Question: Should the United States Ease Licensing Standards for Foreign-Trained Physicians?

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PHC-thumb1Is the United States purposely making it difficult for foreign-trained physicians to become eligible to practice here? And if so, is this blocking out a potential source of relief to the persistent, wrenching physician-shortage crisis?

These are the questions that spring to mind upon reading Catherine Rampell’s article from the New York Times News Service. Rampell claims that the number of immigrant physicians who are already here in the States “with lifesaving skills that are going unused because they stumbled over one of the many hurdles in the path toward becoming a licensed doctor here” is in the thousands.

In a battle reminiscent of the nurse practitioner/physician assistant vs. physicians wars, the line has been clearly drawn by those who stick by the standards (i.e., the aforementioned “hurdles”) and those who think the standards are deliberately “restrictive and time-consuming.”

In this case, immigrant advocates are saying we should be more like Canada who has taken steps toward making it easier for foreign-trained physicians to practice within their borders. Rampell writes that these advocates “and some economists point out 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.”

And as one expert said, allowing foreign-trained doctors to practice within the states “doesn’t cost the taxpayers a penny because these doctors come fully trained. It is doubtful that the U.S. can respond to the massive shortages without the participation of international medical graduates. But we’re basically ignoring them in this discussion and I don’t know why that is.”

There’s another wrinkle to ponder here: some foreign-trained physicians aren’t foreign born.

Because the United States limits how many medical-school slots are open each year, some American-born citizens receive their medical training abroad. “Today,” Rampell reports, “about 1 in 4 physicians practicing in the U.S. were trained abroad…”

So just how unwieldy is the process for immigrant physicians? First, medical school transcripts and diplomas need to be authenticated. This process is usually handled by a private nonprofit organization.

They must then “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).”

Finally, there’s the clincher: obtaining a residency.

Unless they’re from Canada, they have to go through a residency even if they already went through one in their home country.

How long can this take? Rampell estimates close to a decade.

The article contains more info, including the most common counterargument against easing standards, which is that it will attract more physicians from poorer countries.

Nevertheless, as healthcare executives, have you experienced any difficulty in hiring foreign-trained physicians? Are the hurdles as difficult to overcome as the article claims? Would easing these standards or revising them lead to more relief for the physician-shortage crisis?

-by Pete Fernbaugh

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