How a shortage of doctors here can hurt health care in the developing world

Foreign-trained physicians could help fill the growing shortage of doctors in the United States. But guests on The Daily Circuit emphasized Thursday that the United States needs to tread carefully in hiring those doctors, lest it cripple the health-care capabilities of poor countries.

"Easily, it's a tenfold increase in salary to go to London or New York as opposed to staying in Kampala or Tanzania, for instance," said Dr. Fitzhugh Mullan, a professor at George Washington University School of Medicine. "Which is why I think that we need to be very careful and very attentive to the globe as we develop our system. We have an economic magnet. ... that's a very powerful and disruptive force in the rest of the world."

"The expectation that you can come and immediately make an American salary, which is true, is a great lure," he said. "I had someone say, in nursing, if we opened things up we would simply pull every nurse out of the Caribbean. We would pull many nurses out of Africa. If we do not train sufficiently at home by building the schools and offering the positions and arranging the financing in medicine and nursing and pharmacy etc., we will be a constant destabilizing force in the world. I think as a principled country, we need to be concerned about that."

"Twenty-five percent of our physicians, 200,000 physicians, are graduates of schools abroad," Mullan said. "Most of them are in the younger part of their careers when they decide to come, and they sit for the same board examinations that U.S. doctors do, and they're obliged to take a residency in order to get licensure, just as U.S. graduates do."

Calculating that medical schools might graduate 100 students a year, "and they're coming at a rate of about 6,000 a year — it's as if 60 medical schools around the world, most of them in lesser developed countries, were donating their entire graduating classes every year to the United States," he said.

Dr. Jose Ramon Fernandez Pena, who runs an organization that helps foreign-trained medical professionals find work in their field in the United States, said the U.S. has a responsibility to train more of its own health workers.

"We cannot count on the limited educational resources or funds in other countries to supply our needs in the United States," he said. "That's just not ethical, period.

"But we have to be intelligent about how we integrate the immigrant professionals that are already in the United States. How do we detach that from having the series of incentives that we're talking about, in terms of salaries? I don't know how you do that. But people are already here, across all areas. So what are we doing about that, to facilitate their professional and civic and economic integration into the fabric of society?"

Fernandez Pena said foreign-trained doctors who come to the United States may decide to immigrate for a variety of reasons: political persecution, family ties, a poor economy or natural disasters, for example. "We can't just say, one day they wake up and say, 'I'm going to go to the U.S. and try to practice medicine.' Nobody does that.

"Understanding the reasons or the pressures under which they came to the United States is a critical aspect of seeing how we can help them rebuild their professional lives in the United States and often times the option of relicensing in their old profession is just not realistic given all those conditions."

A doctor who suddenly flees his or her home country might be unable to produce an academic transcript, or might already be in his or her mid-40s, and "for them just the idea of starting from zero is certainly not appealing. So we work a lot with our participants in presenting them with options, alternatives that they may well pursue and enter the health profession instead of driving a taxi or working at a fast-food restaurant," Fernandez Pena said.

He acknowledged that "the United States, like every country, has to have a set of standards, and that all people licensed in those professions need to be assessed against those standards. That, I think, is perfectly reasonable and logical."

But he offered the example of a doctor well established in an advanced specialty like cardiology, who balks at having to go back to the status of a first-year resident.

"We're asking that fully formed doctor, in practice in a specialty for a number of years, to pass the tests that a medical school graduate passes in the U.S.," he said. "Are we measuring the right set of skills and standards in order to assess whether this person is ready to practice in the area they already know? I am not sure."

LEARN MORE ABOUT IMMIGRANT DOCTORS:

• Bring on the foreign doctors
There's a simple solution to this problem: Import more physicians from abroad. And yet, it takes years for foreign trained doctors to earn a U.S. license. Some of the safeguards are sensible, like verification of foreign credentials and proving English language fluency. Some are not. Even if a doctor has practiced for years in her home country, she must pass the same exams as graduates of American medical schools, then repeat three or more years of residency and fellowship training. (Slate.com)

• Doctor, doctor, why won't America let in more doctors?
Back in the 1970s, some in Congress argued foreign doctors were inferior to U.S.-educated physicians. If that ever was the case, recent research shows that it is not true today. A study in Health Affairs concluded, "Our analysis of 244,153 hospitalizations in Pennsylvania found that patients of doctors who graduated from international medical schools and were not U.S. citizens at the time they entered medical school had significantly lower mortality rates than patients cared for by doctors who graduated from U.S. medical schools or who were U.S. citizens and received their degrees abroad." (Forbes)

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