Congratulations to all the newly minted and matched doctors! Now that the dust from the celebrations of your feats have settled, there is no time like the present to address the shortage of doctors in the United States. No matter what stage of training you are currently in, you have probably heard that there is a "shortage of trained physicians", especially primary care doctors, in the context of our rapidly aging population - it's all over the news. What I would like to hear more about is the untapped supply of trained physicians available for immediate and excellent patient care: foreign medical graduates and foreign physicians.
American vs. Foreign Medical Schools
If you look at the residency match statistics, the medical school graduates most likely to match are those from American medical schools. Why is this the case? Do students who go to the Caribbean or abroad necessarily not as "well-trained" as those in the US? Absolutely not. We all come out of medical school with a similar base of knowledge. Although students at some medical schools may have more on-the-job responsibility and training than at other schools, there is no evidence that this has any impact on quality of patient care. We become better doctors based on accumulated experience over the years during residency and beyond, so the notion that local and international graduates provide different outcomes is ridiculous. Good doctoring is a matter of perseverance, patience, humility and teamwork - and I have seen this from graduates of medical schools all over the place.
It floors me to hear fellow graduates assess the quality of a residency program by the number of "FMGs" that train there - this reeks of elitism and is not founded in any actual science. No studies have shown different outcomes outcomes in patients depending on the medical school of origin of the residents. The first such study showed no mortality difference between international and domestic graduates, but such studies are very difficult to conduct as numerous physicians, especially at academic centers and residency programs, play a role in the care of each patient.
I consider myself fortunate to have been trained at an excellent medical school - getting into medical school is tough and getting more difficult every year. However, the excellent physicians I have worked with thus far hail from everywhere ranging from the top of the US New & World Report rankings to the bottom, to around the world. What makes them good is their dedication to each of their patients and their hard work.
Foreign Physicians in the United States
As described in this New York Times article, the road to becoming a fully-fledged physician in the US for doctors who have practiced for years in other countries is formidable. I have met innumerable excellent physicians, who have practiced abroad as surgeons, internists, anesthesiologists, ophthalmologists, radiologists and neurologists. These doctors move to the United States and are forced to either pick new careers, or repeat at least three years of residency training in order to continue practicing their trade. Many of these individuals often end up in rural residency programs, since many American graduates tend to shy away from primary care and rural settings.
Why is this the case? Are medical schools and hospitals in other countries inferior to ours? Absolutely not. The language of medicine is universal. To believe that our educational and training capacity are somehow superior reeks of American exceptionalism. There are excellent hospitals in developed and developing nations. Furthermore, these individuals have what may American residents lack: experience. Experience, not regurgitative assessments in examinations, is the vehicle through which doctors learn their trade and become great physicians. If we compare our healthcare outcomes (mortality rates, efficiency, management of chronic disease) to those in many other countries, and then magnify this comparison to efficacy and complication rates in individual top hospitals in different countries, the differences are minimal.
This article on KevinMD.com cites communication as a barrier to higher utilization of foreign physicians. However, does this automatically obligate repeating residency? I propose an abbreviated program (not more than a year) that ensures physicians from foreign countries have the appropriate English speaking capability and can practice up-to-date, evidence-based care - anything more than this is a waste of valuable time that can be spent caring for more patients.
I am happy that we are opening more medical schools to care for our rapidly aging and growing patient population. However, I believe we are doing our patients a disservice by inadequately utilizing FMGs and international doctors, an often very competent and experienced pool of available physicians. If we are going to promote the supremacy of "evidence-based medicine", I would like to see studies of differential outcomes before baseless elitism and American exceptionalism in the way we treat these physicians.
