Jul 2, 2019

Foreign-Trained Doctors Can Help Care for Aging Populations

Looming demographic trends threaten to further strain our already-burdened healthcare system. Unless we act now, our physician shortage problem will only get worse. One way to alleviate the pressure is to make it easier for qualified foreign doctors to practice in the US.

America is getting older. The Association of American Medical Colleges (AAMC) estimates that by 2030, the overall population of Americans will increase by 11 percent. By that same time, the population over 65 years old will increase by 55 percent and the number of Americans 75 and older will increase by 73 percent. More than one third of the population of licensed physicians will have reached the retirement age. Together, these numbers portend a physician shortage.

The lack of licensed physicians is already bad enough. Americans suffer through long wait times, rushed visits, and costly care. Currently, the average wait time to see a family physician is 19 and a half days. After waiting for an appointment, 56 percent of physicians report that they spend 16 minutes or less on average with their patients. A growing physician shortage is only going to worsen access numbers.

As humans age, they need more medical care. AAMC President Darrell G. Kirch reports that older patients “need two to three times as many services.”

This is reflected in increasing health expenditures as one ages. For instance, the Medical Expenditure Panel Survey finds that in 2016, average annual healthcare spending per person for the 45 to 64 age group was $6,406. In the next age bracket (65+), average healthcare spending jumps to $11,316.  As the senior citizen and general populations rise, the shortage of doctors will likely drive costs higher.

In a Mercatus study published in 2018, Jeffrey Flier and Jared Rhoads point out that one solution to combat this shortage is greater use of internationally-trained medical students. International medical graduates constitute 23 percent of practicing physicians in America. Evidence suggests that foreign-trained doctors provide the same level of quality care as graduates of US schools.

International medical graduates are also more likely to practice in rural or poor communities, areas that are typically hit the hardest by a shortage of medical professionals. According to a study published in the American Family Physician, as of 2013, there were 68 primary care physicians per 100,000 residents in rural areas, compared to 84 per 100,000 residents in urban areas.

Currently, these foreign-trained physicians face myriad obstacles to practice in the US that could be solved by certifying the legitimacy of their prior training. The first barrier is the lengthy relicensing process. To begin with, international medical graduates must apply and pay a $135 upfront fee to the Educational Commission for Foreign Medical Graduates (ECFMG). The ECFMG was founded in 1956 to assess whether or not internationally-trained medical graduates are ready to enter into a United States residency program.

The second portion of the process involves passing the first two steps of the US Medical Licensing Exam. Applicants are required to pay upwards of $2,000 for these necessary licensing examinations.

Third, applicants must gain admittance to an accredited US residency program. The American Medical Association reports that residency programs take at least three years, regardless of whether applicants have received equivalent overseas training.

Finally, applicants must pass the clinical skills exam—the final examination for anyone wishing to practice medicine without supervision. Requiring graduate medical education training of international medical graduates serves as a disincentive to migrate to America to practice medicine, especially when compared to other advanced medical countries whose barriers to emigrate may be much less cumbersome.

In conclusion, the United States is facing a growing physician shortage. Overall population is increasing, Americans are getting older, and more doctors are reaching the age of retirement than ever before. The extra layer of bureaucracy and added costs that emigrating doctors face could potentially discourage immigration by skilled labor when Americans need it most. Ideally, our system should validate competency, or validate internationally medical education, rather than adding further training requirements or extra costs. 

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