America Needs to Import More Physicians


 

Desperately needed internationally trained physicians, many of them American citizens, are ready to work in the U.S.

A wave of doctors will soon hang up their stethoscopes. More than one-third of physicians will be 65 or older within a decade, according to a report from the Association of American Medical Colleges.

Their retirements, coupled with our nation's aging population, spell trouble for the health care system. By 2030, the country may have 105,000 fewer doctors than it needs to meet patient demand. Over 40 percent of that shortage will be in primary care.

The solution to that shortage lies abroad, at international medical schools. Graduates of these schools have historically been far more likely to enter primary care and practice in underserved areas than their domestically educated peers. The United States needs more of them.

It's no secret that America is aging. By 2030, the share of Americans ages 65 and older will grow by 55 percent.

The doctor corps is not exempt from this demographic trend. Consider just one crucial specialty -- obstetrics and gynecology. Only 14 percent of OB/​GYNs today are younger than 40.

Many regions throughout the country, especially rural ones, can ill afford to see their doctors retire. At present, South Dakota has enough primary-care physicians to meet 37 percent of the state's total demand. Nebraska's primary-care workforce can meet only 42 percent of demand.

Worse, help is not on the way -- at least, not from U.S. medical schools. Less than 40 percent of U.S.-trained graduates chose primary care in 2015. And even that number is high. Many of this "primary care" group selected internal medicine but plan to subspecialize within the field. Less than 9 percent of graduates from American M.D. programs entered a family medicine residency between 2014 and 2015.

Graduates of international medical schools, on the other hand, are ready to meet America's primary care needs. Last year, nearly 70 percent of internationally trained doctors who accepted residencies did so in primary care. Many of them were U.S. citizens, returning home after training abroad.

Despite lying outside U.S. borders, St. George's University in Grenada, where I teach, is America's top source of new primary-care doctors. Last year, three-quarters of the more than 900 residencies our graduates took were in primary care. Most of our students are actually Americans -- 74 percent of our student body has U.S. citizenship, and 19 percent are U.S. permanent residents.

We're not the only international medical school fortifying the ranks of America's primary-care workforce. In 2015, the Society of Teachers of Family Medicine reported that five medical schools in the Caribbean each sent 40 or more graduates into family medicine residencies. St. George's was one of them; we sent more than 100.

Despite this apparent influx of doctors educated abroad, America still needs more -- particularly in primary care. Here's how it can get them.

First, U.S. leaders must create more residency positions, especially in areas with doctor shortages and in high-need specialties like family medicine and primary care. The majority of doctors who have completed their training since 2007 are practicing in the state where they did their residencies. Therefore, underwriting residencies in high-need areas is an effective way to address their shortage of doctors.

Currently, the federal government caps the number of slots available for federal funding -- a policy that artificially suppresses the supply of residencies when America needs to be training more doctors. Raising that cap would go a long way toward alleviating America's doctor shortage.

There's room for private interests, including foundations and charities, to help address the issue, too.

In 2016, the Walmart Foundation gave the Northwest Arkansas Community Internal Medicine Residency Program $750,000 to cover its first two years of operating costs. The goal is to fund 24 medical residents by this year in an area of the state that could use almost 150 more. The current resident shortage equates to about 3,700 appointments that don't happen each day -- appointments that would likely be taken by the most medically underserved.

Patient demand for doctors is far outstripping the ability of U.S. medical schools to supply them. Graduates of international medical schools are eager to fill that gap. America's leaders must find ways to let them.


Richard Olds, MD, is president of St. George's University (www.sgu.edu).

 
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