Thousands of foreign-trained immigrant physicians are living in the United States with lifesaving skills that are lying fallow because they stumbled over one of the many hurdles in the path toward becoming a licensed doctor here.
The onerous tests and often duplicative training these doctors must go through are intended to make sure they meet this country’s high quality standards, which U.S. medical industry groups say are unmatched elsewhere in the world. Some development experts are also loath to make it too easy for foreign doctors to practice here because of the risk of a “brain drain” abroad.
But many foreign physicians and their advocates argue that the process is unnecessarily restrictive and time-consuming, particularly since America’s need for doctors will expand sharply in a few short months under President Barack Obama’s health care law. They note that medical services cost far more in the U.S. than elsewhere in the world, in part because of such restrictions.
The United States already faces a shortage of physicians in many parts of the country, especially in specialties where foreign-trained physicians are most likely to practice, like primary care. And that shortage is going to get worse, studies predict, when the health care law insures millions more Americans starting in 2014.
The new health care law only modestly increases the supply of homegrown primary care doctors, not nearly enough to account for the shortfall, and even that tiny bump is still a few years away because it takes so long to train new doctors. Immigrant advocates and some economists note that the medical labor force could be ramped up much faster if the country tapped the underused skills of the foreign-trained physicians who are already here but are not allowed to practice. Canada, by contrast, has made efforts to recognize more high-quality training programs done abroad.
“It doesn’t cost the taxpayers a penny because these doctors come fully trained,” said Nyapati Raghu Rao, the Indian-born chairman of psychiatry at Nassau University Medical Center and a past chairman of the American Medical Association’s international medical graduates governing council.
For years, the U.S. has been training too few doctors to meet its own needs, in part because of industry-set limits on the number of medical school slots available. Today, about 1 in 4 physicians practicing in the U.S. was trained abroad, a figure that includes a substantial number of U.S. citizens who could not get into medical school at home and studied in places like the Caribbean.
But immigrant doctors, no matter how experienced and well trained, must run a long, costly and confusing gantlet before they can practice here.
The process usually starts with an application to a private nonprofit organization that verifies medical school transcripts and diplomas. Among other requirements, foreign doctors must prove they speak English; pass three separate steps of the U.S. Medical Licensing Examination; get U.S. recommendation letters, usually obtained after volunteering or working in a hospital, clinic or research organization; and be permanent residents or receive a work visa, which often requires them to return to their home country after their training.
The biggest challenge is that an immigrant physician must win one of the coveted slots in America’s medical residency system, the step that seems to be the tightest bottleneck.
That residency, which typically involves grueling 80-hour workweeks, is required even if a doctor previously did a residency in other countries with advanced medical systems, like Britain or Japan. The only exception is for doctors who did their residencies in Canada.
The whole process can consume a decade — for those lucky few who make it through.
Experts say several things could be done to make it easier for foreign-trained doctors to practice here, including reciprocal licensing arrangements, more and perhaps accelerated U.S. residencies, or recognition of postgraduate training from other advanced countries.