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October 10, 2017

One doctor makes the case for foreign-trained medical graduates

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    Foreign-trained medical graduates make up a significant share of the U.S. medical workforce, and the country should implement policies that encourage—rather than discourage—foreign medical graduates, who can help ease physician shortages and improve access to care, Aaron Carroll, a physician, writes in the New York Times' "The Upshot."

    Why you're in danger of building the wrong workforce

    Meeting an otherwise unmet demand

    The United States is "toward the bottom of developed nations" when it comes to medical graduates per population, Carroll writes, citing data from the Organisation for Economic Co-operation and Development that show the United States lacks "enough graduates ... to fill residency slots.".

    But foreign-trained doctors help "fill the gap" among residents, Carroll continues. And they also make up a "considerable share" of independently practicing physicians, Carroll writes, citing research showing that about one-quarter of doctors in this country are foreign medical graduates.

    Further, in addition to helping address the overall physician shortage, foreign-trained doctors also fill positions in fields "other doctors find less appealing," Carroll writes. For instance, according to Carroll, more than 40 percent of primary care doctors in the United States trained in another country, as are about half of people who focus on caring for elder individuals. And "as if this weren't enough," Carroll adds, research shows that "foreign medical graduates are more likely to practice in geographic areas of the country where there are physician shortages (typically nonurban areas), and they're more likely to treat Medicaid patients."

    Additional benefits

    Carroll also rebuts claims that doctors who trained outside of the United States are "inferior" to U.S.-taught doctors. He cites a Health Affairs study in 2010 that found patients with congestive heart failure or myocardial infarction had lower mortality when treated by foreign medical graduates, as well as a 2017 study in The BMJ that showed older patients—even though they appeared sicker—had lower morality when treated by foreign medical graduates.

    In addition, Carroll highlights foreign medical graduates' contributions outside of clinical settings. He notes that a study in the Annals of Internal Medicine found foreign medical graduates make up more than 18 percent of academic physicians in the country—making integral contributions in medical education and medical research, despite being ineligible for some NIH funding because of their citizenship status.

    Dhruv Khullar—lead author of the Annals of Internal Medicine study, a physician at NewYork-Presbyterian Hospital, a researcher at Weill Cornell, and a contributor to "The Upshot"—said "by some metrics, these doctors account for almost one-fifth of academic scholarship in the United States." He added, "The diversity of American medicine—and the conversations, ideas and breakthroughs this diversity sparks—may be one reason for our competitiveness as a global leader in biomedical research and innovation."

    Despite the fact that the United States faces "a shortage of physician services, especially when it comes to the care of the oldest, the poorest and the most geographically isolated among us," and "even though we know foreign medical graduates care for those patients disproportionately, we make it very difficult for many born and trained elsewhere to practice here," Carroll writes. He concludes, "Evidence suggests that policies should be made to attract [foreign medical graduates], not deter them" (Carroll, "The Upshot," New York Times, 10/6).

    Why you're in danger of building the wrong workforce

    To succeed in the future, health care organizations will need to provide care in the lowest-cost, most appropriate setting—and to accomplish this, they’ll need a different complement of staff than in the past.

    Find out what you need to do to revise your approach—starting from the "outside-in."

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