The US Healthcare System Needs Doctors from abroad
By Dr G. Richard Olds
St George's University
Forty-four million Americans live in counties with a shortage of primary care physicians, according to a discouraging new report from UnitedHealth Group. This shortage will grow worse as our population ages -- and thus requires more medical care.
Doctors educated abroad -- including many American citizens who have gone to medical school overseas -- are eager to fill the gaps in the US physician workforce. And they're doing so in increasing numbers. Given the depth of the doctor shortage, the country will need even more of them.
The average wait to get a first-time appointment with a family medicine physician increased by 50 percent between 2014 and 2016, according to a study of 15 large metropolitan areas. The study found that people in Los Angeles wait an average of 42 days. Bostonians, an alarming 109 days.
They're waiting because most doctors -- 80 percent, per one survey of nearly 9,000 doctors -- are overextended or operating at full capacity.
Things aren't slated to get easier for patients, or doctors. By 2030, the US population will increase by 27 million. The number of Americans over 75 will jump 55 percent. Seniors need more medical care than younger Americans; about four in five people above the age of 75 suffer from multiple chronic diseases.
In total, the United States could be short of 49,000 primary care physicians by 2030.
US medical schools can't fix this shortfall on their own. Last year, less than 40 percent of their graduates chose residencies in primary care.
Doctors trained at international medical schools are more likely to enter primary care specialties. About seven in 10 internationally trained doctors selected residencies in family medicine, internal medicine, and pediatrics in 2018. That's an increase from 2017.
International medical graduates are also more likely to practice in minority communities, where the physician shortage is most severe. Nationally, about one in four doctors was educated at an international med school. But in areas where at least 75 percent of the population is non-white, international medical graduates account for more than one-third of physicians.
Many international medical graduates are actually US citizens intent on returning home to practice. Three in four students from the school I lead -- St George's University in Grenada -- are from the United States.
Last year, international medical graduates matched for US residencies at the highest rate in 25 years. That's good news. But America needs even more of them.
Funding more residencies would be a start. The Resident Physician Shortage Reduction Act would expand the number of federally funded residencies, especially in areas suffering from severe primary care shortages. States ought to contemplate similar initiatives. It stands to reason that doctors will stick around to practice after they've spent years building their professional networks and communities where they've done their residencies.
Medical schools could also recruit more students from rural and low-income areas. Most med students come from the upper end of the income distribution and from urban or suburban areas. They're more likely than not to return to their communities, or ones like them, when they settle down to practice.
At St George's, we've partnered with several US universities that have a history of educating students from a variety of socioeconomic backgrounds to offer qualified undergraduates guaranteed admission to our medical school.
America faces a shortfall of primary care doctors. To fill that shortfall, state and national leaders must look abroad -- to graduates of international medical schools.
(G. Richard Olds, MD, is President of St George's University and founding dean of UC-Riverside School of Medicine. www.sgu.edu).
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