US Health Care's Primary Problem -- A Doctor Shortage
By Dr Fred M. Jacobs
St George's University
Grenada
America's medical system is facing a primary care crisis. To meet our nation's needs would require almost 15,000 additional primary care doctors. Take into account the effects of aging and population growth, and the shortage will climb to almost 50,000 by 2030.
There are thousands of highly qualified students at international medical schools eager to fill this gap. Many are US citizens who are studying abroad and want to return home to practice.
To solve America's doctor shortage, public health leaders must welcome these internationally trained doctors -- particularly because they're likelier than their US-trained counterparts to serve in the poor and minority communities where the shortfall is most severe.
America is aging and growing. By 2035, the number of seniors will surpass the number of minors for the first time in our nation's history. The US population will increase by more than 10 percent over the next decade.
But US medical schools are not keeping pace with our nation's demand for care. Only about 40 percent of graduates from US medical schools choose primary care residencies. The majority become specialists.
The shortfall will hit low-income and minority communities hardest. They already lack access to qualified medical personnel.
That's because US-educated doctors who choose primary care shy away from economically marginalized communities. They're drawn to cities and suburbs where people have private insurance, which pays more than programs like Medicaid. Of the 5,800 US sub-regions with a shortage of doctors, nearly 60 percent have poverty rates above the national average.
African-American and Hispanic patients are less likely to have a doctor than white Americans, according to a study from UCLA and the National Institutes of Health. One in four black and Hispanic Americans lives in a "healthcare desert," an area with low numbers of primary care doctors. That's true of one in ten whites.
Boosting the number of international medical graduates in the United States would narrow these gaps. IMGs enter primary care at a greater clip than US medical graduates. This year, 70 percent of international medical graduates chose residencies in primary care. That's nearly double the percentage of US graduates.
IMGs practice in high-need areas. In communities with a per-capita annual income below $15,000, 42 percent of doctors have been trained abroad. In areas where 75 percent or more of the population is non-white, four in ten physicians are international graduates.
And it's not as if IMGs are second-rate doctors. They meet the same rigorous standards as their US-trained counterparts. There's evidence that international grads provide better care. According to a study published by The BMJ, a medical journal, patients treated by IMGs have lower mortality rates.
The number of US medical residencies is at a high, as is the share of international medical graduates from the United States who are matching to residencies. Ninety-three percent of US graduates from the school I work for, St George's University in Grenada, who were eligible and applied for residencies in the United States secured them this year.
Those all-time highs aren't high enough, given our nation's doctor shortage. Increasing funding for medical training and residencies must become a priority for government leaders, as well as private-sector actors.
Each year, US citizens graduate from international medical schools, hoping to return to practice medicine. It's time we let them.
(Dr Fred M. Jacobs is executive vice president of St George's University (www.sgu.edu). He is the former commissioner of the New Jersey Department of Health and Senior Services)
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