Physicians Educated Abroad Can Fill COVID-Induced Doctor Shortage

This wave of physician retirements will disproportionately affect rural parts of our country.
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The following column by Dr. G. Richard Olds addresses the critical shortage of doctors in America, which has exacerbated by the COVID-19 crisis.

The United States will be short nearly 140,000 doctors by 2033, according to the latest estimates from the Association of American Medical Colleges.

COVID-19 may drive the number of doctor shortages up further. Large numbers of physicians are leaving the profession. Consequently, we must begin preparing now to rebuild the nation's physician workforce. To train all the doctors America will need, medical schools will have to enroll more of the qualified students who apply. International medical schools are particularly well suited to that task.

It's easy to see why the pandemic is nudging doctors into early retirement. Forty percent of the U.S. physician workforce is 55 or older. The coronavirus poses a much greater threat to people in this age group.

And doctors are more likely to encounter the virus, given their line of work. A study published in September in The Lancet Public Health found that "front-line health-care workers were at increased risk for reporting a positive COVID-19 test."

Other U.S. doctors are closing their practices because they have no patients to treat; they're staying home for fear of contracting the virus. Ninety-seven percent of medical practice leaders reported a significant drop in patient visits due to the coronavirus, according to a recent poll. Fewer patient visits mean less revenue -- sometimes up to 80 percent less.

This wave of physician retirements will disproportionately affect rural parts of our country. More than half of rural doctors are over 50, compared to less than 40 percent of physicians in urban areas, according to a recent report.

Rural areas can ill afford an exodus of physicians. Sixty percent of our country's health professional shortage areas are in rural regions.

Nearly 80 million Americans live in a primary care shortage area, meaning they have insufficient access to pediatricians, family medicine, and internal medicine practitioners. That number could grow as the population ages.

To meet that demand, we'll need more medical school graduates.

U.S. medical schools are unable to provide those graduates on their own. Between 2014-15 and 2018-19, the number of U.S. medical school graduates increased just 6 percent.

We'll have to look to medical schools located outside the United States. International medical schools are up to the challenge.

International medical graduates (IMGs) account for roughly one-fourth of the U.S. physician workforce and about the same share of doctors in training. Many of them are U.S. citizens who chose to go abroad for their degrees and then return home to practice.

Thousands of promising students graduate from international medical schools each year. More than 1,100 graduates of the school I lead, St. George's University in Grenada, began residencies in the United States this past summer. About three-quarters of our students are U.S. citizens.

Their skills are on par with U.S. medical graduates. International medical graduates are required to pass the same licensing exams as graduates of U.S. schools. St. George's University students pass the U.S. Medical Licensing Step 1 Exam at a 96 percent clip.

International graduates also have a history of practicing in areas where the need is greatest. Compared to doctors trained at U.S. schools, IMGs are typically "more likely to look after underserved populations and to live and work in rural areas," according to a study published in BMC Family Practice.

The COVID pandemic could stretch our physician workforce to a breaking point. Increasing our reliance on doctors educated at international medical schools can help prevent that from happening.

Dr. G. Richard Olds is President of St George's University (www.sgu.edu).

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