Kevin Lynn, cofounder of Doctors without Jobs, provided testimony to the House Committee on the Judiciary on the topic, “Is There a Doctor in the House? The Role of Immigrant Physicians in the U.S. Healthcare System.”
A link to the hearing and the transcript of Lynn’s testimony are below.
LINK TO HEARING
TESTIMONY OF KEVIN LYNN, Doctors without Jobs
15 February 2022
Is There a Doctor in the House? The Role of Immigrant Physicians in the U.S. Healthcare System
Chairwoman Lofgren, ranking member McClintock, distinguished members of the subcommittee, thank you for allowing me the opportunity to discuss the consequences of immigrant physicians in the U.S. healthcare system.
The United States is facing a doctor shortage.1 However, it is a shortage of our own making. In recent years, thousands of American medical doctors – U.S. physicians – have been denied the right to practice medicine. This is one of the most unreported stories, and one of the most ignored situations by our elected officials and medical community leadership in America, including our medical schools and the various governing bodies who purport to represent physicians.
In 2018, Institute for Sound Public Policy (PFIR) started the Doctors Without Jobs (DwJ) project to build awareness of the number of U.S. citizen doctors graduating from medical schools who were not “matching” to residency positions each year, while foreign-trained physicians were. This encouraged more doctors to advocate for themselves and push back against graduate medical education profiteers.
The “match” is the mechanism by which medical school graduates move into medical residencies at teaching hospitals. It is a process managed by the NRMP – the National Resident Matching Program. Please understand that without a medical residency a doctor cannot practice medicine. And a residency may require three to seven years to complete, depending on the medical specialty. Each year, over 7,000 U.S. citizens and lawful permanent resident medical graduate physicians which includes seniors and prior-year graduates do not match for a medical residency.2 All of whom are qualified, ready and willing doctors who have been sidelined and are waiting to serve their communities now, a situation we worked to draw attention to at the start of the pandemic so that they might be deployed. Our call went unanswered.
There is much more to this story that should concern this subcommittee. In 2021, 4,356 noncitizen foreign-trained physicians received residencies in the U.S. This is an enormous increase from ten years prior when 2,721 foreign trained physicians received residencies.3 Between 2011 and 2021, more than 40,000 non-U.S. citizens/foreign-trained physicians were given U.S.-taxpayer-funded residencies. This is all data from the NRMP.
Each residency costs taxpayers about $150,000 a year, so we are subsidizing foreign doctors. Many foreign-trained physicians arrive in the U.S. for residency training via the J-1 visa, a cultural exchange visa. In addition, foreign trained physicians arrive via the H-1B visa program to work directly in hospitals. In 2020, 3,508 labor condition applications (LCAs) were filed for 4,252 workers for the occupation of 2 medical doctor of those, 3,004 were approved. In addition, another 5,232 applications to extend from prior years were approved.4 Every other country prioritizes its citizens. Canada, the last holdout, has changed its policy to prioritize Canadian citizens and permanent legal residents.5 Failure to prioritize Americans is emblematic of our medical establishment preferring to import foreign healthcare workers instead of making the necessary investments that would broaden medical education and improve our healthcare delivery infrastructure.
This doesn’t just cause problems here at home. A 2020 Migration Policy Institute article, “Global Demand for Medical Professionals Drives Indians Abroad despite Acute Domestic Healthcare Worker Shortages,” describes the brain drain and the harm it does to India’s healthcare system.6 The same can be said for countries in Sub-Saharan Africa where healthcare professionals also are lured to the U.S., UK and Canada.
A poor country’s loss is a rich country’s gain. The estimated financial benefit to the United States from luring physicians from Sub-Saharan Africa is $846 million. The sending countries lose about $2.1 billion from the investments made in their doctors who leave.7 According to American Communities Survey data, in 2020, roughly 70 percent of doctors in the U.S. were born here. About 20 percent were naturalized. Some 7 percent are noncitizens. These percentages have remained fairly consistent for the past 10 years.8
Every area of American endeavor has been impacted by the relentless importation of foreign workers. Starting with lower-paying work, seasonal hospitality workers, and then on to manufacturing jobs, to technology workers and now to our doctors, who have spent at least eight years and hundreds of thousands of dollars to practice the healing arts, a very specialized profession, only to be sidelined and saddled with debt they are unlikely to be able to pay off if they can’t practice medicine.9 The demand and enthusiasm to enter the medical profession is there. Applications to medical schools are at an all-time high,10 as are enrollments in the nation’s nursing programs.11
In closing, we have thousands of physicians in the line waiting for residency training. We need more residency positions and we must prioritize U.S. citizens and lawful permanent residents.
Thank you for your time.
Footnotes
1 U.S. physician shortage growing, AAMC, 26 June 2020
https://www.aamc.org/news-insights/us-physician-shortage-growing
2 NRMP https://www.nrmp.org/match-data-analytics/residency-data-reports/
3 ibid
4 H-1B LCA Data on U.S. Physicians: 2011-2021 https://econdataus.com/physician20data.htm#lca
5 CMA Policy on Equity and Diversity in Medicine Encouraging for International Medical Graduates
https://cmajblogs.com/cma-policy-on-equity-and-diversity-in-medicine-encouraging-for-international-medical-graduates/
6 Global Demand for Medical Professionals Drives Indians Abroad Despite Acute Domestic Health-Care Worker Shortages, Migration Policy Institute, 23 January 2020
https://www.migrationpolicy.org/article/global-demand-medical-professionals-drives-indians-abroad
7 Diagnosing Africa’s medical brain drain, Africa Renewal, December 2016 to March 2017
https://www.un.org/africarenewal/magazine/december-2016-march-2017/diagnosing-africa’s-medical-brain-drain
8 Census Data on U.S. Physicians: 2011-2020
https://econdataus.com/physician20data.htm#census
9 Medical school graduate sees nearly all of his $440,000 in student loans discharged
https://finance.yahoo.com/news/medical-school-graduate-440000-student-loans-discharged-151422886.html
10 Applications to medical school are at an all-time high. What does this mean for applicants and schools? AAMC, 22 October 2020 https://www.aamc.org/news-insights/applications-medical-school-are-all-time-high-what-does-mean-applicants-and-schools
11 Student Enrollment Surged in U.S. Schools of Nursing in 2020 Despite Challenges Presented by the Pandemic, American Association of Colleges of Nursing, 1 April 2021
https://www.aacnnursing.org/News-Information/Press-Releases/View/ArticleId/24802/2020-survey-data-student-enrollment
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