HEALTHCARE
February 13, 2013

“Foreign” Doctors to the Rescue

One quarter of medical students get their degree outside the US. They could be the answer to doctor shortages and runaway costs.

If you have tried to make a doctor's appointment lately and found that you had to wait weeks to see a physician, you have experienced the doctor shortage firsthand. The lack of primary care physicians contributes to the cost of healthcare as well. It's a simple case of supply and demand.

At least twenty-five states could end their primary care doctor shortage by changing doctor residency requirements simply by making the requirements of foreign-educated physicians the same as those for U.S.-educated physicians says a study from the University of Virginia. The change would also save billions of dollars in annual health care costs. Over 25% of the doctors in the country received their medical education outside the U.S.

The additional screening that longer residency requirements supposedly provides is nothing more than an artificial barrier to professional entry for foreign trained medical students.

All new doctors must complete a residency, a period of supervised training, before they can earn their license. Right now, most states require MDs graduating from foreign medical schools to complete a residency that is one to two years longer than that required of U.S.-schooled doctors. The Virginia researchers see no good reason for this training disparity.

Even before being allowed to apply for residency in the U.S., foreign-schooled doctors are required to demonstrate their competence. They have to pass three sections of the U.S. Medical Licensing Exam (USMLE). Then they have to be accepted into a residency program, something only 73% of those who pass the test are able to do.

This is all the screening that is needed, say the researchers. There are no differences between foreign- and U.S.-licensed medical graduates in patient health outcomes or in the frequency of disciplinary actions by state medical boards. The additional screening that longer residency requirements supposedly provides is nothing more than an artificial barrier to professional entry for foreign trained medical students.

In the 1960s, roughly 25 states prohibited non-citizens from obtaining medical licenses. After the Supreme Court found this practice unconstitutional in the 1970s, residency requirements for foreign-schooled doctors began to rise, suggesting that this was a replacement for the outlawed citizenship restrictions.

According to the Department of Health and Human Services there are now 5,848 areas in the nation facing a shortage of primary care physicians (PCPs), affecting 56.8 million people. Foreign-educated doctors are more likely to become general practitioners, and they're more likely to work in localities suffering from doctor shortages than their U.S.-schooled counterparts are. Needless to say, states with longer residencies for foreign-schooled doctors have fewer foreign-schooled doctors come to them.

If residency requirements were equalized, half the states (25) would have gained enough new physicians to end their shortages. The researchers used Department of Homeland Security records on migration of foreign-schooled doctors entering each state. Populous states would gain the most. California, New York and Illinois were respectively estimated to gain 3321, 2816 and 1030 extra physicians over the six years from 2005 to 2010.

Because an increase in primary care doctors lowers the number of hospitalizations, the authors estimate that easing residency requirement would have saved about $6 billion in health care costs annually from 2005-2010. This savings estimate is likely a conservative one because greater access to primary care doctors decreases health care costs in a number of different ways, not just by lowering unneeded hospitalizations.

These are only estimates, not facts. But the researchers see equalizing residency requirements as a straightforward and practical policy change that solves two healthcare problems — the shortage of doctors and runaway costs — at once. There is little evidence to suggest a downside.

The study is available as a working paper published by the University of Virginia's Frank Batten School of Leadership and Public Policy. It is currently under journal review.

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