America is facing a shortfall of doctors, in part due to the retirement of many Baby Boomer doctors. As of 2016, there were 2.6 doctors for every 1,000 patients. And yet a lot of newly graduated American doctors can’t get a job. What’s the problem?
In the U.S. half of all practicing physicians plan to cut back on the number of patients they see. According to the American Association of Medical Colleges (AAMC), by 2025, the U.S. will have a shortfall of 46,000 to 90,000 physicians, about one of whom will be primary care physicians. But this year alone, over 4,200 taxpayer-funded medical residencies went to doctors from other countries.
Over the past 10 years, over 36,000 medical students and graduates of international medical schools who are not U.S. citizens were given the U.S. residencies. The number of residencies given to noncitizens has increased by close to 65% in that decade. One instigator of the increase has been the American Medical Association, which has lobbied for visas (H-1B and J-1) for foreign doctors.
An article in the Harvard Review suggested that the problem in the U.S. is not a shortage of doctors, but instead a collection of distribution issues: some areas (often those that are rural or poor) lack doctors. The rate of people who have no medical insurance is still rising. Doctors’ office hours can be inconvenient. Some people (and doctors) demand physician care for medical issues more easily and cheaply handled by physician’s assistants or nurse practitioners. Doctors are now stuck doing more paperwork, an inefficient use of their time. And many doctor’s offices refuse to take on low-paying patients.
While all of these issues may well exist and also affect the relationship between patient and doctors, they don’t completely explain the doctor shortfall. The “paperwork” (computer work?) a doctor now must do to satisfy the government and insurance companies may well be a deterrent to young people who might have considered becoming a doctor. It’s driving existing doctors out of the business now. But that doesn’t explain why young American medical school graduates who are looking for a job can’t find one.
One part of the problem is that American graduates tend to seek residency slots for specialty care, which has higher earning potential. For example, American graduates filled 90% of orthopedics residency slots in 2016 but only 43% of family medicine residencies. Given the price of education in American colleges and medical schools, this is not a surprise. But international medical graduates are not only more likely to take internal or family medical residencies, they are more willing to work with patients in lower socioeconomic groups. International medical graduates are not actually foreign-born; they are Americans that chose to go to medical school overseas, because it was cheaper or because they didn’t get into a U.S.-based medical school.
Foreign medical graduates, or those who both are citizens of other countries and went to medical school outside the U.S., face a different set of problems. Hospitals initiating residency matches sometimes may look past these graduates out of fear that they will not be able to communicate successfully with American patients, due to language or cultural barriers. And doctors from foreign countries are sometimes less likely to consult the patient before making a decision, based on their own cultural practices, which doesn’t sit well with many Americans.
In 2015, the match rate for U.S. residencies among students who graduated from foreign medical schools was just 50%. So, while there may seem like there are more doctors than ever in the U.S. who are not citizens, not nearly as many foreign or foreign-educated doctors are in the U.S. than would actually like to be here.
Another part of the problem is that there are not enough residencies to go around. According to Kevin Lynn of Doctors Without Jobs, 6% of graduates from U.S. medical colleges didn’t get matched with a residency for 2020. This is after they’ve made it through both undergraduate degrees and medical school. But even after passing the Medical Licensing Exam (MLE), graduates must serve a residency in a hospital. They are competing against several thousand foreign graduates, and the number of residencies is limited.
The residencies are funded by Congress. Who actually should be paying for the residencies? That question is worthy of debate. But meanwhile, we ostensibly don’t have enough doctors. The young graduates who are not matched with residencies are not unqualified. Yet the number excluded from residencies has gone up 93% since 2016, not including doctors who tried to get matched a second time.
There are less residencies because Congress caps the funding. Less funding means less new doctors, which means higher salaries for existing physicians—but not more new doctors. The mismatch also leads health care employers to seek doctors from India, Africa, and the Middle East under the H-1B and J-1 visa programs. Ironically, this harms the nations these doctors come from, by depriving them of doctors. But many African nations won’t fund training programs for their own new doctors.
Meanwhile, Senator Robert Menendez of New Jersey is sponsoring a bill to provide funding for 15,000 new residencies per year. Kevin Lynn agrees that adding the residencies is a good idea, but also advocates that Americans be given those residencies first over foreign doctors. Now all we have to do is convince young doctors that it’s worth it to be primary care physicians.
Disclaimer: This article does not provide medical advice. Do not take action based solely on this article and always consult with an appropriate healthcare professional. This article is purely for informational purposes.