I grew up in a small town. When I was in grade school the local physician, Dr. Dailey, retired and moved away. For a time my uncle, Dr. Ralph Herrick, set up practice in what had been his hometown growing up. A year or two later, he moved away to practice medicine elsewhere. The next doctor who began to practice medicine at the Stanton County clinic was “Dr. Rom.” He was an Indian, whose actual name was Ramchandani.
Many small towns lack physicians, especially towns far from major cities. The rural county where I grew up always had a doctor because the county subsidized the local physicians with guaranteed income and free office rent. However, it is getting increasingly difficult to find physicians willing to practice in small, rural towns.
Completing a residency, like an apprenticeship program or on-the-job training, is required to practice medicine in all 50 states. It is grueling, with 60-hour work weeks and on-call hours on top of the work requirement. It takes from three to seven years to complete a residency program, depending on the specialty. Most countries have a similar requirement. Yet even foreign-trained doctors, who have gone through residency elsewhere, still must complete a second residency program in most states. This is slowly changing. According to the Kaiser Family Foundation, nine states have passed laws granting some foreign-trained physicians an avenue to practice medicine without repeating a residency program. A dozen more states are debating similar legislation. Not everyone is happy about this change:
Proponents of the new laws say qualified doctors shouldn’t have to spend years completing a second residency training. Opponents worry about patient safety and doubt the licensing change will ease the doctor shortage.
Foreign-trained physicians are nothing new. About one-quarter of physicians who practice in the United States were born in another country. The U.S. is known as a desirable country in which to practice medicine. One advantage is that the reward of a licensure could be used to attract/restrict physicians to underserved areas and rural towns for a period of time.
Supporters of the new licensing laws include Zalmai Afzali, an internal medicine doctor who finished medical school and a residency program in Afghanistan before fleeing the Taliban and coming to the U.S. in 2001.
He said most physicians trained elsewhere would be happy to work in rural or other underserved areas.
Dr. Afzali is something of an exception. It took him 12 years to gather the required paperwork and complete a residency to practice medicine in the U.S. Today there is a shortage of residencies (graduate medical training positions), and foreign-born, foreign-trained physicians are the last on the list for residency. Upwards of 10,000 residency applicants fail to match to a residency every year. They can try again the following year, but most will likely never match to a residency and likely never be allowed to practice in the U.S.
But a commission of national health organizations questions whether loosening residency requirements for foreign-trained doctors would ease the shortage. Doctors in these programs could still face licensing and employment barriers, it wrote in a report that makes recommendations without taking a stance on such legislation.
Some of the other hurdles to medical practice are hard to overcome. Most foreign-trained physicians would need to work with a mentor to supervise them for the first year. Finding a supervising physician may be difficult. Malpractice insurance may be difficult to obtain. Physicians who are trained in a specialty may have difficulty getting recognized by national boards that govern that specialty. That could mean cardiologists have to work as primary care physicians, for example.
How well these new laws work depends on the details. The laws will attract few applicants if restricted to only English-speaking countries like Canada, Britain, Australia and New Zealand. Both federal and state programs could also consider funding abbreviated residency programs, say, one-year programs, to help ease foreign trained physicians into practice eligibility. This should also be extended to many of the 10,000 medical school graduates who fail to match with a residency each year.
The United States has a physician shortage, and residency is the bottleneck. The U.S. does not have a shortage of medical school graduates who would like to practice medicine, however. States should pursue these as an opportunity to address the growing physician shortage.
Read More at KFF Health News: States Facing Doctor Shortages Ease Licensing Rules for Foreign-Trained Physicians
If foreign-trained doctors are required to go through residency, are they subject to the same residency matching as new medical students? If so, do they take away available slots from U.S. medical students?
It seems to me that the match quota needs to be expanded or eliminated before we start deliberately poaching other countries’ physicians.
Yes, international medical graduates compete for the same pool of residency slots as American medical graduates. Some foreign medical graduates are American citizens who studied abroad, while others are foreigners who trained abroad and wish to practice in the US. Even doctors who have gone through a residency abroad cannot practice in the US until they have gone through a US residency, except for the nine states I wrote about. The shortage of residency positions is because the AMA convinced Congress to cap the number of slots at 1996 levels to “avoid” a surplus of doctors.