The following blog was provided by a public health professional in Washington, DC, in response to a March 7th article that appeared in the New York Times.
It is expensive to produce doctors. It is a significant investment by both the individual pursuing a medical degree and our government to help subsidize their education and residency training. It is also difficult to become a doctor. Fewer than half (43% in 2012) of those who apply to medical school in the U.S. each year are accepted. If you are lucky enough to be admitted to a U.S. medical school, you face four years of school, a mountain of debt, and competition for a limited number of residency spots.
In this climate of heated competition for medical school admissions and even with the opening of several new medical schools, we are still not producing enough doctors to keep pace with population growth, much less the predicted physician shortage of 150,000 to 200,000 over the next 20 years. This shortage is most acute within primary care, an area where foreign doctors are becoming increasingly more common. With the passage of healthcare reform and the retirement of the “baby boomer” generation from the healthcare workforce and into the age where healthcare utilization increases, we are facing a legitimate crisis.
Increasingly, graduates of U.S. medical schools are competing for residency spots, which are subsidized by U.S. taxpayers, with non-citizens who completed medical school outside the U.S. In 2010, 13% of residents were foreign graduates of foreign medical schools. As the number of non-U.S. citizens filling residencies increases, we are not only “stealing” these doctors from foreign countries but we are taking away opportunities from U.S. citizens. This constant importing of foreign doctors deters our own citizens from becoming doctors AND discourages the U.S. government from investing in domestic medical education.
U.S. medical schools, for their part, are hesitant to increase enrollment without a corresponding increase in the number of residencies. They do not want to produce doctors who are unable to find work because they are not placed in one of a finite number of residencies, which are primarily funded by Medicare and capped by Congress.
We need to produce more doctors and importing foreign medical school graduates is not a long term solution. We cannot rely on foreign countries to produce our doctors for us and then flood the market with those willing to work for less. The best and brightest from our own country will stop pursuing medicine and create an unsustainable workforce in an area where it is necessary to attract our top minds. By increasing the number of U.S. medical school slots, as well as residencies, and incentivizing U.S. medical school graduates to pursue primary care, we can begin to move our healthcare system in the right direction without resorting to attracting foreign doctors away from developing countries.