Tide turning for doctors from abroad Medicine: Physicians from overseas find their calling in Crisfield, but a backlash might curtail the number practicing in the United States.

August 04, 1998|By Jonathan Bor | Jonathan Bor,SUN STAFF

CRISFIELD -- Two years ago, doctors from India, the Philippines and Nigeria started coming to this sleepy crabbing capital to set up practices. They made little Edward J. McCready Memorial Hospital the most ethnically diverse place in town -- and probably saved it from financial ruin.

McCready's new chief executive had realized that American doctors weren't interested in a place that could offer hospitality but not a lot of money, prestige or excitement. So he tapped the foreign market, finding 10 of 16 new physicians from overseas.

"It was a question of whether this hospital was going to survive," said J. Allan Bickling, who also recruited doctors from Switzerland and Scotland. Within a year, patient admissions and revenues jumped more than 60 percent.

Increasingly, the nation's less glamorous hospitals and clinics are relying on foreign doctors who are willing to practice in places like the Eastern Shore or inner-city Baltimore, Appalachia or the Dakotas.

But the trend has sparked a backlash. Led by the American Medical Association, several organizations have proposed laws that would greatly reduce the number of foreign doctors entering or staying in the United States. Health economists say the newcomers are contributing to an oversupply of doctors, driving up the nation's health care bill and making it hard for U.S. physicians to compete.

"Many physicians are having trouble finding a place to work when they get through their many years of training," said Dr. Michael Scotti, the AMA's vice president for medical education.

Tougher requirements

Already, the requirements for foreign doctors are getting tougher. Starting this month, those trained overseas must take a competency test designed to test clinical and language skills. In the test, physicians are required to interview and take medical histories from "patients" who are actually examiners.

Today, 22,000 -- almost a fifth -- of the 104,000 medical residents training in U.S. hospitals come from other countries. Most come here on visas that require them to leave at the end of their training, presumably to apply their medical knowledge back home.

But more than 1,000 each year obtain waivers that allow them to stay if they spend three years working in places shunned by American doctors. This is giving the medical profession an increasingly international flavor. This year, a quarter of the 600,000 physicians in practice come from other lands, with large contingents from India, Pakistan and the Philippines.

Many of the arrivals acknowledge that they occupy a second tier of American medicine. For instance, internists starting at McCready can expect to make about $70,000, said Bickling, about half of what could be earned in more cosmopolitan practices.

Despite this, foreign doctors say they enjoy salaries and technological advantages they could only dream of back home.

"The United States is the mecca of medicine," says Dr. Kumar Rajagopalan, 34, who trained in New York and Cleveland before becoming McCready's first cancer specialist. "Back in India, the schools all followed textbooks done in the United States. Here, it's nice to practice what you read."

He says he has every amenity he needs -- "a big house, a big yard, peace and quiet. And the air is clean. Life here is a lot less stressful."

Rajagopalan says he has been accepted warmly by the townspeople who "truly admire and respect what a doctor does." Patients stumble over his last name, so he is known simply as "Dr. Kumar." Some of Crisfield's other foreign doctors encourage the practice.

Raised in southern India, Rajagopalan learned English as a child while attending British-style schools. In high school and medical school, he was reading textbooks written in English. And though he speaks with a lilting accent, he chooses his words confidently and with few missteps.

Helen Seifert, who was diagnosed recently with lung cancer, says she doesn't care about her doctor's nationality. "He's one of the best isn't he?" said Seifert, 67. "He's aware of everything you need."

Seifert sees Rajagopalan every other week for three days of outpatient chemotherapy. "If I had to go to Salisbury, that would be a hardship," she said, explaining that she couldn't drive herself. "My son and daughter, they both work. It would be hard for them to get off work."

'Glamour' of United States

Near the hospital, in a rickety house next to a laundromat, Dr. Eshwara P. Kanchana practices internal medicine with two doctors from Nigeria. Kanchana, who moonlights in the hospital emergency room, moved to Crisfield last year after finishing his residency at Nassau County Medical Center on Long Island.

A native of southwestern India, Kanchana is the first doctor in his family but by no means the first professional. His father is a lawyer; other family members work with computers. After graduating from an Indian medical school and spending a year in an ophthalmology residency, he looked toward the United States.

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