I have had limited experience in this area, so perhaps some one can explain to me how Luka has the credentials to practice medicine in the US. I have occasionally encountered people from the old Soviet Bloc who were trained as doctors in their countries, but were working at much lower levers of medical care here in the US. I had the same nurse or perhaps even an aide (I don't recall what her exact title was, but she was helping me get up and around the next day, not administering meds or anything like that) attend to me in the hospital after the birth of my last two babies, and she was a pediatrician in Russia. Her training simply was insufficient to practice in the US. Do you remember 'Bob,' the vascular surgeon, who was nowhere near that position? Luka seems to be very young and far more experienced than I would expect him to be given his background. Wouldn't he need to receive additional training and go through board exams, etc., etc., which would take more years that he appears to have under his belt. I am not trying to bash him. I liked him, until this season. Can we get him back?

-- Marie (Momba@mariesmail.com), February 19, 2001

Answers

We don't know where Luka got his medical training or how long he has been in the US. In the case of "Bob," she told Carter she had to learn English and American medical terminology in order to "be boarded", that is, pass the licensing board exams. Luka's English is a lot better than Bob's was, and he has demonstrated familiarity with American medical terminology. All he would have to do would be to prove he attended a medical school which the licensing board regards as acceptable, pass his exams, and serve a year's residency in the US. TPTB seem to have set Luka up as being about 10 years older than GV, so he would have time. There are actually a lot of foriegn doctors practising in the US, particularly in inner city hospitals and rural areas where the big money isn't, and most American doctors don't want to be.

-- Melinda (mross@value.net), February 19, 2001.

I have had similar questions too. I have known foreign physicians taking the American exams for foreign doctors and they seem to have taken off a year of their life just to study for them. I can't imagine that Luka had the presence of mind to do this after his family was killed. I wonder why Luka came to the United States anyway? By the way, have you read that the actor (GV) is not really as fluent in English as he appears on TV?

-- violet (violet@pon.net), February 19, 2001.

I have read this, and when it comes to medical terminology, its pretty obvious. (Though he is getting better at it.) :-)

But then, Antonio Banderas did a wonderful job in "The Mambo Kings" (I thought, anyway) and he had to actually learn his lines phonetically. Didn't speak a word of English. I guess it's possible to act if you get the gist of what's being said.

-- S. Trelles (trelles@ix.netcom.com), February 19, 2001.

Typically a physician trained outside the United States & Canada must go through an approved US residency program in order to practice medicine unless the state of Illinois has different rules than the rest of the country. It doesn't matter where you come from or where you are willing to work. There is no special dispensation for being from a former Soviet state. That is why you will find foreign trained surgeons in psychiatric residency programs & internists working as physician assistants. Psych residencies are easier to get into than surgery. Nursing & PA training is shorter than medical residency. Luka would have had to have trained in the US & maybe returbed to Yugoslavia for the time line to be correct. He just hasn't been in the country long enough to have done a full residency. Elizabeth, if you recall, came over initially as a fellow in surgery. When Romano ended her fellowship, she had to do a surgery residency & actually spent a year or so as an intern & resident before Romano gave her "credit" for the rest of her training & made her an attending. She would have had to pass the Surgery Boards though to get credentialed in most hospitals, even one in an underpriviledged area. They actually are most stringent about credentials than other hospitals because people are always scutinizing their staff more than an affluent hospital. The show pretty much overlooked those little details but it is television. What happened with 'Bob' was more realistic. I guess they needed a doctor fast so Luka got fasttracked.

-- (ripwoman@aol.com), February 20, 2001.

Possibly Luka was educated in the United States and returned home to Croatia after medical school. Just a possibility, maybe far-fetched, but it would explain his excellent English and also how he has managed to become a full-fledged doctor already.

-- Laura Lindstrom (llindstr@law.harvard.edu), February 20, 2001.

Croatia HAS NEVER BEEN a Soviet state.

-- Dubravka Hranilovic (duhran@yahoo.com), February 20, 2001.

-- Dubravka Hranilovic I say this full hearted respect for you, your answer made laugh.

-- Victoria A. (toria55@aol.com), February 20, 2001.

Luka, if he was educated in Croatia, is in the same boat as Dave. Remember, Malucci went to med school in Grenada.

-- Zorbo (RDomino1@aol.com), February 21, 2001.

Luka & Dave are in different situations. If you go to medical school outside of the US & Canada, you have to do what they call a 5th pathway, which is a year of unpaid clinical rotations, similar to a sub-internship, BEFORE you can start a residency. That is what Dave is doing. He did his 5th pathways & is now doing his residency. Luka, in contrast, is working as an attending physician. This assumes he has completed a residency in the US because you cannot work as an attending physician in the US otherwise. Since he is older & obviously was practicing medicine in Croatia, he must have, at the very least, done a residency in the US before returning to Croatia.

As for foreign doctors practicing in inner-cities & other places American doctors don't want to be, in the 1970s & 80s there were programs called the Public Health Service & the National Health Service Core or something like that which paid for medical school education in exchange for 2 - 4 years of service in a 'physician underserved' area. A lot of people went to medical school this way & became primary care physicians. Ronald Reagan ended these programs. There are still some incentives to draw people to underseved areas like the Indian Health Service, which will sometimes pay a physician's school loans in exchange for a few years of service. Some foreign doctors on certain types of student/training visas eill work in underserved areas in exchange for a residency visa. This is why you may see more foreign doctors in some places.

-- (ripwoman@aol.com), February 23, 2001.

When Luka was telling the Bishop about what happened to his family didn't he mention that he was in his final year of internship? This Croatian war was not that long ago so does that fit in with the timeline for him to be able to be a full fledged, practicing doctor in the US? Didn't anyone else catch that?

-- amanda (amanda.rehm@home.com), February 23, 2001.

I don't mean to disagree and I may be incorrect, but Malucci's first season on the show he was asked if he was a resident by Dr. Lawrence (Alan Alda) after he (Malucci) said something stupid and I believe that Malucci said he was a 2nd year resident. He never mentioned doing a 5th pathway (correct term?). Now I don't dispute that this exists, I just don't think that Malucci was ever doing one on the show. If anything, perhaps he did it before he came to County. (This could be one more thing that we find out about him.)

-- Kelley (takel@earthlink.net), February 23, 2001.

Amanda you are right. Kula saying he did his internship in Croatia effectively blew my explaination for how he could be an attending now out of the water. I must only conclude that the writers wanted a foreign - read: exotic Doug-like replacement - doctor on the show & did so without regards to how he would get credentialed in real life. Much as I like her I've felt the same way about Elizabeth. In real life she would be back in England or COMPLETING an entire residency in surgery. I know many doctors, who were you name the specialty practicing physicians in England or some other place, who wre repeating their residencies or doing entirely new residencies because they had decided to come to the US.

-- (ripwoman@aol.com), February 24, 2001.

I think the regulations must vary from state to state or something because I know several people who have stated that a foreign doctor must only repeat -one- year of residency (aka the intern year) before being liscensed to practice in the US. While it would be easily to believe that one or two folks could have been mistaken, I find it hard to buy that they're -all- wrong.

So if Luka was a full-fledged doctor in Croatia and came to the US, he only would have to repeat 1 year of residency (as Elizabeth did) before he could be a full-fledged doctor (and thus, an attending) in Illinois.

-- Lynn (lynn@wordsmyth.org), February 24, 2001.

It should be pointed out that Luka was at Vukovar, which fell to Serb forces in November, 1991 after a 3-month siege. He was about to finish his internship (which I *assume* is the equivalent of an American residency...anyone?). Once he finished that, he would be the equivalent of an attending in Europe. I'm only guessing, but Luka probably came to America in the mid-1990's (1996 at the latest, maybe), and thus did his required one year's residency and qualifies to serve as an attending in any U.S. hospital. Nine years is quite enough time for him to qualify for the position, IMVHO.

-- Miesque (miesque48@hotmail.com), February 26, 2001.

This is actually about Deb Chen's medical credentials, but it seemed the most suitable thread to add it to. Where The Heart Is told us, in case we never knew, that she's a third year resident (she would have been/will be Chief Resident in her fourth year is what Kerry seemed to be implying). I'm confused. She was in the same year as Carter at med school, right? But now she's a year behind him (Atlanta brought it down to nine months).

At first, for the last eighteen months, I thought that this was because leaving med school for four months put her a year behind on her residency. A reasonable conclusion. But recently I've realized that she WOULD HAVE CAUGHT UP WITH CARTER! He spent a year on the surgical service, which, other than a couple of glancing references in 'The Crossing' and 'Survival of the Fittest', TPTB seem to have forgotten. He started over as an intern in season 4, and, am I being totally thick here, or would that have put Deb either level with him or say, maybe six months or so ahead of him.

Thoughts appreciated. This has been bugging me for weeks but I was cut off from the Internet.

-- Elizabeth Routledge (elizabethroutledge@uluru.freeserve.co.uk), July 28, 2001.