FOREIGN PHYSICIANS: U.S.: ‘United Nations’ of Medicine?
CBS' Sixty Minutes last night ran a segment on the growing number of U.S. physicians of foreign origin. Correspondent Leslie Stahl said, "If the question used to be 'Is there a doctor in the house,' today it's more likely to be, 'Where are you from, doctor, and how did you end up in the Unites States?' Not a bad question, considering that doctors from abroad now account for ... 25% of all our MDs. There's not another profession in America with numbers like that." Stahl continued, "Big city hospitals today are a United Nations of medicine. You're as likely to be treated by someone from the Philippines as someone from Philadelphia. The same thing is true in small-town America. Marcus Welby doesn't practice there anymore. ... Dr. Abraham Verghese, who himself came from India 20 years ago ... [is] training this year's crop of residents as a professor of Internal Medicine at Texas Tech Medical School." Not one of Verghese's 24 residents this year was educated in America.
'A Very Powerful Incentive'
"Simply put," Stahl said, "American medical schools aren't graduating enough doctors to go around. ... Seventeen thousand Med School graduates, twenty-four thousand jobs; the huge disparity was created by a massive government subsidy through Medicare, $8 billion this year alone, which has encouraged teaching hospitals to create more and more residency slots." Former Assistant Surgeon General Fitzhugh Mullen noted, "The best data we have suggest that the average resident is worth $70,000 a year from Medicare to a given hospital. That's a very powerful incentive." Stahl: "So in other words, these hospitals kept adding residency slots because they were getting this money?" Mullen: "We saw the number of residents in the country go up about 25% over a period of about six or eight years, every year 4 or 5% more residents. They were already hiring all of the U.S. graduates, the only place they could go to get more residents was abroad." Stahl notes that the "government did recently put a cap on the number of residents it'll pay for, but that still leaves room for thousands of foreign medical school graduates every year."
Not Enough for Schools
But Mullen says it's preventing U.S. students from becoming doctors. Mullen said, "You had upwards of 30,00 students last year rejected from medical school. Of every five individuals who applied to go to U.S. medical schools, three do not get in." Stahl explained, "For the last 20 years, enrollment at American medical schools hasn't grown, partly because they don't have anything like the federal subsidy that hospitals get for residents. In fact, some have squeezed their enrollments down slightly. That, according to Abraham Verghese, has produced foreign medical schools in which every student hope to come to the U.S." Stahl asked Verghese, "Now you sometimes go back to India to recruit residents?" Verghese: "I was absolutely inundated by applicants. I put in a small ad in a newspaper in India, and I set a very high standard of what I was looking for in terms of the scores on these examinations we go through, and I had something like 400 responses. I spent days trying to get my five candidates." Stahl: "Verghese was able to choose the cream of the crop, and it's typical: generally the best, most qualified graduates of foreign medical schools end up in the U.S. Many of them come on what is called a J-1 visa, which is meant to be just a temporary ticket into the U.S., good for only as long as a doctor is in training." But Verghese said that "most don't go back, because of this loophole that says if you can show that there's an underserved area that would require your services and cannot find anybody else, you can have a J-1 waiver."
'De Facto Segregation'
Stahl continued: "Foreign doctors take jobs where American doctors won't, and practice in places where American doctors won't, and that has produced a de-facto segregation." She asked Mullen, "If we have a system where the foreign doctors come and serve these areas that the American doctors don't seem to want to go to, aren't willing to go to, what's wrong with that?" Mullen replied, "We have no business using the medical schools of India and Pakistan and Romania and Canada to staff our needs. That's like 30 or 40 medical schools, full-out medical schools, graduating all of their classes into the United States. This is the brain-drain, and it's not necessary." Mullen said U.S. schools should admit more Americans and "convince them to practice where they're most needed once their training is over." He advocates expand the National Health Service Corps, which pays off American graduate student loans worth several hundred thousand per student, "if they practice in small towns or inner cities for a few years" ("60 Minutes," CBS, 11/7).