The U.S. Health Workforce, Importing Physicians and the Global HEALTH Act
One week before President Obama signed America's new health care bill, nearly 30,000 medical school graduates found out where they would train for the next 3-7 years to join the ranks of skilled health workers who keep our national health care system together.
The American Association of Medical Colleges and other experts on the health workforce have a standing recommendation to increase the number of doctors we train for the US physician workforce. However, the number of international medical school graduates applying for US medical residency slots increased by a greater number than did American-trained new doctors - this year, 10,874 applied -- 570 more than last year. Medicare provides the funding for American residency programs, and it will fund the training of 22,427 new physicians this year.
Primary care providers keep our society healthy. They are a patient's best advocates, coordinating care among different specialists when we become sick and working to prevent illness. The number of new doctors entering the field of family medicine is taken as an indicator of the balance of physicians planning to practice primary care.
When a doctor from another country wants to practice medicine in the US, her license is not transferable; she is obligated to complete a US residency program. This year as in previous years, the proportion of family medicine slots filled by foreign medical graduates is much higher than for specialty care fields - careers that offer greater salaries and more favorable working conditions. About 1 out of every 4 new physicians training in the U.S. is from another country.
Results of various workforce analyses:
- 28% of physicians in the U.S. were trained abroad (Health Affairs, 26, no. 4 (2007): 1159-1169)
- International Medical Graduates (IMGs) constitute 28.3% of US primary care physicians (Physician Characteristics and Distribution in the US, 2002-2003 Edition. Chicago, IL: AMA Press; 2002)
- 26.8% of U.S. medical residents in August 2005 were IMGs (JAMA. 2006;296(9):1154-1169)
This trend is worrisome, and raises the question: is America farming out our most critical - and lowest-paying - physician jobs to an imported workforce?
Many foreign-trained physicians come from countries suffering a severe health workforce shortage, but the pay and working conditions here in the U.S. are strong incentives to emigrate. HAI has a long history of advocating for the right of health workers to pursue opportunities for employment in the country of their choosing. But in light of the great disparity in health workforce shortages between rich and poor countries, it is incumbent upon highly developed countries to build up their own workforces in ways that decrease our dependency on hiring workers away from countries that can ill afford to lose their own.
President Obama's Administration is turning its focus to domestic job creation. To stimulate the American job market and to decrease our own demand for foreign doctors, we need to train more of our own. Our new U.S. health reform law doesn't add any new funding to train American medical students, and so falls short of offering a sustainable approach to decreasing our contribution to brain drain.
There is a piece of legislation, however - the recently introduced Global HEALTH Act - that would create a global health workforce initiative to meet our responsibility .
The Act builds upon global health priorities our government has set and proposes a more integrated plan than that as of yet in the Administration's Global Health Initiative plan by creating a new focus and government department to train and retain health workers in poor countries. It will also create incentives - salary and benefit support, health supplies, management systems - to make practicing medicine near home a viable and attractive choice for highly skilled health professionals in developing countries. And it will direct the U.S. to undergo a thorough review and revision of our health workforce recruitment practices and policies - including changing the way our leaders vote in international bodies like the World Health Organization and the International Monetary Fund - in a way that promotes a robust skilled health workforce around the world.
If we intend our global health investments to be integrated and highly effective - goals to which the Global HEALTH Act aspires - we must start by coordinating the training and retention of our the health workforce here at home and in the developing world.
Mary Carol Jennings is a past Jack Rutledge Legislative Director for the American Medical Student Association and will graduate from medical school this May to join the 2010 ranks of skilled health workers as an Obstetrician/Gynecologist at the Boston University Medical Center. She is currently continuing her health workforce advocacy during an internship with HAI's New Initiative Team.
See the related blog on the Global HEALTH Act.
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