Beginner Medical English

A Reference Handbook for Mongolian Students and Healthcare Professionals (DOWNLOAD)

Medical Terminology

ONLINE LESSONS for Healthcare Professionals in Mongolia

Human Anatomy and Physiology

by Dr. Bruce Forciea, 2012 (DOWNLOAD)

Cells: Molecules and Mechanisms

University Cell and Molecular Biology textbook (DOWNLOAD)

Tuesday, September 24, 2013

The online games teaching children about their cancer

Originally posted on the BBC on September 4th, 2013

A non-profit company called HopeLab has developed a series of free online games, known as Re-Mission 2, designed to help young people learn about their cancer.

The company spoke to those who had suffered from the disease for ideas about how to make the games more appealing.

HopeLab's research found players were more likely to stick to their treatments and view their chemotherapy treatment as a means of defence rather than an obligation.

Click's Sumi Das finds out more.






FIGHT CANCER

Re-Mission 2 games help kids and young adults with cancer take on the fight of their lives. Based on scientific research, the games provide cancer support by giving players a sense of power and control and encouraging treatment adherence.

Each game puts players inside the human body to fight cancer with an arsenal of weapons and super-powers, like chemotherapy, antibiotics and the body’s natural defenses. The game play parallels real-world strategies used to successfully destroy cancer and win.

All six Re-Mission 2 games can be played online. The Re-Mission 2: Nanobot’s Revenge mobile app is available for download for iOS and Android.

ORIGIN STORY

Re-Mission 2 is a project of HopeLab, a nonprofit that harnesses the power and appeal of technology to improve human health and well-being. The games are an evolution of the original Re-Mission, inspired by the vision of HopeLab founder Pam Omidyar to fight cancer with gameplay. All Re-Mission games are designed in collaboration with medical professionals, game developers and – most importantly – young cancer patients. We are deeply grateful for their input and expertise.



Definition List:

  • appealing: attractive or interesting
  • obligation: something which you must do because you have promised, because of a law, etc.
  • adherence: the fact of behaving according to a particular rule, etc, or of following a particular set of beliefs, or a fixed way of doing something
  • arsenal: a collection of weapons
  • strategies: a plans that are intended to achieve a particular purpose
  • collaboration: the act of working with another person or group of people to create or produce something
Pronunciation MP3:
= appealing
= obligation
= adherence
= arsenal
= strategy
= collaboration

Monday, September 16, 2013

The low cost technology saving premature babies' lives

Originally posted on the BBC.co.uk on August 26, 2013
By Shilpa Kannan, BBC News, Bangalore

Tiny lives: Premature babies have very little body fat and are unable to regulate body temperature
Every year more than 20 million babies are born prematurely or with low birth weight - and an estimated 450 of them die each hour.

Yet most of these deaths could be avoided by simply keeping them warm.

"A new-born baby wailing can generally be heard outside the room - even across the hallway. But not my baby. Mine can only whimper," says Jayalakshmi Devi.

She's standing outside the neo-natal intensive care unit (ICU) staring at the glass box where her baby son is kept.

Born too soon, her baby boy weighs less than 1.2 pounds (0.54kgs). Doctors have given him around a 40% chance of survival.

Having lost two babies already, Jayalakshmi didn't want to take a chance this time. After delivering her child in a rural healthcare centre three hours outside Bangalore, she brought the baby to the state run hospital in the city.

Women often give birth at home in rural areas and only bring them to hospitals when there is a critical need.

At Vanivilas hospital, the neo-natal ICU sees scores of premature babies. Most are born at home, in far off rural areas and are brought here in critical condition.

Row after row, the transparent boxes create warmth to hold the tiny, bare-bodied babies with only an oversized diaper around them. Some of the babies are small enough to fit into your palm.

Life-saving warmth

A baby's body temperature drops as soon as it is outside the controlled environment of the mother's womb. So just after labour, it's important to regulate the temperature.

But premature babies have very little body fat, so they are unable to do that.

The babies need incubators to help keep them alive - equipment which state-run hospitals like this one often cannot afford.

So, GE Healthcare created the Lullaby baby-warmer, to help to save lives in a country that has the highest rate of pre-term baby deaths in the world.

Small packages: Premature babies kept in the low-cost incubators in the neo-natal ICU in Vanivilas hospital in Bangalore

Low-cost innovation

It was developed in Bangalore and launched in 2009. The baby warmer costs $3,000 (£1,900) in India, 70% cheaper than traditional models.

The design includes pictorial warnings and colour coding, so that even illiterate rural healthcare workers can operate the machine.
Premature infants
  • Babies born before the 37th week of pregnancy are called pre-term and they have a lower survival rate.
  • Some 20 million babies are born prematurely or with a low birth weight every year.
  • More than one million of these babies die on their first day of life, and nearly three million die within the first month of life according to Save the Children.
  • Those babies who survive often suffer from serious ailments including diabetes and heart disease.
The Lullaby warmer also consumes less power than most incubators, which means cost savings for the healthcare centre.

"Where better to make a baby warmer than here - India produces a baby nearly every second," says GE Healthcare's Ravi Kaushik.

He believes India is an ideal innovation centre when it comes to products like this, because 70% of the population is rural and 30% is urban, and within this you all different stratas of society.

"So you can have very great world class hospitals that want and require world class medical equipment that America or Europe would require. But at the same time there is a population in rural space that would require same kind of medical attention," says Mr Kaushik.

"So when you design a product, you have to cater to the entire plethora of needs. That allows you to almost hit the entire world because India is a small representation of that."

Engineers at GE's technology centre are stripping down lifesaving, high tech medical devices of all their frills to understand how to create products that are affordable.

This project is now widely quoted as an example of "reverse innovation".

This is where large global companies design products in developing markets like India and then take the successful creation back to international markets to sell.

After success in the domestic market, GE now sells the warmer in more than 80 countries.

Bundled up

While this works for healthcare centres on a budget, it still needs continuous electricity to run.

The Embrace warmer is a low-cost sleeping bag-like product designed to be durable and re-usable

But go further down the population pyramid, and the problems get more complex.

Women in villages give birth at home and have little access to basic healthcare or electricity.

For them, keeping babies warm means wrapping them in layers of fabric and hot water bottles, or putting them under bare light bulbs.

Many of them don't survive.

But now a low cost baby bag is saving thousands of young lives. Called the Embrace, it emerged out of a class assignment at Stanford's Institute of Design in 2007.

Four graduate students - Jane Chen, Linus Liang, Naganand Murty, and Rahul Panicker - were challenged to come up with a low-cost incubator design that could help save premature babies born into poverty.

The team created a sleeping bag with a removable heating element.

Using high school physics, they used phase-change material (PCM), a waxy substance that, as it cools from melted liquid to solid, maintains the desired temperature of 37 degrees celsius (98.6 F) for up to six hours.

The end product looks like a quilted sleeping bag that is durable and portable. It requires only 30 minutes of electricity to warm up using a portable heater that comes with the product.

More importantly for mothers, it allows for increased contact with their child, unlike traditional incubators.

So it also encourages Kangaroo care, a technique practiced on newborn, especially pre-term infants, which promotes skin-to-skin contact to keep the baby warm and facilitate breastfeeding and bonding.

The infant warmer costs about $200 to make, is inexpensive to distribute, and is reusable.

All wrapped up: The Embrace warmers are donated to mothers in impoverished communities

Embrace is a non-profit venture. The product is not sold, but is donated to impoverished communities in need.

The invention is thought to have helped save the lives of more than 22,000 low birth-weight and premature infants.

Taking the programme forward, the organisation has developed a new version designed for at-home use by mothers. The model has been successfully prototyped and is currently undergoing clinical testing in India.

The organisation has also set up educational programmes to address the root causes of hypothermia.

"We provide intensive, side-by-side training to mothers, caretakers, and healthcare workers," says Alejandra Villalobos, director of development at Embrace.

"We develop long-term partnerships with local governments and non-profits in every community where we work.

"We believe that increased access to both technology and education is necessary to achieve our ultimate vision: that every woman and child has an equal chance for a healthy life."

To partner with EmbraceGlobal, click this link!



Definition List:
  • to wail: to make a long loud high cry because you are sad or in pain
  • to whimper: to make low, weak crying noises; to speak in this way
  • transparent: allowing you to see through it
  • to regulate: to control the speed, pressure, temperature, etc. in a machine or system
  • incubator: a piece of equipment in a hospital which new babies are placed in when they are weak or born too early, in order to help them survive
  • plethora: an amount that is greater than is needed or can be used
  • frills: things that are not necessary but are added to make something more attractive or interesting
  • venture: a business project or activity, especially one that involves taking risks
  • impoverished: very poor; without money
Pronunciation MP3s:
= wail
= whimper
= transparent
= regulate
= incubator
= plethora
= frill
= venture
= impoverished

Monday, September 9, 2013

When patients have 'music emergencies'

Originally posted on CNN.com on August 23, 2013
By Elizabeth Landau, CNN

Brian Jantz, a music therapist at Boston Children's Hospital, plays with a patient, Yaneishka Trujillo. Jantz uses music to engage with children.

Brian Jantz marched down the hallway of the hospital with his guitar, accompanying a 4-year-old oncology patient with a maraca and a drum. He remembers they were singing their own creative version of "Itsy Bitsy Spider."

The girl had been anxious about an upcoming X-ray, he said, and resisted going to the procedure. Hospital staff paged Jantz to help. He kept the music going even on the elevator; the girl's parents, a nurse and a child-life specialist sang, too.

"I'm not completely sure that she realized when it was happening ... because before you knew it, we were back on the elevator, back in the room, and the music just continued straight through," Jantz said.

Jantz is one of two music therapists at Boston Children's Hospital, where the idea of using music to help patients as young as premature babies in the neonatal intensive care unit has taken off in the last decade. Jantz and his colleague have scheduled visits with patients in almost every unit but will come to a melodic rescue in urgent situations.

"We kind of joke around, 'It's like a music emergency,' but it really is," Jantz said. "It really can be like, 'This patient needs music therapy right now.' "

Music therapy formally began in the 20th century, after musicians went to play for World War I and World War II veterans at hospitals across the United States. Today, there are about 5,000 board-certified music therapists in the United States, according to the American Music Therapy Association. Over the last decade, the group's membership has expanded, particularly among students.

Music therapy has many uses, from treating individuals in private practice to elderly care settings.

"We're not huge, but are slow growing -- but a mighty -- group," said Barbara Else, senior adviser for policy and research at the American Music Therapy Association.

Why it works

There is scientific research to back up the idea that music has healing properties. A 2013 analysis by Daniel Levitin, a prominent psychologist who studies the neuroscience of music at McGill University in Montreal, and his colleagues highlighted a variety of evidence: for instance, one study showed music's anti-anxiety properties, another found music was associated with higher levels of immunoglobin A, an antibody linked to immunity.

The brain's reward center responds to music -- a brain structure called the striatum releases the chemical dopamine, associated with pleasure. Food and sex also have this effect. The dopamine rush could even be comparable to methamphetamines, Robert Zatorre, professor of neurology and neurosurgery at Montreal Neurological Institute, told CNN last year.

Beyond that, music presents a nonthreatening tool for interventions that is already attractive to patients, Jantz said.

"On the surface it works because, in some way, everyone relates to music," Jantz said. "Music really is universal."

Music therapists often work nonverbally, which is why the method is particularly effective for individuals with verbal expression difficulties, such as children with autism, Else said. The profession helps people at every age, from babies to Alzheimer's patients.

For individuals with autism in particular, music therapy has shown to be a positive reinforcement of appropriate behaviors and a motivator to reduce negative ones, according to the American Music Therapy Association. Music can also help with the development of language skills, and the identification and expression of emotions, which are characteristic challenges in autism. Some children with autism have superb musical abilities, and music therapy can help them focus on their strengths.

Alzheimer's patients, who have memory and thinking impairment, may still recognize songs of their youth or respond emotionally to music. Music can also be used in elderly care settings to calm or stimulate residents.

Music as a tool

Singing with someone when you feel anxious, or expressing emotions through songwriting, are more than just casual activities in music therapy. Therapists always have specific goals in mind, such as helping patients overcome a fear.

One fundamental of music therapy is called the "Iso principle," the idea that the therapist takes cues from the client when choosing what music to play. This can inform the improvised music that therapists and clients play together. If the client feels hyped up, the therapist and client might play vigorous drum beats together, but if the goal is to relax, they might begin energetically and then tone down.

Therapists are conscious of rhythm, tempo, texture and melody of the music as clients express themselves. In a hospital setting such as Jantz's, such components of music can also distract a patient who is in pain.

In Else's private practice, she has been helping a college student with an anxiety disorder called agoraphobia; the young woman, who was homeschooled, has been fearful of leaving her house.

The student writes song lyrics when she meets with Else, and also learns guitar from the therapist in the process. By discussing the lyrics and other elements of the music that the student generates through improvisation, the client and therapist uncover clues about what is fueling the woman's anxieties.

"We are using music as a mechanism. One, for motivation, but also as a mechanism so she can express herself and we can figure out what are some of these things that are driving her fears," Else said. "We've made a lot of progress."

Having worked through her issues with music, the young woman became more open to going out in public, Else said. She accompanied Else to a rehearsal for an opera, and then to an actual opera performance.

She has now started junior college and is doing well, Else said. The young woman still sees Else for follow-up maintenance.

"Part of that therapeutic process working with her ... was building a high level of trust," Else said. "Developing trust with someone so she could understand that the world isn't quite so scary out there, to get to the root cause."

Music as a lifesaver

Going through music therapy isn't always relaxing, fun or easy.

Cpl. Demi Bullock, 25, a former Marine, experienced post-traumatic stress disorder after her second deployment in Afghanistan. In summer 2011, music therapy was part of her treatment program.

At first, Bullock, who had played the guitar since she was 15, hated music therapy. Her therapist, Rebecca Vaudreuil, would organize activities such as a drum circle, lyric analysis, listening exercises or instrumental playing for service members in the program.

Impatience, and a desire to withdraw from emotion, quickly overtook Bullock. She refused to participate.

"I did not like playing music, having something make me feel that pain and that sadness, that can be completely overwhelming," she said.

Such resistance isn't unusual among returning military, Vaudreuil said. Some people can connect with music more than others, but in some cases it takes time and "soul-searching" for music to become a beneficial part of recovery.

Bullock rediscovered music therapy more than a year after her initial encounter with it. In January, Vaudreuil invited her to join the Semper Sound Band, a musical program through the nonprofit Resounding Joy Inc. that helps service members reintegrate into the community and promotes group cohesion. Vaudreuil was the band director at that time.

The invitation came at a particularly dark moment. Bullock was in the process of getting evicted and continued to struggle with PTSD and depression. She had also recently attempted suicide.

Bullock came to discover that jamming on a guitar, keyboard or drum set helped her cope with stress or intrusive thoughts. The band also provides a social support system and an outlet for self-expression.

"The songs that come out of it, and the process they go through, is so genuine," Vaudreuil said. "The songs are a direct reflection of their emotions, their trials, what they've been through, their experiences, and it's completely cathartic for them."

Bullock continues to play with the band, and works as an intern at Resounding Joy. Her job allows her to be on the facilitator side of music therapy, and connect with other veterans.

"If I hadn't gotten into it (music therapy), I'd literally be dead or still be homeless," Bullock said. "It literally did save my life."

Measuring calm

Other therapists are exploring technologies that allow them to see what effect music has on the human body, and use that information to guide clients. This is called biofeedback.

Eric B. Miller, a music therapist in Phoenixville, Pennsylvania, uses real-time data about patients' physiological responses to inform how he runs sessions. He recently discussed a biofeedback method at the Interdisciplinary Society for Quantitative Research in Music and Medicine conference in Athens, Georgia.

"The idea is that this information is informing me as a music therapist how I want to be playing my guitar, what tempo I'm going for," he said at the conference.

Conference attendees took turns listening to music while wearing a finger sensor. Through a computer program, a graph appeared on a projector screen showing relative heart rate, heart rate variance and skin conductivity in real time. The computer program then translated the readings from the sensor into tones, which could be heard overlayed with music.

Independent researcher Elijah Easton listened to another conference attendee (full disclosure: it was the author of this article) improvise on the piano. Easton said he found the activity relaxing; Miller noted that Easton's heart rate had decreased after the music stopped.

In a real session, Miller would create a physiological profile of a client by looking at his or her responses to sitting naturally, doing a cognitive task, relaxing and envisioning something emotional. After more relaxation, he would set up the biofeedback system of tones, and challenge the client to lower the tone, an indication of relaxation. Different tones can be assigned to different variables such as heart rate.

The point is helping clients learn the art of self-regulation, of adjusting their own bodies, Miller said.
"The music and the data are both co-therapists," Miller said.

Biofeedback-oriented music therapy can be used in a variety of conditions, including high blood pressure and seizures -- not necessarily instead of mainstream medicine, but in concert with it, Miller said.

"Western doctors may recommend it to complement existing treatment or as a trial in cases of adverse reaction to typical pharmacological remedies," he said.

In a more subtle way, Jantz also uses biofeedback with patients who are already hooked up to monitors at Boston Children's Hospital for medical reasons. When he plays music in the neonatal intensive care unit, he can see what impact strumming his guitar has by observing the heart rate graph.

Fun is part of it

Jantz sees music itself as having an intrinsic therapeutic value, in addition to the positive experience that a person can have with a music therapist. For children in particular, it can encourage them to learn a new skill; sometimes patients who stay at Boston Children's Hospital for longer periods get good at guitar.

Occasionally Jantz has to dress in a surgical gown and gloves, but for the most part the kids don't view what he does as a therapy -- they're just relieved that instead of poking and prodding, he's there to play music with them.

"There's nothing wrong with having fun," he said. "That's part of how it works."

He's prepared for a full repertoire of traditional children's songs, but he has also worked with young kids who love The Beatles. And some teens would rather hear music from their earlier childhood than Justin Bieber.

The phone that pages him, though, doesn't beep or ring to alert him to his next destination.

It vibrates, so as to not interrupt the music.



Definition List:
  • oncology: the scientific study of and treatment of tumors (cancer) in the body
  • maracas: a pair of simple musical instruments consisting of hollow balls containing beads or beans that are shaken to produce a sound
  • melodic: connected with the main tune in a piece of music
  • prominent: important or well known
  • neuroscience: the science that deals with the structure and function of the brain and the nervous system
  • nonthreatening: not likely to frighten anyone; not threatening
  • autism: a mental condition in which a person finds it very difficult to communicate or form relationships with others
  • motivator: something that makes somebody want to do something, especially something that involves hard work and effort
  • superb: excellent; of very good quality
  • impairment: the state of having a physical or mental condition which means that part of your body or brain does not work correctly
  • hyped up: very worried or excited about something that is going to happen
  • vigorous: very active, determined or full of energy
  • agoraphobia: a fear of being in public places where there are many other people
  • improvisation: to invent music, the words in a play, a statement, etc. while you are playing or speaking, instead of planning it in advance
  • to drive: to influence something or cause it to make progress
  • to reintegrate: to become or make somebody become accepted as a member of a social group again
  • cohesion: the act or state of keeping together
  • to evict: to force somebody to leave a house or land, especially when you have the legal right to do so
  • PTSD: Posttraumatic stress disorder is a severe condition that may develop after a person is exposed to one or more traumatic events, such as sexual assault, serious injury or the threat of death.
  • to jam: to play music with other musicians in an informal way without preparing or practising first
  • to cope: to deal successfully with something difficult
  • cathartic: the process of releasing strong feelings, for example through plays or other artistic activities, as a way of providing relief from anger, suffering, etc.
  • biofeedback: the use of electronic equipment to record and display activity in the body that is not usually under your conscious control, for example your heart rate, so that you can learn to control that activity
  • cognitive: connected with mental processes of understanding
  • to envision: to imagine what a situation will be like in the future, especially a situation you intend to work towards
  • adverse: negative and unpleasant; not likely to produce a good result
  • intrinsic: belonging to or part of the real nature of something/somebody
  • to poke: to quickly push your fingers or another object (like a needle) into somebody/something
  • to prod: to push somebody/something with your finger or with a pointed object
  • repertoire: all the plays, songs, pieces of music, etc. that a performer knows and can perform
Pronunciation MP3s:
= oncology
= maracas
= melodic
= prominent
= neuroscience
= dopamine
= methamphetamine
= autism
= motivator
= superb
= impairment
= hype
= vigorous
= agoraphobia
= improvisation
= reintegrate
= cohesion
= evict
= jam
= cope
= cathartic
= biofeedback
= cognitive
= envision
= adverse
= intrinsic
= poke
= repertoire

Monday, September 2, 2013

Path to United States Practice Is Long Slog to Foreign Doctors

Originally posted on The New York Times on August 11, 2013
by Karsten Moran

Thousands of foreign-trained immigrant physicians are living in the United States with lifesaving skills that are lying fallow because they stumbled over one of the many hurdles in the path toward becoming a licensed doctor here.

Mr. Abeyawickrama was an anesthesiologist in Sri Lanka.

The involved testing process and often duplicative training these doctors must go through are intended to make sure they meet this country’s high quality standards, which American medical industry groups say are unmatched elsewhere in the world. Some development experts are also loath to make it too easy for foreign doctors to practice here because of the risk of a “brain drain” abroad.

But many foreign physicians and their advocates argue that the process is unnecessarily restrictive and time-consuming, particularly since America’s need for doctors will expand sharply in a few short months under President Obama’s health care law. They point out that medical services cost far more in the United States than elsewhere in the world, in part because of such restrictions.

The United States already faces a shortage of physicians in many parts of the country, especially in specialties where foreign-trained physicians are most likely to practice, like primary care. And that shortage is going to get exponentially worse, studies predict, when the health care law insures millions more Americans starting in 2014.

The new health care law only modestly increases the supply of homegrown primary care doctors, not nearly enough to account for the shortfall, and even that tiny bump is still a few years away because it takes so long to train new doctors. Immigrant advocates and some economists point out that the medical labor force could grow much faster if the country tapped the underused skills of the foreign-trained physicians who are already here but are not allowed to practice. Canada, by contrast, has made efforts to recognize more high-quality training programs done abroad.

“It doesn’t cost the taxpayers a penny because these doctors come fully trained,” said Nyapati Raghu Rao, the Indian-born chairman of psychiatry at Nassau University Medical Center and a past chairman of the American Medical Association’s international medical graduates governing council. “It is doubtful that the U.S. can respond to the massive shortages without the participation of international medical graduates. But we’re basically ignoring them in this discussion and I don’t know why that is.”

Consider Sajith Abeyawickrama, 37, who was a celebrated anesthesiologist in his native Sri Lanka. But here in the United States, where he came in 2010 to marry, he cannot practice medicine.

Instead of working as a doctor himself, he has held a series of jobs in the medical industry, including an unpaid position where he entered patient data into a hospital’s electronic medical records system, and, more recently, a paid position teaching a test prep course for students trying to become licensed doctors themselves.

For years the United States has been training too few doctors to meet its own needs, in part because of industry-set limits on the number of medical school slots available. Today about one in four physicians practicing in the United States were trained abroad, a figure that includes a substantial number of American citizens who could not get into medical school at home and studied in places like the Caribbean.

But immigrant doctors, no matter how experienced and well trained, must run a long, costly and confusing gantlet before they can actually practice here.

The process usually starts with an application to a private nonprofit organization that verifies medical school transcripts and diplomas. Among other requirements, foreign doctors must prove they speak English; pass three separate steps of the United States Medical Licensing Examination; get American recommendation letters, usually obtained after volunteering or working in a hospital, clinic or research organization; and be permanent residents or receive a work visa (which often requires them to return to their home country after their training).

The biggest challenge is that an immigrant physician must win one of the coveted slots in America’s medical residency system, the step that seems to be the tightest bottleneck.

That residency, which typically involves grueling 80-hour workweeks, is required even if a doctor previously did a residency in a country with an advanced medical system, like Britain or Japan. The only exception is for doctors who did their residencies in Canada.

The whole process can consume upward of a decade — for those lucky few who make it through.

“It took me double the time I thought, since I was still having to work while I was studying to pay for the visa, which was very expensive,” said Alisson Sombredero, 33, an H.I.V. specialist who came to the United States from Colombia in 2005.

Dr. Sombredero spent three years studying for her American license exams, gathering recommendation letters and volunteering at a hospital in an unpaid position. She supported herself during that time by working as a nanny. That was followed by three years in a residency at Highland Hospital in Oakland, Calif., and one year in an H.I.V. fellowship at San Francisco General Hospital. She finally finished her training this summer, eight years after she arrived in the United States and 16 years after she first enrolled in medical school.

Dr. Sombredero was helped through the process by the Welcome Back Initiative, an organization started 12 years ago as a partnership between San Francisco State University and City College of San Francisco. The organization has worked with about 4,600 physicians in its centers around the country, according to its founder, José Ramón Fernández-Peña.

Only 118 of those doctors, he said, have successfully made it to residency.

“If I had to even think about going through residency now, I’d shoot myself,” said Dr. Fernández-Peña, who came to the United States from Mexico in 1985 and chose not even to try treating patients once he learned what the licensing process requires. Today, in addition to running the Welcome Back Initiative, he is an associate professor of health education at San Francisco State.

The counterargument for making it easier for foreign physicians to practice in the United States — aside from concerns about quality controls — is that doing so will draw more physicians from poor countries. These places often have paid for their doctors’ medical training with public funds, on the assumption that those doctors will stay.

“We need to wean ourselves from our extraordinary dependence on importing doctors from the developing world,” said Fitzhugh Mullan, a professor of medicine and health policy at George Washington University in Washington. “We can’t tell other countries to nail their doctors’ feet to the ground at home. People will want to move and they should be able to. But we have created a huge, wide, open market by undertraining here, and the developing world responds.”

About one in 10 doctors trained in India have left that country, he found in a 2005 study, and the figure is close to one in three for Ghana. (Many of those moved to Europe or other developed nations other than the United States.)

No one knows exactly how many immigrant doctors are in the United States and not practicing, but some other data points provide a clue. Each year the Educational Commission for Foreign Medical Graduates, a private nonprofit, clears about 8,000 immigrant doctors (not including the American citizens who go to medical school abroad) to apply for the national residency match system. Normally about 3,000 of them successfully match to a residency slot, mostly filling less desired residencies in community hospitals, unpopular locations and in less lucrative specialties like primary care.

Over the last five years, an average of 42.1 percent of foreign-trained immigrant physicians who applied for residencies through the national match system succeeded. That compares with an average match rate of 93.9 percent for seniors at America’s mainstream medical schools.

Mr. Abeyawickrama, the Sri Lankan anesthesiologist, has failed to match for three years in a row; he blames low test scores. Most foreign doctors spend several years studying and taking their licensing exams, which American-trained doctors also take. He said he didn’t know this, and misguidedly thought it would be more expeditious to take all three within seven months of his arrival.

“That was the most foolish thing I ever did in my life,” he says. “I had the knowledge, but I did not know the art of the exams here.”

Even with inadequate preparation, he passed, though earning scores too low to be considered by most residency programs. But as a testament to his talents, he was recently offered a two-year research fellowship at the prestigious Cleveland Clinic, starting in the fall. He is hoping this job will give residency programs reason to overlook his test scores next time he applies.

“Once I finish my fellowship in Cleveland, at one of the best hospitals in America, I hope there will be some doors opening for me,” he said. “Maybe then they will look at my scores and realize they do not depict my true knowledge.”

The residency match rate for immigrants is likely to fall even lower in coming years. That is because the number of accredited American medical schools, and therefore United States-trained medical students, has increased substantially in the last decade, while the number of residency slots (most of which are subsizided by Medicare) has barely budged since Congress effectively froze residency funding in 1997.

Experts say several things could be done to make it easier for foreign-trained doctors to practice here, including reciprocal licensing arrangements, more and perhaps accelerated American residencies, or recognition of postgraduate training from other advanced countries.

Canada provides the most telling comparison. Some Canadian provinces allow immigrant doctors to practice family medicine without doing a Canadian residency, typically if the doctor did similar postgraduate work in the United States, Australia, Britain or Ireland. There are also residency waivers for some specialists coming from select training programs abroad considered similar to Canadian ones.

As a result, many (some estimates suggest nearly half) foreign-trained physicians currently coming into Canada do not have to redo a residency, said Dr. Rocco Gerace, the president of the Federation of Medical Regulatory Authorities of Canada.

In the United States, some foreign doctors work as waiters or taxi drivers while they try to work through the licensing process. Others decide to apply their skills to becoming another kind of medical professional, like a nurse practitioner or physician assistant, adopting careers that require fewer years of training. But those paths present barriers as well.

The same is true for other highly skilled medical professionals.

Hemamani Karuppiaharjunan, 40, was a dentist in her native India, which she left in 2000 to join her husband in the United States. She decided that going back to dentistry school in the United States while having two young children would be prohibitively time-consuming and expensive. Instead, she enrolled in a two-year dental hygiene program at Bergen Community College in Paramus, N.J., which cost her $30,000 instead of the $150,000 she would have needed to attend dental school. She graduated in 2012 at the top of her class and earns $42 an hour now, about half what she might make as a dentist in her area.

The loss of status has been harder.

“I rarely talk about it with patients,” she said. When she does mention her background, they usually express sympathy. “I’m glad my education is still respected in that sense, that people do recognize what I’ve done even though I can’t practice dentistry.”



Definition List:
  • fallow: when nothing is created or produced; not successful
  • to stumble: to make a mistake or mistakes and stop
  • hurdle: a problem or difficulty that must be solved or dealt with before you can achieve something
  • to loath: not willing to do something
  • advocate: a person who supports or speaks in favour of somebody or of a public plan or action
  • exponentially: to increase faster and faster
  • shortfall: if there is a shortfall in something, there is less of it than you need or expect
  • substantial: large in amount, value or importance
  • gauntlet: an open challenge
  • counterargument: an argument offered in opposition to another argument
  • to wean: to make somebody gradually stop doing or using something
  • reciprocal: involving two people or groups who agree to help each other or behave in the same way to each other
Pronunciation MP3s:
= fallow
= stumble
= hurdle
= loath
= exponentially
= shortfall
= anesthesiologist
= substantial
= gauntlet
= counterargument
= wean
= reciprocal