Should foreign-trained physicians be limited in working in U.S.?

The Outlook

January 28, 1996|By Mark Hyman

When you need a physician, it's helpful to have one as nearby as the community hospital or the neighborhood office. But those who monitor health care issues are debating whether America may be on the verge of an oversupply of doctors. Last week, a panel of physicians from the Institute of Medicine concluded a 10-month study of the issue.

Among its findings: A doubling of the number of doctors in the last quarter-century has largely resulted from an influx of graduates of foreign medical schools who obtain jobs as interns and residents and remain to practice.

The report raises questions about the growing number of physicians -- and where they are coming from. Should access to residencies and internships be restricted for foreign-trained doctors? Should they be permitted to establish their practices in the United States when their training is completed?

Donald E. Wilson

Dean, University of Maryland School of Medicine

It's a complicated problem, and one of the reasons is that many communities rely almost totally on foreign graduates for their care. Before coming to Maryland, I ran a huge department of medicine at the State University of New York Health Science Center at Brooklyn. Across the street was another hospital. Without foreign medical graduates, they could not have begun to fill their training programs. A large number of people would be without care.

The report is on target, in that it attacks the number of residency training spots. People who say we're producing too many doctors are off the mark. I don't think we are. We don't even know how many we should be producing as we go to managed care.

I don't think the issue is [how many physicians] are being produced by U.S. medical schools. The issue is deciding how many people can come into this country and provide care from foreign countries, then stay here. While I agree with the report, I have great concerns about how some inner city areas that aren't medical centers, are going to get their trainees.

Dr. Donald H. Dembo

Immediate past president, Medical and Chirurgical Faculty of Maryland, associate physician-in-chief and vice chairman of medicine at Sinai Hospital

It would be a mistake for us not to offer training [to foreign graduates]. We have such superb training, to be able to share that with world, under appropriate circumstances, is the right thing to do. We also have to appreciate that many foreign graduates are outstanding doctors. I know of many who could care for me anytime.

An option is to say to residents who come from foreign countries, "You can't immigrate to this country, having come here with an advanced degree. If you come with the plan of returning to your country, then you must go back." Otherwise, we are really going to be inundated with too many doctors, which begets a decrease in quality of heath care. When doctors are struggling to make a living, I'm not sure that is the best environment for delivering quality heath care.

Don E. Detmer

Senior vice president, University of Virginia, co-chairman of Institute of Medicine study

We did not recommend limiting entry of international medical graduates, though some [press] reports lead one to believe we were advocating that. We're saying, in the near future, the country will face, not just an abundance, but over, oversupply [of physicians]. Facing that, we don't see any clear reasons to continue to subsidize [medical] training of even more physicians with tax dollars.

But nothing [in the report] says that foreign medical graduates can't come to the country and hospitals can't offer programs for those folks. We did say we think the number of training positions should approach the number of U.S. graduates.

It's important to say that a number of these nations can use that talent. It's not as if the United States is the only place that can use bright people who want to be physicians.

Catherine DeAngelis

Senior associate dean for academic and faculty affairs, Johns Hopkins University Medical School

I understand the need for many big cities to staff hospitals, and that the least expensive way to do it is with residents. However, I don't think it is fair to patients and to the foreign medical graduates, when those foreign graduates are relied on so heavily. For the most part, graduates of foreign medical school are not at the same level as those in the United States, except for those from Canada and Great Britain. That's not meant to denigrate. It's just a fact.

We should take the best medical students to fill our residency slots. In general, those people are from the United States. Then we need to curtail the number of residency slots. What we should not do is cut slots for medical schools in America. I think it would be criminal to suggest we eliminate those slots when we continue to train foreign graduates [at current levels].

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