they should also start devoting more time to learning from this ‘new age medicine’, acquire a new lingo and ready up for what is here and still to come, especially the precise professional ethic they’ll be expected to bring to table.

(2) Non-US medical students and IMGs could be part of the US healthcare think tank by becoming more active in a few of those online Twitter and Facebook medicine, paediatrics, emergency medicine, etc. groups and platforms. This diversification into interest groups will help develop new age leadership skills. It will also assist innovative and creative thinking about health systems, as distinct from ivory tower approaches to healthcare and biomedicine.

I believe proactive engagement in the fast changing healthcare debate might give them an edge in their US pursuits of higher medical education and training.

Although their generation will have the shorter end of the stick as my generation (gen X) is phasing out, what the ‘millennials’ have got going for them is extreme optimism for the future.

And hope is a good thing.


*Note: The author acknowledges Faysal Subhani, a 4th year medical student at AKU, for researching relevant data for this article.

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