The US Health Care System Needs Immigrants


as a recent eight-nation bracket
tournament in the new york times showed and i’ve discussed that a lot many
people think the united states healthcare system has a lot of problems
so it seems reasonable to think of policy changes that make things better
not worse making it harder for immigrants to come here to practice
medicine would fail that test that’s the topic of this week’s healthcare triage by any objective standard the United
States trains far too few physicians to care for all the patients who need them
we rank towards the bottom of developed nations with respect to medical
graduates per population when physicians graduate from medical school they spend
a number of years in a residency program I did not enjoy mine although they have
their degrees we still require them to train further in the clinical
environment to hone their skills residents are more than learners though
they’re doctors they fill a vital role in caring for patients in many hospitals
across the country we don’t have enough graduates even to fill residency slots
this means that we’re reliant on physicians trained outside the country
to fill the gap a 2015 study found that almost a quarter of residents across all
fields were foreign medical graduates and more than a third of residents and
sub specialist programs were even training aside foreign medical graduates
are also responsible for a considerable share of physicians practicing
independently today about a quarter of all doctors in the United States are
foreign medical graduates as in many other fields foreign medical graduates
work in many of the areas that other doctors find less appealing more than
40% of the American primary care workforce is made up of people who
trained in other countries and moved here more than half of all the people
who focus on caring for older people or geriatricians are foreign medical
graduates as well as if this weren’t enough foreign medical graduates are
more likely to practice in geographic areas of the country where there are
physician shortages like non urban areas and they’re more likely to treat
Medicaid patients – as a physician who graduated from a domestic medical school
I’ve often heard others disparaging doctors who went to medical school
outside this country as if they were inferior those complaints are not
supported by data study from health Fair’s in 2010 found that patients with
congestive heart failure or myocardial infarction had lower mortality rates
when treated by doctors who were foreign medical graduates another from earlier
this year in the BMJ found that older patients who were treated by foreign
medical graduates had lower mortality as well even though they seemed to be
in general in other words foreign medical graduates take care of patients
who appear to be more ill but seem to achieve better outcomes a recent study
in annals of internal medicine shows that these graduates are also
responsible for a significant amount of teaching of the 80,000 or so academic
physicians in this country more than 18% were foreign medical graduates more than
15% of full professors and medical schools in the u.s. were educated
elsewhere most often in Asia Western Europe the Middle East Latin America and
the Caribbean foreign medical graduates also do a lot of research although they
are ineligible for some NIH funding which is granted only to citizens of
this country they still manage through collaboration to be primary
investigators on 12 and 1/2 percent of grants they led more than 18% of
clinical trials in the US and were responsible for about 18% of
publications in the medical literature I spoke to the lead author of the study
Dhruv cooler who’s a physician at New York Presbyterian Hospital and a
researcher at Weill Cornell he said and I’m quoting our findings suggest that by
some metrics these doctors account for almost one-fifth of academic scholarship
in the United States 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 the
United States is not the only country that relies on doctors trained or
educated in other countries we’re not even the country with the highest
percentage of such physician according to data from the OECD almost 58 percent
of physicians practicing in Israel are foreign medical graduates about 40
percent of doctors in New Zealand and Ireland
we’re also trained outside those country because of the sizes of those nations
even though the percentages of foreign medical graduates are higher there the
total numbers aren’t as high as in the u.s. though in 2015 the OECD estimated
that the United States had more than two hundred and thirteen thousand foreign
trained doctors and no other country comes close Britain had about 48,000
Germany about thirty-five thousand and Australia France and Canada had between
22 and 27 thousand I’ve listened to people tell me stories of physicians who
leave Canada because they were dissatisfied about working in a
single-payer health care system that might have been true debt
to go but in the last 10 years that number has dropped precipitously the
number of Canadians returning to their country to practice may actually be
higher than the number leaving and although many feared the coverage
expansions from the Affordable Care Act might lead to an overwhelmed physician
workforce that didn’t happen that doesn’t mean that America doesn’t have a
shortage of physician services as we’ve discussed in previous episodes
especially when it comes to the care of the oldest the poorest and the most
geographically isolated among us even though we know foreign medical graduates
care for these patients just proportionally we make it very difficult
for many born and trained elsewhere to practice here some Americans need those
doctors desperately all the evidence seems to suggest that policies should be
made to attract them not deter them sometimes talking about drugs and sex
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