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No Scrubs
The head of Wisconsin’s Medical Examining Board says the state has become a toilet bowl for foreign-trained doctors. But why?

Illustration by Shaw Nielsen

As a former state legislator, Sheldon Wasserman knows how to frame an issue. And as chairman of the Wisconsin Medical Examining Board, which screens physicians applying for state medical licenses, he’s on a mission to raise Wisconsin’s requirements for doctors trained in foreign countries. So he’s developed a revolting meme. We’re a “toilet bowl,” he says, for medicos with degrees from outside the United States.

A key standard, it turns out, is lower here than in any other state. Wisconsin law requires just one year of training in a local facility before an aspiring med school graduate can apply for a full-blown medical license. All other states require at least two years, and some mandate three.

Wisconsin sets the bar even lower, Wasserman adds, by allowing applicants to flit from one residency to another while building up the year they need. The system would seem accommodating to doctors with mediocre skills who, like moths to a flame, would flock to Wisconsin.

“They’re dangerous,” says Wasserman, who’s also a practicing gynecologist at Columbia St. Mary’s. “That’s what it boils down to. Wisconsin should not be the toilet bowl of the country for physicians.”

But have no fear, Wasserman insists. The Medical Examining Board acts as a safety net to keep bad apples from acquiring licenses. It approves or denies each application and hears appeals a dozen or more times a year. Many applicants fail, he says, because they’re just not ready to practice medicine, and they get weeded out.

At times, Wasserman can sound a little like a bureaucrat who’s besieged by grads from medical schools he’s never heard of and all the associated paperwork. Applicants with degrees from foreign schools (which are properly called “international medical graduates,” he says) sometimes fail the United States Medical Licensing Examination – a four-step test that all medical students take – at alarming rates.

Among graduates of U.S. and Canadian medical schools, the average first-time pass rates for Steps 1-4 are 91, 94, 97 and 94 percent, respectively. Among international graduates, the figures drop to 63, 74, 70 and 71, and some who appeal to Wasserman’s board have failed as many as 16 steps after taking the exam multiple times.

Wasserman says such a record is frightening, and handling appeals from these students takes up much of the board’s limited time. To alleviate that, Wasserman and other board members are lobbying the state Legislature to increase Wisconsin’s standard of one year of training to “at least two,” bringing it in line with most other states.

To the board’s benefit, Wasserman has 14 years of legislative experience, and the Wisconsin Medical Society, which represents doctors in the state, seems at least open to the proposal.

“We’re aware of the desire by some on the [Medical Examining Board] to change the current one-year requirement,” says Mark Grapentine, the society’s lobbyist. “We’re monitoring [the board] as that discussion continues, and we’ll be having internal discussions about the issue in our council policymaking process.”

In the meantime, Wasserman has a disclaimer he’d like to make. “This is not about foreign doctors,” he says, noting that some of the international graduates are actually U.S. citizens who couldn’t get into a U.S. medical school. “We are against poorly prepared, ill-equipped doctors practicing in Wisconsin. Foreign expertise is wanted and needed.”

Especially, some say, because the state faces a predicted shortage of 2,200 doctors by 2030, as estimated by a 2011 Wisconsin Hospital Association white paper. The Medical College of Wisconsin is planning new regional campuses in Green Bay and central Wisconsin, but they may not be able to churn out enough graduates soon enough.

“If the requirements are increased here in the state,” says John Raymond, Medical College president, “and we don’t produce a new pool of medical students, it may be difficult to fill the existing slots that we have, let alone the ones that we hope to expand.”

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