I’ve been away for a while, as the new job doesn’t allow nearly as much time for goofing off on the internet - it took me a while to find you geezers/procrastinators, and someone is going to have to update me on what the hell exactly happened. But now I'm procrastinating from my real work to ask a work-related question (hmmm... maybe that doesn't really count as true procrastination). I had a question/situation about which I would appreciate your thoughts:

As of our move in July, I am the associate director of a training program in New Orleans, one that took a pretty hard hit from Katrina, both in terms of quality and quantity of personnel. As a result, over half of our current trainees are foreign graduates (FGs), and there is some stigma attached to this – it is generally seen as the sign of a weaker program. This is not really a fair generalization, as I’ve seen good and bad trainees come from “good” and “bad” medical schools alike, but part of this process is a game of perception – the perception among potential recruits that a program is dominated by FGs (and therefore weaker) tends to become a self-fulfilling phenomenon as top candidates become harder to attract once that perception has solidified. The quality had already begun to improve before I got here, but we are entering recruiting season shortly, so it is a front-burner issue to keep that trend going.

When I entered the job, I was told that we wanted to interview US graduates (USGs) first, then fill any available gaps in the interview schedule with foreign grads – but that filling it with Americans first would be preferable (I should note that at least half of the “foreign” grads are actually Americans who studied abroad). I already had my hands full with tuning up other aspects of the recruiting process, so I was glad to have an easy way to winnow down the number of applications I needed to review. As a result, I didn’t start looking at FGs until the schedule was nearly full with USGs; once I started looking, it became clear to me that the cream of these FGs clearly should be considered over the bottom tier of the USG contingent. I sent personalized invitations to them, and they appear to be responding – problem solved, right?

Well, no. Our chairman has been very clear that he wants to fill our program with USGs exclusively if possible, for the perception reasons mentioned above. I understand his reasoning, but I’d rather have a few of the best FGs rather than accept the dregs of the USG class. I also have noticed over the past few weeks that some fairly mortifying comments have escaped out into the general discussion; at one staff meeting, the chairman remarked on how great it was that we had our interview schedule almost full, all with American graduates, doing so in front of a room whose members were by majority foreign-trained. In talking with a couple of our trainees, I became aware that there was a significant sense among the FGs in our program that they were second-class citizens here. This bothered me on a fairly fundamental level, and I sent a letter out to all of the FGs in our program telling them that their place of training was not important to me, but rather their level of skill and their commitment to improving those skills. I also apologized for not including the best of the FGs among the initial invitations and said that this would not happen again in the future.

My chairman (whom I had sent the message to as well) was predictably displeased. He said that I should have simply told people “this is the departmental policy – take it up with the chairman.” I responded by saying that if these trainees felt unwanted, unappreciated and unhappy, that it would be visible to interviewees, and that it would impair our recruiting efforts ; I also said something to the effect that promising to invite people was not the same as promising to hire those people. I basically presented it to him as “we need these FGs to be happy with the program so that they will present a good face for us on interview days and create the conditions for them to become a progressively smaller fraction of our program.” He relented and said to go ahead as I was doing.

So the problem is “solved,” but I can’t help feeling unsatisfied with the resolution. The result is the one I wanted – the trainees clearly feel and appreciate that I have their back, and this should help toward realizing everyone’s longer-term goals. But I find it bothersome that I’ve had to cast something in quite Machiavellian terms when from my standpoint I am just trying to do the right thing by people for its own sake. I should be clear that our chairman is not the ogre this email may make him seem; he commands much respect and affection within the department (including from myself) for almost single-handedly rescuing it from dissolution after he took over a few years back. He is, in fact (irony-sensitive people cover your eyes) an FG himself, a highly intelligent person and someone for whom I am generally proud to work. I just happen to feel that his thinking is wrong on this particular issue.

Am I being stupid/needlessly complicated in letting myself be troubled by the disconnect between my chairman’s motivations and my own? Should I be more explicit about speaking up for what I see as the right thing, or should I just be content that the end result is the same? Am I setting myself up for trouble down the road when our interests (mine and my chairman’s) diverge more – when hiring foreign graduates is no longer a necessity but I continue to find one or two that merit inclusion and he wants all American-trained hires? I’m acutely aware of my status as the FNG (Fuckin’ New Guy), so I’m also wary of defecating where I eat, so to speak.

Alternatively, am I being more Machiavellian than I want to admit? This always gets me in a tail-chasing fit when “doing the right thing” results in a tangible benefit for me. Any thoughts you have would be welcome.

If you get to do the right thing for the wrong reasons, it's still the right thing.

(Also, nice to see you here.)

It's not Machievellan just because you are trying to be strategic.

The "right thing" for the organization (and its customers) aligns with the right thing for you as well as the right thing for the portion of the staff who are FG. At least in your analysis. Advocating that is nothing to feel guilty about.

Machavellianism, to my mind, is when you advocate actions that further your self interest at the expense of (or without consideration to) others and to the organization. Or if you advocate positions you do not necessarily believe. Or if you use others as cannon fodder without their permission.

Now then, if you use these FGs to make happy for a while, and then cut them loose or abandon them, that would be Machiavellan.

The question of the wisdom of undercutting or being perceived to undercut the boss. That's a whole different issue.

We are in a recession, unemployment is near 10%. Give those jobs to Americans.

Hey Bones. Welcome.

I'm a little unclear about the effect of an increased number of FGs in the program from an institutional standpoint.

You mentioned that there is a "stigma" attached to a program with a, what ..disproportionate?, number of FGs and that stigma impacts potential new recruits.

Are you saying that Biff from Ann Arbor Med School might be hesitant to get with the program if there are lots of University of Oslo candidates? Why? Why is there that perception that FGs are beneath USGs? Is that a legitimate concern? meaning, are USGs generally better? Or is it just that way in Biff's mind?

Also, do you think Chairman MxXenophobe is paying attention to that "stigma", and playing to it, because he's most interested in attracting USGs dueto the quality of their Med School training, and the message it sends to the next wave of Biffs from Ann Arbor, or is he just one of those characters who dislike fahhhrrrreiners?

upon sight before even reading it, because I was so gratified to see your moniker. Regarding this board, suffice it to say that Schmutzie deserves credit for accomplishing something very rare indeed, and exceedingly rare for mere posters----that is, actually changing the landscape of the Fray.

To your issue---my take is driven by what you do and where you do it. This isn't an Office Space or Mad Men cubicle conundrum. You and your program exist first and foremost to help people, especially people in your hard-hit area. So my answer is that you should take whatever course will result in the best healthcare outcome for the most folks in your area, plus wherever else the trainees may end up.

I have always found, in the many doctors and specialists we have been privileged to work with from Shands Teaching Hospital in Gainesville to The Hospital For Special Services in NYC, that those who were well-trained and who were able to do the work they loved were simply terrific healers. Whatever their age, gender, skin color or nationality we have felt the combination of training and support that they felt. It comes through their hands. It comes through their eyes. It comes through their tone of voice during consultation and diagnosis.

My husband taught at a professional school (law school) for 30 years. The Dean had to juggle many balls, some of which by the act of his juggling the professors got to eschew completely. These balls were often the "community" balls. Perhaps your Chairman has to deal with "community" pressures that the hires (USG or FG) don't have to -- and that's a good thing for the doctors and the patients. Tough on the Chairman though.

Sounds to me like your rationale, and your willingness to see it through, may have helped him bridge some of these variants.

I'm very glad to see you - and hope you, Mrs. Sawbones and Junior Sawbones are all well.

And we need him more and more every day. (You're not helping.) What did Lenin say the essence of politics was? кто кого?

In my field, there's an advantage to U.S. citizenship if one is accepting research contracts from the DoD. We work with universities quite a lot, however (and of course I went through a couple myself), and while Americans are certainly represented in the system, there is not generally an impression that they're the superior candidates. (Sometimes there is an impression otherwise.)

English communication skills are important on lots of levels, however, and there's an advantage for native speakers in that case. (Lucky for me.) Not sure how much your FG trainees have to deal with people. Could be some rational baiss for the bias.

Personally, I think you did the right thing.

My department looks like the bridge of the Starship Enterprise. There are at least eight different languages spoken here. It's a Japanese company. I'm not going to be much help. A long time ago, I had to take a physical & drug test to get a formal job offer. This Indian lady-doctor wrapped her cold hands around my testicles and said, 'Now you should cough, please." and squeezed like it was a rosin bag. Like I said, I'm not going to be much help.

I hope they know how lucky they are to have you.

I am sure you will be able to come up with just as convincing arguments later as you did here. Something about getting the best of both worlds etc. ect.

And by then they will have realized that your judgement can be trusted because they will know you better.

Like Ducadmo, I may not be much help, either. If I had a dollar for every international student that comes through these (community) college doors, telling me "I have Medical Degree from my country"... it happens often enough that one of my admissions colleagues regularly does the line in his Apu voice.

No matter how often one's own personal experience influences their beliefs and ideals, stereotyping is wrong. Your scenario is compelling though, because your director is a foreign trained graduate himself - he's obviously seeing it from a perspective that you can't. Yet somewhere, someone gave him the opportunity to work in this country - with the end result being that you consider him highly intelligent and someone with whom you are proud to work.

You are doing the right thing.

Well, it sounds to me like you finessed it fairly well. You have signaled to the crew you have that, as you said, you have their backs.

As I read your post, though, I sense that are either downplaying, or have an ethical twinge about, the long-term impact of being perceived as a disproportionately FG program. If it is indeed a self-fulfilling prophesy, with long-term consequences for the quality of the program, then as I see it you have three nearly co-equal priorities, and the tension between them will be greatest in the early years.

1. Work like hell to recruit good US graduates;

2. Also try to encourage the best of the FGs; and

3. Treat all who are on board with the same dignity.

But if you don't work hard enough at #1 in the interest of being scrupulous with 2 and 3, you could be trading away the future.

You're in the right state for this one, SB.

For those of you who don't know the story, Huey Pierce Long, gov of the Dream State of Louisiana convinced the state to agree to hire black doctors and nurses for all hospitals by telling everyone that they wouldn't want to make white nurses and doctors care for black folks.

Here's Huey P. Newton on the topic, from Revolutionary Suicide:

My parents named me after Huey Pierce Long, the former Governor of Louisiana, assassinated seven years before I came along. Even though he could not vote, my father had a keen interest in politics and followed the campaigns carefully. Governor Long had impressed him by his ability to talk one philosphy while carrying out programs that moved Louisiana in exactly the opposite direction.

My father says he was up front, "looking right into his mouth," when Huey P. Long made a speech about how Black men in the hospitals, "out of their minds and half naked," had to be cared for by White nurses. This was, of course, unacceptable to southern Whites, and therefore a number of Black nurses were recruited to work in Louisiana hospitals. This was a major breakthrough in employment opportunities for Black professionals.

Huey Long used this tactic to bring other beneficial programs to Blacks: free books in the schools, free commodities for the poor, public road- and bridge-construction projects that gave Blacks employment. While most Whites were blinded by Long's outwardly racist philosophy, many Blacks found their lives significantly improved. My father believed that Huey P. Long had been a great man, and he wanted to name a son after him.

Biff finding out that there are a lot of Suzies and Darrells from Granada Med U. The reason is that most Americans who want to be doctors and can't cut it in a US school, try for offshore schools next, and are more likely to get in. There's a whole industry built around this in the Caribbean. It has less to do with foreign birth than perception of the quality of the education.