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Stealing From the Poor to Care for the Rich
Saturday, December 17th, 2005
For nearly 30 years Normal Wahl was chief of medicine and director of medical education at a Catholic hospital in a small Pennsylvania town. He observed that because American-trained doctors usually preferred university hospitals or metropolitan areas, foreign medical graduates, mainly from Asia, filled all of the residency slots at his hospital, and they were happy to have them.
The foreign-trained doctors who qualified tended to stay in the community, where they worked hard. Many who left went to other small communities and small hospitals where there was a need. But in all this time, he noticed that virtually none of these doctors returned home. Wahl was aware of only one doctor from his program who did so. When spots in medical centers were vacant, foreign-trained doctors often recruited friends and relatives in their homelands to fill them.
It turns out that our gain was the developing world's loss. According to a study published in October in The New England Journal of Medicine, 25 percent of all doctors in the United States are foreign medical school graduates. A large majority - 60 percent - come from the developing world, where doctors are scarce and countries are being destroyed by AIDS, malaria, tuberculosis and other infectious diseases.
Because the globalization that brings foreign doctors here also means the potential spread of viral-born diseases like avian flu to the West, it is increasingly clear that these diseases must be addressed at the source. By luring and keeping large numbers of immigrant doctors, the American medical establishment is reducing medical care where it is needed most - and, perversely, hastening the eventual arrival of health problems in our own communities.
Why are we so reliant on foreign doctors? The problem is that even as the demand for doctors has grown significantly in the United States, medical school enrollment has barely budged (one only need look at the cost of medical school for an indication of why this is the case). The annual number of medical school graduates has remained almost constant since 1980, despite a population increase of 50 million. Over that same period, only one new medical school has opened its doors. As baby boomers reach retirement, the shortage of doctors will only grow worse, creating even greater demand for doctors from Africa, Asia and the Caribbean.
American medical schools have long limited enrollment, thanks in part to a deeply ingrained elitism. Though medical schools are no longer excluding groups like Jews and Italian-Americans, there remains a strong bias in favor of training an elite few for research instead of rank-and-file general practitioners. This practice should be against the public policy.
What can be done to reverse this situation? First, create more places in American medical schools. Thousands of young Americans who would make good doctors are rejected by schools here. They go to Mexico and Europe to study medicine. There is not a medical school in America that cannot increase its enrollment without lowering its standards. The Council on Graduate Medical Education now endorses this approach, recommending that medical schools increase enrollment by 15 percent over the next decade. However, exposure of the colleges and universities that are living in the 19th century need to be brought to the public attention by the media.
Second, curtail foreign aid and open more medical schools in the U.S. There are now only 125 medical schools for a population of nearly 300 million. Not all medical schools need to be world-class academic research centers. With more private support, and the opening of faculty slots to clinical physicians, new medical schools geared toward training general practitioners would increase the supply of American-trained doctors at a relatively low cost.
Third, the United States should not invest in training doctors and building hospitals overseas, particularly in Africa and Asia - the foreign governments should be forced to stop internal corruption and building their armed forces, and invest in their own internal healthcare. While some American medical centers operate programs abroad, they need encouragement and greater financing. Outfitting clinics and hospitals is necessary to keep medical graduates at home in the third world - and we could help here - but so should the other developed countries. Pharmaceutical companies should also join in the effort to ensure critical drugs are available and affordable. They make billions off the citizens of this country - and can surely put a few bucks in the pockets of underdeveloped countries. Either they do, or the preferred tax status they enjoy should be eliminated.
Fourth, the World Health Organization, should augment the meager pay doctors and health care workers receive in the developing nations so they have a respectable salary. Lets face it, when a foreign doctor graduates a U.S. medical school, why should he or she go back to India and make $40,000.00 when they could make $400,000.00 by putting their shingle out in any big US city?
Only by taking these steps, and more, will we provide the incentives and encouragement for doctors to remain where they are most needed.
The United States and other Western countries have not only ignored the appalling lack of qualified doctors in undeveloped countries, but because of self-interest have perpetuated this problem. We should resolve our shortage by ourselves, without stealing doctors from countries that desperately need them.
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