Howard Dean wrote an op-ed defending the use of
foreign international medical graduates:
Today, young physicians with degrees from international medical schools face skepticism from some in the American medical community. That strikes me as misinformed thinking, given the large number of international medical school graduates practicing in the United States, alongside American medical school graduates, and given that the American medical system depends on them to fill the growing doctor shortage.
The federal Health Resources and Services Administration predicts there will be a shortage of approximately 55,000 physicians in the United States by 2020. We simply can't build the capacity to meet our growing needs for skilled physicians -- especially given budgetary constraints on schools receiving government subsidies. Even if the new medical schools now in the planning stages all come to pass, they won't turn out enough primary care physicians to meet urgent needs in urban and rural communities.I actually don't have a lot to say about the IMG thing, I have worked with and hired many IMG's and their skill and quality vary as much as US graduates. But this whole argument seems to miss the central point regarding the projected physician shortage. The supply of new medical graduates is not the choke point, under the current state of affairs. The choke point is the number of residency training slots.
The Balanced Budget Act of 1997 put a cap on the number of residency slots at 1996 levels. For those who don't know, pretty much all postgraduate medical education in the US is funded through medicare. That cap has remained in place ever since. Medical school enrollment has increased since that time, but the overall number of residencies has not (at least not by a meaningful measure).
There's a frustrating lack of information out there: a common misperception is that the AMA is somehow artificially restricting the number of doctors to keep reimbursement high. Nothing could be further from the truth. First of all, the AMA has essentially no say in the number of physicians trained -- that's largely the province of the AAMC, which has been warning of the physician shortage and calling for action for a long time. Furthermore, the AMA itself has been making the same call for years, too.
The problem is compounded by the fact that many residents, whose training is being paid for by the US taxpayer, are foreign-born and here on a type of student visas. When they are done training, they have to go home unless they can find an employer who is willing and able to sponsor them for a green card. I don't know how many US-trained foreign physicians actually do return to their country of origin -- not too many, I suspect -- but the wrongheadedness of the policy is maddening. If we are going to pay for their education, it should more or less automatically put them on a pathway to permanent residency.
Unfortunately, I don't see a solution in the works any time soon. In the current health care budget crisis, the likelihood that policymakers are going to increase funding for medical education is slim indeed. This means that physician extenders will continue to fill the gaps and provide more and more services. Some of this is just fine -- a PA or NP can be a great surgical assistant, fast track provider, or simple wellness care provider. But as medical students persist in their exodus from primary care, more and more complex disease management will fall on the shoulders of midlevel providers whose training is not intended to encompass it. Those patients who decompensate as a result, or who simply cannot access primary care services do to the shortage will be shunted to ... the ER, of course. The final dumping ground of American healthcare.
We are so screwed.